Altitude Scaffolding based in Hull, East Yorkshire

Employment Application Form

Please find below, an application form to submit yourself for any job vacancies. We will keep your information on file and if any vacancies arise, we shall contact you with the details.

If you do not have time to fill in the application form right now, you can also download the form, print it off and send it in to us when you have filled it in. To download the form please click here.

Position applied for
Available start date
Wage required per month
Prepared to work	Full-time Part-time Shift work

Personal Details
Surname
Forename(s)
Email
Address
Postcode
Phone number(s)
Day
Evening
Mobile

Do you own a car?	yes no
Do you have a driving licence?	provisional full HGV no
What date does your licence expire?
Do you have any current endorsements?	yes no

Are you in good health?	yes no
Do you have any disabilities which may affect your application?	yes no
Describe disabilities and any reasonable adjustments to our recruitment process or to the job itself that would assist you

Do you have any other vocational qualifications? [ADR, CPC, DGSA, CITB, FORKLIFT]

Do you speak or read a foreign language?

yes no

Interests / Hobbies / Sports / Pastimes

Offices held in social / sports clubs etc

Public Duties [JP, councillor etc] undertaken

Member of Territorial Army

Member of a professional organisation

Have you ever been convicted of a criminal offence? [declaration subject to the Rehabilitation of Offenders Act - Spent Convictions need not be mentioned] yes no

Do you need a work permit to work in the UK? yes no

If offered this position, will you continue to work in any other capacity? yes no

Previous Employment
[Please include details of your most recent employment first and then work backwards]

Employer 1
Type of Business
Address
Postcode
Start Date
Leaving Date
Starting Pay	Per
Leaving Pay	Per
Job Title
Duties
Reasons for leaving

Employer 2
Type of Business
Address
Postcode
Start Date
Leaving Date
Starting Pay	Per
Leaving Pay	Per
Job Title
Duties
Reasons for leaving

Personal Referees [not members of your family]

Name
Address
Occupation
Contact number(s)

Name
Address
Occupation
Contact number(s)

If you wish to do so, please give details of who should be contacted in case of an emergency

Name
Address
Relationship
Contact number(s)

PRE-EMPLOYMENT MEDICAL QUESTIONNAIRE The Pre-Employment Medical Questions below are to help establish if you can carry out the work that you are being employed to do without affecting your Health, Safety and Welfare and others who may be affected by the work involved. All information disclosed will be treated in the strictest confidence and will be used in accordance with the Data Protection Act 1998 and, where relevant, Disability Discrimination Act 1995. This document will not be provided to third parties without your prior written consent.
Do you, or have you during the last five years suffered from any of the following:
Diabetes	yes no
Epilepsy or fainting	yes no
Heart problems, high blood pressure, angina or a stroke	yes no
Circulatory problems such as thrombosis or varicose veins	yes no
Back problems	yes no
Bone fractures	yes no
Problem with joints or tendons, arthritis or rheumatism	yes no
Respiratory problems such as asthma or severe bronchitis	yes no
Any other significant health problem such as impaired vision	yes no
Have you:
Suffered any form of work related injury in the past	yes no
Worked in an environment with high levels of noise, dust or vibration/asbestos	yes no
Do you:
Suffer from impaired hearing or vision	yes no
Suffer from any other significant health problem	yes no
Are you:
Currently receiving medical treatment	yes no
Currently taking any form of medication	yes no
Please provide further information for all questions answered yes

It is the company's policy to employ the best qualified personnel and provide equal opportunity for the advancement of employees including promotion and training and not to discriminate against any person because of race, colour, national origin, sex or marital status, or disability.
I authorise the company to obtain references to support this application once an offer has been made and accepted and release the company and referees from any liability caused by giving and receiving information.
I confirm that the information given on this form is, to the best of my knowledge, true and complete.
Any false statement may be sufficient cause for rejection or, if employed, dismissal.

Employment Application

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