WEST PENNINE TRUCKS LTD
CONFIDENTIAL APPLICATION FOR EMPLOYMENT
PERSONAL
Surname ____________________________________ Forenames ___________________________________________ __ Mr/Mrs/Miss/Ms
Address __________________________________________________________________________________________ _______________
________________________________________________________________________________ Post code _______ _______________
Telephone:
Home ___________________________ Business ___________________________ _______________________________
Next of kin and relationship ___________________________________________________________________________________________
Address __________________________________________________________________________________________________________
________________________________________________________________________________ Telephone: ______________________
EMPLOYMENT
Position applied for _________________________________________________________________________________________________
Would you work: full time? * YES

NO

Part time? * YES

NO

Shift work? * YES

NO

If part time, state days / hours ________________________________________________________________________________________
Have you previously worked for us?
* YES

NO

If YES, when and where ____________________________________
Have you any relatives working for us?
* YES

NO

If YES, please give names, relationship and company _____________
________________________________________________________________________________________________________________
On what date would you be available for work? ___________________________________________________________________________
Have you any skills, experience or qualifications which you feel would especially suit the job you are applying for? ______________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
PERSONAL REFERENCES
Please give details of two people (not relatives) we could approach for references, after obtaining your permission.
Name___________________________________________________ Name ___________________________________________________
Occupation ______________________________________________ Occupation ______________________________________________
Address _________________________________________________ Address _________________________________________________
_______________________________________________________ ________________________________________________________
_______________________________________________________ ________________________________________________________
_______________________________________________________ ________________________________________________________
Telephone _______________________________________________ Telephone _______________________________________________
The Company reserves the right to seek a reference from your present / last employer before an offer of employment is made.
WPT JM/Appl. 01/95
EDUCATION
Schools
from
to
Examinations and results
College / University Part time *  Full time * 
from
to
Courses and results
Other Education and Training
from
to
Courses and results
Professional membership and qualifications
INTERESTS
Please give details of any hobbies / social activities and personal achievements of which you are particularly proud
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
EMPLOYMENT HISTORY
Present / last employer ___________________________________________________starting date ________________________________
Address _______________________________________________________________leaving date _________________________________
_____________________________________________________________________job title _____________________________________
Brief description of duties ____________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
Reason for leaving _______________________________________________________Finishing / Current pay _______________________
* please tick appropriate boxes
WPT JM/Appl. 01/95
2
Other most recent employer _______________________________________________Starting date ________________________________
Address _______________________________________________________________Leaving date ________________________________
_____________________________________________________________________Job title ____________________________________
Brief description of duties ____________________________________________________________________________________________
Reason for leaving _______________________________________________________Finishing / Current pay _______________________
________________________________________________________________________________________________________________
Previous employer ______________________________________________________Starting date ________________________________
Address _______________________________________________________________Leaving date ________________________________
_____________________________________________________________________Job title ____________________________________
Brief description of duties ____________________________________________________________________________________________
Reason for leaving _______________________________________________________Finishing / Current pay _______________________
________________________________________________________________________________________________________________
Previous employer ______________________________________________________Starting date ________________________________
Address _______________________________________________________________Leaving date ________________________________
_____________________________________________________________________Job title ____________________________________
Brief description of duties ____________________________________________________________________________________________
Reason for leaving _______________________________________________________Finishing / Current pay _______________________
DRIVING LICENCE
Do you hold a current Driving Licence?
* YES

NO

If YES, give details below
Licence Number
Date of Expiry
Length of time held
Class I
Class II
Class III
Ordinary (Car)
Please give details of any current endorsements __________________________________________________________________________
Have you ever been refused Motor Insurance?
* YES

NO

If YES, give details _____________________________________
________________________________________________________________________________________________________________
Please give details of any motoring convictions ___________________________________________________________________________
PLEASE BRING YOUR DRIVING LICENCE TO THE INTERVIEW
GENERAL
Public duties (JP, local councillor, etc) undertaken ________________________________________________________________________
Have you ever been convicted of a criminal offence?
(Declaration subject to the Rehabilitation of Offenders Act): _________________________________________________________________
Membership of professional organisation or trade union: ___________________________________________________________________
* please tick appropriate boxes
WPT JM/Appl. 01/95
3
Do you need a work permit to work in the UK?
* YES

NO

If offered this position will you continue to work in any other capacity?
* YES

NO

If YES give details:
________________________________________________________________________________________________________________
DECLARATION
I accept that should any statement made by me in connection with this application be found to be false the application shall be void and any
contract arising therefrom may be terminated by the Company at any time.
Signature ______________________________________________________________Starting date ________________________________
 FOR OFFICE USE ONLY 
Interviewer _____________________________________________________________ date ______________________________________
Comments
Interviewer _____________________________________________________________ date ______________________________________
Comments
* please tick appropriate boxes
WPT JM/Appl. 01/95
WEST PENNINE TRUCKS LTD
CONFIDENTIAL MEDICAL QUESTIONNAIRE
Please complete the questionnaire below. The information is required with your interests in mind. As a result of the information you have
given you may be referred to a doctor appointed by the company so that a medical examination can be carried out.
HAVE YOU AT ANY TIME:
NO
YES
Please give details
1. Had an operation?
2. Been seriously injured?
3. Received in-patient treatment for a
physical or mental condition?
4. Been refused or dismissed from
employment for health reasons?
5. Received a disability pension?
6. Been registered disabled?
Card no:
Expiry date:
7. Been made ill by your work?
8. Been refused a driver's licence
because of ill health?
DO YOU SUFFER FROM OR HAVE YOU EVER HAD:
* YES
NO
* YES
NO
* YES
Diabetes
Skin rashes/eczema
Swelling of legs/ankles
High blood pressure
Anaemia
Period of prostate problems
Asthma
Headaches (frequent)
Varicose veins
Cough (frequent)
Heart trouble
Rupture
Rheumatic fever
Chest trouble
Back trouble
Arthritis
Fainting or dizziness
Ear trouble
Epilepsy/fits
Hay fever
Eye trouble
Shortness of breath
Jaundice
Nerve trouble
1. Do you take
medicine regularly?
* YES

NO

2. Do you need glasses
to read?
* YES

NO

3. Have you worked in
a dusty trade?
* YES

NO

4. Have you ever had
a head injury?
* YES

NO

NO
5. Do you suffer from
any other ailments?
* YES

NO

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________________________________________________________________ ___________________________________________
WPT JM/Mdc. 01/95
WPT JM/Mdc. 01/95