APPLICATION FORM FOR EMPLOYMENT (CONFIDENTIAL)
An Equal Opportunity Employer



Please complete this application form in BLOCK CAPITALS
Use BLACK / BLUE INK
Other information you feel is relevant – please attach to the back of the form
Application details
Post Applied For
:
________________________________________
Department
:
________________________________________
Location
:
________________________________________
Date you can start :
________________________________________
Personal Details
Title
:
________________________________________
First Name(s)
:
________________________________________
Surname
:
________________________________________
Address
:
________________________________________
________________________________________
Post Code
________________________________________
Telephone (Home) :
________________________________________
(Mobile)
________________________________________
NI No.
:
____________________________________ ____
E Mail address
:
________________________________________
Education
Secondary School
From
To
Examination Passed
College/University
From
To
Subjects Studied
Application Form – V4 April 2014
Level
Grade
Results/Grade
Page 1 of 8
Technical/Professional/Occupational/Commercial training (if any)
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
Other Qualifications or Attainments (include details of courses
attended)
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
Leisure Activities (include club and society memberships, voluntary work etc).
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
Current Employment
Employer’s Name
:
________________________________________
Employer’s Address:
________________________________________
________________________________________
Post Held
:
________________________________________
Salary and Grade
:
________________________________________
Supervisor’s Name :
________________________________________
Notice Required
:
________________________________________
Details of Duties
:
________________________________________
________________________________________
________________________________________
Application Form – V4 April 2014
Page 2 of 8
Other Posts held
(if any)
:
________________________________________
Date Appointed
:
________________________________________
:
________________________________________
End Date
(if applicable)
Previous Employment (please begin with your most recent) please
supply at least 2 years previous employment history with dates
Employer 1
Employer’s Name
:
________________________________________
Employer’s Address:
________________________________________
________________________________________
Post Held
:
________________________________________
Salary and Grade
:
________________________________________
Start Date
:
________________________________________
End Date
:
________________________________________
Supervisor’s Name :
________________________________________
Responsibilities
________________________________________
:
________________________________________
________________________________________
________________________________________
Reason for leaving :
________________________________________
Work Reference
Contact person
:
________________________________________
Contact no.
:
________________________________________
:
________________________________________
Employer’s Address:
________________________________________
Employer 2
Employer’s Name
________________________________________
Application Form – V4 April 2014
Page 3 of 8
Post Held
:
________________________________________
Salary and Grade
:
________________________________________
Start Date
:
________________________________________
End Date
:
________________________________________
Supervisor’s Name :
________________________________________
Responsibilities
________________________________________
:
________________________________________
________________________________________
________________________________________
Reason for leaving :
________________________________________
Work Reference
Contact person
:
________________________________________
Contact no.
:
________________________________________
:
________________________________________
Employer’s Address:
________________________________________
Employer 3
Employer’s Name
________________________________________
Post Held
:
________________________________________
Salary and Grade
:
________________________________________
Start Date
:
________________________________________
End Date
:
________________________________________
Supervisor’s Name :
________________________________________
Responsibilities
________________________________________
:
________________________________________
________________________________________
________________________________________
Reason for leaving :
________________________________________
Work Reference
Contact person
:
Application Form – V4 April 2014
________________________________________
Page 4 of 8
Contact no.
:
________________________________________
I hereby give permission to contact the employers listed on the above pages
regarding my prior work experience.
Signed
:
________________________________________
Date
:
________________________________________
Note : If there is a particular employer(s) you do not wish us to contact, please
indicate which one(s).
Driving
Do you hold a current clean driving licence?
Yes / No
What category of Licence do you hold? (Please add date passed under each
category)
A
B
B1
BE
C
CE
C1
C1E
D1
D1E
Have you ever had any difficulty obtaining car insurance? Yes / No
If yes, please give details :______________________________________
_______________________________________
Do you own a car which you can use for work/business use?
Yes / No
Others
Do you have the right to work in the UK?
Yes / No
If yes, please provide evidence of your nationality / work permit details
Please note any criminal convictions current or ‘spent’ under the
Rehabilitation of Offenders Act 1974. If none please state. (Please
note that The Mansfield Group are exempt from the Rehabilitation of
Offenders Act 1974 due to contracts held with Local Police
Authorities) All applicants will undergo a Criminal Record Bureau
check. Failure to disclose may result in the company taking
disciplinary action which may lead to dismissal.
Application Form – V4 April 2014
Page 5 of 8
Have you applied for any position or been employed within The Mansfield
Group before?
Yes / No
How did you hear of this vacancy?
________________________
Declaration
I certify that the information I have given is correct to the best of my knowledge
and belief, and that I have not omitted any facts which may have a bearing on
my application. I understand that if any of the information provided by me is
found to be false any Contract of Employment may be terminated without notice.
Signed:____________________________________Date:___________________
Application Form – V4 April 2014
Page 6 of 8
MONITORING SHEET
(to be returned separately – details at the end of the form)
The Mansfield Group is committed to the principle of equal opportunities and to
active policies to eliminate unfair discrimination and does not discriminate on any
grounds other than the ability to carry out the task.
The Equal Opportunities Commission and the Commission for Racial Equality
strongly recommend that such policies are monitored effectively and we fully
support this.
Monitoring is essential to ensure that the policies are being properly implemented
and your answers to the questions below will provide statistical information to
enable the Company’s selection process to be carried out effectively.
This sheet will be detached before your application is considered. Any information
given will be held in strict confidence and will not affect your application. We ask for
your co-operation in completing this sheet.
First Name(s)
Surname
Post Applied For
Department
Date of Birth
Gender
Marital Status
Nationality
Place of Birth
:
:
:
:
:
:
:
:
:
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
Male / Female
Single/Married/Separated/Divorced/Widowed
________________________________________
________________________________________
Which is your ethnic group? Choose ONE section from A to E, then tick the
appropriate box to indicate your cultural background
A White
White British
White Irish
Any other White background
B Mixed
Mixed White and Black Caribbean
Mixed White and Black African
Mixed White and Asian
Any other Mixed background
C Asian or Asian British
Indian
Pakistani
Bangladeshi
Any other Asian background
D Black or Black British
Black or Black British Caribbean
Black or Black British African
Any other Black background
E Chinese or other ethnic group
Chinese
Any other ethnic group
Please specify ______________
Application Form – V4 April 2014
Page 7 of 8
Do you consider that you have a disability under the Equality Act 2010 (ie a
physical or mental impairment which has a substantial and long-term
adverse effect on your ability to carry out normal day-to-day activities)?
Yes / No
Do you need any special assistance in attending interview? Yes / No
If yes, please give details :______________________________________
_______________________________________
Declaration
I hereby give my consent for The Mansfield Group to use, store and process the
personal data contained within this application form and monitoring form.
Signed:____________________________________Date:___________________
NOTE – Please return this part of the form (MONITORING SHEET) to the
following address
Human Resources Department
The Mansfield Group
Unit 5, Parkway Drive
Sheffield
S9 4WU
Application Form – V4 April 2014
Page 8 of 8