Aquanet Services Ltd

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Aquanet Services Ltd Application Form


Title
Profession
Surname*
Forename*
Current Address*
Post Code*
Telephone Number*
Mobile Number*
N.I No*
Proof of N.I No Seen?
P45 enclosed?	Yes No
P46 Required?	Yes No
Sex	Male Female
Nationality
Next of Kin
Next of Kin Tel No
Where did you hear of the advert?
Are you a British Citizen / EU National?	Yes No
If the answer is no, What entry stamp was put on you passport by Immigrations? (Please enclose a photocopy of entry
Are there any restrictions on your passport that prohibit you from working in the uk?	Yes No
Are you subject to work Provisions? (If yes, please provide copy of work permit)	Yes No
For security purposes, please provide a copy of one of the following:	Passport Driving Licence Birth Certificate Utility bill showing your name and address
Availability Dates available for work
In which areas can you work
Type of work Preferred	Full Time Part Time Annual Holidays Weekends Other
Own Transport Available?	Yes No
Driving Licence Held	Full UK Provisional Other
Specify
Language Skils Language Spoken / Level of Fluency
Bank Details Name of Carer
Name of Bank or Building Society
Branch
Name of Account Holder
Sort Code
Account No.
Education (Please submit copies of vocational certificates) University / School Qualifications Date of Qualifications
Courses Attended
Work History (most recent or current first). We need a minimum of two employers references Name and Address of Employer
Managers Name
Manager
Position you held From / To
Experience gained
Reason for leaving
Name and address of Employer Manager
Manager
Position you held From / To
Experience Gained
Reason for leaving
References Please give details of two references who will be able to comment on your ability to meet the demands of the post you are applying for. One of these should be your present or most recent employer. Name
Their Job Title
Company Name
Compay Address
Telephone / Fax
Doctors Name
Doctors Telephone No.
Doctors Address
DECLARATION OF HEALTH Surname
First Name
Have you any physical, mental or related problems, which might prejudice you undertaking an assignment?	Yes No
If Yes please give details
Date of chest X-Ray / Result
Have you work in an environment where MRSA has been diagnosed?	Yes No
Have you had any of the following Vaccinations?	Hepatitis Tuberculosis BCG Polio Tetanus Rubella
Date of last medical

DECLARATION (PLEASE SIGN BEFORE RETURNING)
I declare that the information given herein is true and complete and is not presented in a way to mislead. Furthermore, I am aware of any condition, medical or otherwise, which would limit or affect my employment performance.

I agree that I give or have given false and misleading information or omit to give relevant information, this may result in termination of assignment without notice, as well as a claim for recovery of any payments I have received, together with a claim for loss of profits to Aquanet Services Ltd.

I acknowledge that I have been given a copy of the current terms and conditions of service issued by Aquanet Services Ltd which is mine to keep, and that I have read these terms and agree to abide by them.

Signed (Surname)*

Date*