Blank Form (#3)

Personal Details:

Work History:

Start with your current or most recent employment and work backwards

Your references:

Refree no.1

Employee Date

Refree no.2

Employee Date

Refree no.3

Employee Date


  • Please read the following statements carefully. If there is anything you do not understand, please ask before you sign at the bottom of the page.
  • I, the job applicant named on the front of this form, confirm that the information I have given in this application is accurate and true to the best of my knowledge. I also understand and agree that:
  • The company may make checks to verify the information I have provided;
  • Providing misleading or false information in this form or at any other time during the application process may disqualify me from appointment or, if I have already been appointed, may result in my dismissal;
  • The personal information I have provided in this form (and any other personal information that I or my referees may provide) is confidential and will be handled in line with the Data Protection Act 1998;
  • If my application is unsuccessful, the company will keep only basic information about me and destroy the rest;
  • If my application is successful, my personal information will be used for legitimate purposes only
  • The company may process my personal information for the purposes described above or as otherwise permitted or required by law in line with its registration with the Information Commissioner;
  • Any offer of employment will depend on the receipt of satisfactory employment references and the satisfactory completion of a criminal records disclosure (see part six above);
  • I will be required to complete a pre-employment induction training programme prior to my starting work
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