EmailMe Form - High Peak Job Opportunities

Which position are you applying for? *

PCV Engineer

Apprentice PCV Engineer

Cleaner

Applicants Salutation

Applicants Name *

First Last

Address

Street Address City State / Province / Region Postal / Zip Code Country / Region

Date of Birth

DD / MM / YYYY

Phone *

Email *

Smoker

Yes

No

Driver Licence Number

Entitlement

Category D

Category D1

Manual Car Licence

Automatic Car Licence

Is your licence clean? *

Yes

No

Give details of any points on licence *

If you hold a PCV licence, how many completed modules of the Driver CPC to do you hold? *

Are you legally eligible to live and work in the UK in accordance with the Asylum and Immigration Act 1996? *

Yes

No

Give details of any criminal convictions in the past 5 years, together with ANY which have resulted in a prison sentence. If none, you must write NONE here. (exclude those spent under Rehabilitation of Offenders Act 1974)

Can you provide a specified document such as passport, P60, or UK birth certificate? *

Yes

No

Are you generally in good health? *

Yes

No

If NO give details

Are you receiving medical treatment for any condition? *

Yes

No

If YES give details

Have you in the past 10 years had a period of illness resulting in a long-term (more than 4 weeks) absence from work? *

Yes

No

Are you registered disabled or do you suffer otherwise from any disability? *

Yes

No

If YES give details

Do you have outside commitments that could limit you working hours, such as being a JP, councillor in local government or a member of the TA? *

Yes

No

If YES give details

Are you willing to undergo a medical examination? *

Yes

No

How many weeks notice would you have to give to your current employer?

Please give dates of ALL existing holiday/leave commitments

Please give details of schools, colleges and universities attended since age 14, dates attended and qualifications obtained

Please give details of other skills and qualifications you have obtained

Are you currently employed? *

Yes

No

If NO please give reason

Have you ever been dismissed by an employer? *

Yes

No

If YES please give details of what happened

Please give details of your past employment. Start with your current or last employer first. Please show all driving positions held previously. Include, company name, address, your position, rate of pay and dates employed.

Do you have any part-time or evening jobs that you intend to continue? *

Yes

No

If YES please give details

Please give the name and addresses of two people that we may contact for references. One must be a past employer *

DECLARATION

I declare that the information I have given on this form is correct and that any misrepresentation by me may be sufficent grounds for my dismissal if I am employed. I give my permission for my previous employers and any references to be contacted.

• Consent under the Data Protection Act 1998 – the information given to Centrebus Ltd in this form will be processed only by Centrebus Ltd for the purpose of considering your application for employment. If you are successful in your application this form and the information in it will be retained for such times as you are an employee and for up to 6 years after the end of your employment. Otherwise, this form will only be retained by Centrebus Ltd for so long as it is required in connection with your application.

• By signing this consent you give your express consent to retain and process all the information contained in this form. *

First Last

Date Time *

DD / MM / YYYY