The following information will be treated in the strictest confidence. Job Details Are you related to an existing Staff Member? Post Applied for: Office and Agency: Personal Information Surname: First Name: National Insurance Number: Address: Contact Details Daytime Evening Telephone Number: Mobile: Email Address: Are you Registered with Professional Y/N Registration No: Bodies (this will be checked prior to short listing) Are you involved in any activity which might limit your availability to work or Y / N your working hours e.g. local government? If yes please give full details Are you subject to any restrictions or covenants which might restrict your Y / N working activities? Have you any convictions (other than the spent convictions under the Y / N Rehabilitation of Offenders Act 1974)? If yes please give full details If offered employment, you will be required to complete a Pre-Employment Y / N Medical Questionnaire. Are you prepared to undergo a medical examination before employment? Have you ever worked for PiCS or an associated agency before? Y / N If yes please give full details Have you applied for employment with PiCS or an associated agency before? Y / N Do you need a work permit to take up employment in the UK? Y / N Driving Status Full Driving Y/ N Do you have a Y / N Do you have any Y / N Licence? car? endorsements If yes please give details including dates:
The following information will be treated in the strictest confidence. Job Details Are you related to an existing Staff Member? Post Applied for: Office and Agency: Personal Information Surname: First Name: National Insurance Number: Address: Contact Details Daytime Evening Telephone Number: Mobile: Email Address: Are you Registered with Professional Bodies Y/N Registration No: (this will be checked prior to short listing) Are you involved in any activity which might limit your availability to work or your working hours e.g. local government? Y / N If yes please give full details Are you subject to any restrictions or covenants which might restrict your working activities? Y / N Have you any convictions (other than the spent convictions under the Rehabilitation of Offenders Act 1974)? Y / N If yes please give full details If offered employment, you will be required to complete a Pre-Employment Medical Questionnaire. Are you prepared to undergo a medical examination before employment? Y / N Have you ever worked for PiCS or an associated agency before? Y / N If yes please give full details Have you applied for employment with PiCS or an associated agency before? Y / N Do you need a work permit to take up employment in the UK? Y / N Driving Status Full Driving Licence? Y/ N Do you have a car? Y / N Do you have any endorsements Y / N If yes please give details including dates:
Group-Application-Form.docx