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Please return this form to Wilson James Limited 80-81 Fleet Street London EC4Y 1EL Telephone 020 7353 4171 Facsimile 020 7353 4169 APPLICATION FORM Please answer all questions using BLOCK CAPITALS in your own handwriting and using BLACK INK. If a question or section does not apply to you do not cross through but insert NO or N/A. Position applied for. Where did you hear about this vacancy. Have you worked for Wilson James previously YES/NO Circle If yes give approximate leaving date. TITLE Mr/Mrs/Miss/Ms Circle SURNAME. FORENAMES. Have you ever been known by any other name YES/NO Circle If yes give details. ADDRESS*. POST CODE. EMAIL ADDRESS. TEL NO. MOBILE NO. ARE YOU PERMITTED TO WORK IN THE UK YES/NO Circle PLACE OF BIRTH. WORK PERMIT EXPIRY DATE NATIONAL INSURANCE NUMBER. NATIONALITY. DO YOU HAVE A FULL DRIVERS LICENCE YES/NO Circle QUALIFICATIONS BLOCK CAPITALS DETAILS DATES DO YOU HOLD A VALID SIA LICENSE LICENSE NO. YES/NO Circle TYPE i*e* Security Door Supervisor CCTV. Expiry Date D M Y ANY OTHER ACCREDIATION / QUALIFICATION RELEVANT TO THE ROLE YOU ARE APPLYING FOR Qualifications i*e* Airside pass CSCS Card. PLEASE PROVIDE FULL DETAILS OF PREVIOUS ADDRESSES FOR THE LAST 5 COMPLETE YEARS Address. From Postcode. To ANY ADDITIONAL ADDRESSES WILL NEED TO BE DISCLOSED ON A SEPARATE SHEET OF PAPER EMPLOYMENT AND EDUCATION HISTORY RECORD. State ALL periods of employment unemployment self-employment and/or education for the LAST 5 YEARS or back to the age of 16 if this date is more recent unless otherwise informed* For periods of unemployment give the address of the Benefit Office in the Employer column* There must be no gaps of more than 14 days you must explain how you are going to account for any time not covered* Most recent or current first. CURRENT EMPLOYER Name. Your Job. Reporting to. Reason for Leaving. Employee/Student No. Email Address. Tel/Fax Nos. ARE WE ABLE TO CONTACT YOUR MOST TWO PERSONAL CHARACTER REFERENCES Give the name address and telephone number of TWO people who have known you for AT LEAST 2 YEARS* Neither Character Referee can be related to you by blood or marriage living with you or living with one of your relations a Wilson James employee or a previous employer. Occupation. Telephone Number. How long known. SELF EMPLOYMENT REFERENCES If you have been self-employed please give the name and address of two people other than those given as personal references who can confirm the details. One should be your Accountant. CRIMINAL OFFENCES CAUTIONS CONVICTIONS ETC. or had any order made against you by a criminal civil or military court or public authority within the UK YES/NO Circle Kingdom Are there any alleged offences outstanding against you If you have answered YES to any of the questions above please give details. Disclosure is not required where there is a sentence to which the Rehabilitation of Offenders Act 1974 applies. Failure to disclose an unspent sentence may result in summary dismissal* Note All applicants are subject to screening and may also be required to obtain records of any convictions from the Police under the Subject Access provisions of the Data Protection Act or Disclosure from The Disclosure and Barring Service DBS.

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