Employment With Us.

Name:	Mr. Ms. Dr.
	Title Name Surname
Address:
	Address Line 1
	Address Line 2
	City Post Code
Email:
Phone:
	Land Line Mobile
Personal Details
National Insurance Number:
Place of Birth:
Marital Status:	Single Married
Next of Kin:
Address:
	Address Line 1
	Address Line 2
Technical Qualifications:
Please indicate those items in which you have had practical experience or gained technical qualifications:	Fire Extinuishers Emergency Lighting Fire Alarms Fire Sinage Portable Electrical Appliance Testing
First Aid experience and Certificates held
Rate of Pay Required (£/hr):
Do you have a valid UK Driving License?:	yes no
Are you prepared to work anywhere in the UK?:	yes no
Are you a member of a Trade Union?:	yes no
If YES please state which

Employment Record
Starting with current / last employment

Declaration and Terms & Conditions.

I agree that the Company can seek references from those companies listed under 'Employment Record' above which includes my present Employer, and if any application is successful, employment with the company will be subject to the satisfactory completion of a Probationary Period of up to three months.

I certify that, to the best of my knowledge, the answers given by me on this form are true and I accept the above Terms & Condition.