Part H: Further Information Do you have any disciplinary warnings in force against you? YES NO If Yes, please give details including dates, on a separate sheet. Are you involved in any employment dispute with your current or previous Employer? YES NO If Yes, please give details on a separate sheet. Part I: References Please give names and addresses of at least two people (other than relatives or friends) with knowledge of you and your work to whom professional reference can be made. One should be your current or most recent employer. For overseas referees please ensure an email address is included where available. Present or most recent employer Name and title: Full address: Position held: Postcode: Telephone: Fax: Email: Other referee Name and title: Full address: Position held: Postcode: Telephone: Fax: Email: Other referee Name and title: Full address: Position held: Postcode: Telephone: Fax: Email: May we approach your present employer for a reference before interview? If no please ensure that you give two other referees. Yes No No offer of employment will be made until two references, including that of your current or most recent employer, have been received. Part J: Declaration You are required to sign the declaration below certifying that all the information you have provided is accurate. The Ascension Island Government may wish to check any of the details you have provided. Providing incorrect information or deliberately concealing any relevant facts may result in disqualification from the selection process or, where discovery is made after an appointment, in summary dismissal. I declare that the information given in this form and in any accompanying documentation is true to the best of my knowledge and belief and give my permission for enquiries to be made to confirm qualifications, experience and dates of employment and for the release by other people or organisations of necessary information to verify the content. I understand my application may be rejected and/or I may be dismissed following appointment if I have given any false or misleading information or have withheld any relevant details. Signature………………………………………………………… Date……………………………………………….. Please return the completed form to Human Resources at: or by fax to (247) 66816
Part H: Further Information Do you have any disciplinary warnings in force against you? If Yes, please give details including dates, on a separate sheet. YES NO Are you involved in any employment dispute with your current or previous Employer? If Yes, please give details on a separate sheet. YES NO Part I: References Please give names and addresses of at least two people (other than relatives or friends) with knowledge of you and your work to whom professional reference can be made. One should be your current or most recent employer. For overseas referees please ensure an email address is included where available. Present or most recent employer Name and title: Full address: Postcode: Position held: Telephone: Fax: Email: Other referee Name and title: Full address: Postcode: Position held: Telephone: Fax: Email: Other referee Name and title: Full address: Postcode: Position held: Telephone: Fax: Email: May we approach your present employer for a reference before interview? If no please ensure that you give two other referees. Yes No No offer of employment will be made until two references, including that of your current or most recent employer, have been received. Part J: Declaration You are required to sign the declaration below certifying that all the information you have provided is accurate. The Ascension Island Government may wish to check any of the details you have provided. Providing incorrect information or deliberately concealing any relevant facts may result in disqualification from the selection process or, where discovery is made after an appointment, in summary dismissal. I declare that the information given in this form and in any accompanying documentation is true to the best of my knowledge and belief and give my permission for enquiries to be made to confirm qualifications, experience and dates of employment and for the release by other people or organisations of necessary information to verify the content. I understand my application may be rejected and/or I may be dismissed following appointment if I have given any false or misleading information or have withheld any relevant details. Signature………………………………………………………… Date……………………………………………….. Please return the completed form to Human Resources at: or by fax to (247) 66816
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