Staff Application Form

Please complete all sections clearly
ALL BOXES MUST BE COMPLETED FULLY TO PROCESS THIS APPLICATION FORM.
ALL FIELDS MARKED * ARE COMPULSORY.

1. Personal Details

Surname:	*
Place of Birth
National / EU Insurance no:	*
Are you:	Self employed
	Unemployed
	Employed elsewhere
	Student
Do you have a full driving licence?	Yes No *
Are you conversant in a second language, and if so please state?
Can you use sign language?	Yes No
Earliest date available for work:

First name(s):	*
Permanent Address:	*
Postcode:	*
Home telephone no.:	*
Mobile telephone no:	*
Email address:	*
Term Time Address: (if different)
Telephone no.:
Email address:
Tick if you would like to be sent details of set-up work

Where did you hear about this vacancy?
If Other, Internet or Friends or family, please specify:

What is your Nationality?

Please indicate your ethnic origin by selecting one of the boxes below:

European

Afro Caribbean

Asian

Oriental

Other:

Date of Birth:

Some of our areas have a restricted work environment in terms of space and access that people with disabilities may find difficult.

Do you consider yourself to have a disability?	Yes No
If registered disabled, Disabled No.
If yes, please provide further details as relevant:
If employed, would you need to be accompanied by a carer or supporter?	Yes No

2. Emergency Contact

Name	*
Address:	*	Home Telephone no.	*
		Work Telephone no.
		Mobile Telephone no.
Postcode:

3. Details of the job you are applying for

Please indicate 1st, 2nd and 3rd preference of position applied for:	1. *
	2. *
	3. *
Have you worked for The Compass Group before?	Yes No *
When?
Position held:
Unit worked in:

Uniform Size:	Male Chest	Female Dress

4. Employment Record

List relevant employers from present to last in that order.

Duration	Name and Address of Employer	Brief details of duties with position held	Hourly wage or salary	Reasons for leaving
*	*	*	*	*

5. Referees

Please give the name of two referees past employers or professional names. .

Name of referee:*
Occupation:*
Address:*
Telephone number:*
Email:

Name of referee:*
Occupation:*
Address:*
Telephone number:*
Email:

I authorise the company to obtain a reference to support or clarify this application.

6. Education

Education and Trade / Professional details to be completed as applicable.

Names and Addresses of School, College, University	Examination Subjects taken with results	Responsibilities Held
*	*	*

7. Convictions

Have you ever been convicted of a criminal offence? (Note: Subject to the Rehabilitation of Offenders Act)	Yes No *
If yes, please give details:

8. Medical Declaration

Have you suffered or are you suffering from:		Yes	No	Please give details
Typhoid or Paratyphoid?	*
Recurrent infection of mouth, nose, ears or eyes?	*
Back trouble?	*
Heart disease?	*
Epilepsy, fits, blackouts or fainting attacks?	*
Skin conditions e.g. Dermatitis?	*
Mental ill health, nervous breakdown or nervous debility?	*
Chest disease?	*
Digestive or bowel disease?	*
Diabetes?	*
Any other serious illness?	*
Are you at present receiving medical treatment?	*
Do you always wear glasses or contact lenses?	*
Do you wear glasses or contact lenses for close work?	*

Please give details of any other illness or injuries relevant to your application:
Are you willing to be medically examined?	Yes No*

9. Data Protection

By providing the information contained within this application form you are consenting to its use for the purpose of processing your application, assessing your performance in the future (should your application be successful) and monitoring your efficiency of our recruitment and other employment procedures.

By submitting this form, I certify that the information given by me in this application for is, to the best of my belief, correct in every detail. I understand that giving false or incomplete information could result in my rejection for employment or, subsequent dismissal.

All applicants must be aware that information provided as part of this application process may be shared with the Police, the Home Office and other law enforcement agencies in order to protect the security of those working for The Compass Group.

Today's Date:

The Compass Group welcomes applicants from all sections of the community irrespective of age, race, colour, gender, sexuality or disability. We are an equal opportunities employer and the questions on this form are designed to ensure that we do not discriminate against any applicant and our policy of equal opportunities is implemented.