APPLICATION FORM
Please return completed application forms to:
Human Resources
Allerton Court Hotel
Darlington Road
Northallerton
North Yorkshire
DL6 2XF
Tel: 01609 780525
Fax: 01609 780491
Please be advised that if you are not contacted within three weeks
of submitting your application, you may assume that you have not
been called for interview. A letter of regret will not be sent to you in
the post.
Please note: due to the nature of business, any position within this company would require
successful candidates to work unsociable hours including evenings, weekends and bank
holidays.
PLEASE COMPLETE THIS APPLICATION IN BLACK INK
Position Applied for:
Date of Application:
Other position you would consider:
Employed Full
Time
Employed Part Time
Casual
work
unemployed
Type of Work Required
Full Time
Part Time
Temporary
Casual Work
Source of Application
Newspaper
Job Centre
Phone
Employee
Current Employment
Status
PERSONAL DETAILS
Surname:
Forename(s):
Address:
Tel No (Mobile)
(Home)
Email Address:
National Insurance Number
Date of Birth:
GENERAL INFORMATION
Minimum salary acceptable:
Do you have a valid work permit?
(* verification required at interview)
Date Available to start:
Yes
No
Nationality:
Have you been convicted of any criminal offences, which are not yet
spent under the Rehabilitation of Offenders Act 1974?
Yes
No
Do you hold a current driving licence
Yes
No
Yes
No
Do you write or speak any other languages (if yes please give details);
Hobbies:
Please give any other facts which you feel would be useful in considering this job application:
EDUCATION
From
Name and Address of
school/college/university
To
Qualifications
Other relevant qualifications, courses or awards:
Are you a member of a professional organisation or association?
(If yes please give details)
EMPLOYMENT HISTORY
From
To
Company Name and
Address
Job Title and
duties
Salary
Reason for
leaving
MEDICAL DETAILS
Do you have a problem with your health problem which is relevant
to this job application
Are you at present receiving any medical treatment or taking any
medications which are relevant to this job application:
(If yes please explain)
Yes
No
Yes
No
CONTACT IN CASE OF EMERGANCY
Name:
Relationship:
Address:
Telephone Number:
REFERENCES
No information will be sought from your present employer without your consent
Name:
Name:
Address:
Address:
Telephone Number:
Telephone number:
DECLARATION
I confirm that the above information is correct and true and has no deliberate
omissions. I understand that if this does not prove to be the case there may be
sufficient grounds for cancelling any agreement made.
I agree that in submitting this application references provided can be taken up and I
will undergo a medical examination if asked to do so.
Signature of applicant ………………………………………………………………………………
Print Name …………………………………………… Date ………………………………………..
FINANCIAL INFORMATION (to be completed by employee at commencement of employment)
Account Number
Sort Code
Bank Name
Branch Name
FOR OFFICIAL USE ONLY
Date of commencement:
Job Title:
Salary/wage:
Hours:
MONITORING
Allerton Court Hotel is committed to developing its policies to provide equal
opportunities in employment. All applicants will be treated on their merits regardless
of sex, marital status, disability, race, colour, national or ethnic origin.
To monitor the effectiveness of our equal opportunities policy, we would be grateful if
you would provide the information requested below. Please mark as appropriate
boxes.
Gender:
Male
Female
Marital Status
Single
Married
Ethnic Origin
African
Black
Caribbean
Other
Indian
Pakistani
Asian
Bangladeshi
Chinese
Other
White
Do you have any disabilities: (if yes describe briefly)
Are you registered disabled? (if yes, please state number and expiry date:
Number:
Yes
No
Yes
No
Date:
FOOD HANDLERS DECLARATION
Name: ……………………………………………. Job Title: ………………………………………..
A food handler is a person whose work at anytime involves him or her on handling
and/or service of food and drink and the use of equipment and utensils connected
with the service and preparation of food and drink.
I agree to report to the manager on the following occasions and understand that I
may be required to submit samples for examination:
1. If I develop the following:
a.
b.
c.
d.
e.
Vomiting
Diarrhoea
Sink Rash
Septic Skin Lesion (boils, infected cuts etc. however small
Discharge from ear, nose or any site
2. Before commencing work following an illness involving any of the above
3. On return from holiday during which an attack of vomiting and/or diarrhoea
lasted for more than two days.
Signed: …………………………………….. (Employee) Date …………………………………
WEIGHTS AND MEASURES
DECLARATION
It is vital for our business that we have the right to sell alcohol. This is an area that is
heavily regulated by law and failure to follow the legal requirements can put our
licence at risk. It is therefore essential that you familiarise yourself with the relevant
provision.
I agree not to participate in or permit any of the following activities:
a.
b.
c.
d.
serve intoxicating liquor in incorrect quantities
serve diluted beer
serve or permit the corruption of intoxicating liquor out of permitted hours
falsely describing any goods and/or selling drinks at a price different to that
displayed on the bar tariff
e. serve alcoholic drinks to underage persons or for the consumption by
underage persons
Signed: …………………………………….. (Employee) Date …………………………………
CONFIDENTIAL MEDICAL QUESTIONNAIRE
Please complete the questionnaire below. The information is required with your
interest in mind. As a result of the information you have given you may be referred to
a doctor appointed by the company so that medical examination is carried out. If
you wish, you may request an interview with the companies first aid representative
either as an alternative to completing this questionnaire or to provide supplementary
information.
Have you ever
Yes
No
Had an operation
Been seriously injured
Received in patient treatment
for a physical or mental
condition
Been refused or dismissed from
employment for health reasons
Received a disability pension
Been registered disabled
Card
No
Expiry Date
Been made ill by work
Been refused a drivers licence
because of ill health
Do you suffer from or ever had:
YES
NO
YES
Diabetes
Skin Rashes/Eczema
Swelling of legs/ankles
High Blood Pressure
Anaemia
Period or Prostate Problems
Asthma
Migraine
Varicose Veins
Cough (frequent)
Hearth Trouble
Rupture
Rheumatic Fever
Stress/Depression
Back Trouble
Arthritis
Fainting or dizziness
Ear Trouble
Epilepsy/Fits
Hay Fever
Eye Trouble
Shortness of Breath
Jaundice
Nerve Trouble
NO
Food Allergies (please state)
Any Other Ailments
To the best of my knowledge and belief the information given above is correct. I
understand that if I am appointed and this information is inaccurate I am liable to
dismissal.
Signature:………………………………………………… Date: ……………………………………...
Name: ……………………………………………………. Date of Birth: …………………………….
Job Title: ………………………………………………….
Doctors Name and address: