Position applied for:

Salary Required:

Job Reference:

PERSONALDETAILS:

National Insurance No:

Title:

Surname:

Forenames:

Maiden Name:

Date of Birth:

Permanent Address:

Contact Address:

Telephone Number:

Daytime/Mobile:

E mail address:

NEXT OF KIN

Name: Relationship:

Address:

Telephone No:

Dependants. Please state relationship and D.O.B. if under 18.

Current Driving Licence? YES NO Own Vehicle? YES NO

EQUAL OPPORTUNITIES bartlett mitchell ltd is an equal opportunity employer. In order to ensure the continuing development of this policy, applicants are asked to provide the following information which will only be used for monitoring purposes.

ETHNIC U.K: OTHER:

ORIGIN: IRISH: CARRIBEAN: AFRICAN: ORIENTAL: EUROPEAN:

ASIAN: OTHER:

SEX: MALE FEMALE

MARITALSTATUS:

RELIGION:

EDUCATION:
Please give details of schools/colleges attended, dates, subjects taken and qualifications gained

TRAINING:
Please give details of course title, name of company or external company tutored by, number of days, year attended, qualifications/certificates.

EMPLOYMENT RECORD
Please start with last/present job first and give details of dates, name and full postal address of emploment, position, salery, and reason for leaving. Please also notify availability for reference.

What notice do you have to give to your present employer?

HEALTH
I confirm that I have received a copy of the bartlett mitchell ltd Medical Questionnaire
YES NO

Date of completion of medical questionnaire:

Registered disabled No. (IF APPLICABLE):


HOBBIES Please list your hobbies and interests.

Have you ever been convicted of a criminal offence before: YES NO
If Yes please give details:

DECLARATION BY APPLICANT
I confirm that to the best of my belief, the above information is correct, and understand that any misleading statement or deliberate omission may be sufficient grounds for cancelling any agreements made.

AGREE:

DATE: