Application Form

Position Applied for:..................................................................

Attached Documents:	Signed Application Form	[ ]

Proof of ID	[ ]

Proof of Address	[ ]

Right to Work	[ ]

Personal Information:

Title: Mr / Mrs / Miss / Ms (Circle)	Surname:.................................................................................

(If different from above) Forename:...................................................................	Surname at Birth:....................................................................

Address:..................................................................................................................................................................................

.................................................................................................................................................................................................

Postcode:.............................................................	Place of Birth:..........................................................................

Home Telephone:................................................ Mobile:.....................................................................................

Email Address:…………………………………….................................................................................................................

Nationality:..............................................…....... National Insurance Number:....................................................

Passport Number:................................................

(If applicable) (If applicable) Work Permit:....................................................... Date and Place of entry into UK:……………………….........

SIA License Sector:................................................	SIA License Number:...............................................................

SIA License Expiry Date:……………………

Person to contact in case of emergency/Next of kin:

Relationship to next of kin:......................................	Name:..........................................................................................

Address:......................................................................................................................................................................................

......................................................................................................................................................................................................

................................................................................	Postcode:.......................................................................................

Telephone:...............................................................	Mobile:.........................................................................................

Criminal Convictions:

Have you, ever been fined, cautioned, sentenced to imprisonment or placed on probation for a criminal act (subject to the Rehabilitation of Offenders Act)?	Yes / No

Are there any alleged offences outstanding against you?	Yes / No

Have you, ever been made bankrupt or have any Court Judgements against you, whether satisfied or not, within the last 6 years?	Yes / No

Has any order been made against you by a Civil or Military Court or Public Authority?	Yes / No

If yes to any of the above questions, please give details ………………………………………………………………………….

Driving:

Type of Driving License: Full / Provisional / None	Auto/Manual

License Expiry Date:…………………	Own Transport: Car / Motorbike / None

Driving License Number:...................................................	Have you ever been disqualified? Yes / No

Any Motoring offences/convictions? Yes / No – If yes, please provide description of your offence/s ...........................................................................................................................................................................

If applying for a Security Officer position:

Are you prepared to work day and night shifts working to a 4 on/off rota?	Yes / No

Personal References:

Please provide us with a personal reference who you have known for at least 2 years and are not your relative or former employer or resident on same address.

Name:........................................................................

Address:....................................................................

.....................................................................………..

Tel. No.:……………………………………………..

Occupation:…………………………………………

How long known:……………………………………

Email Address:……………………………………….

Equal Opportunities:

This section is voluntary and will NOT be used in assessing your application. Diligence Security Solutions Ltd is an equal opportunities employer. If you decide to complete this section it will help us to monitor the effectiveness of our Equal Opportunities Policy. Please tick the appropriate box below.

My ethnic origin is:

British
African
Asian
Caribbean
Chinese
White
Other

If other, please specify..............................................................

Bank Details:

Bank Name:............................................................................... Account Holder Name:....................................................

Sort Code:………...........................................................……… Account No:.............................................................
Employment: Please state all periods of employment, unemployment, self-employment and/or full time education for the past 5 years; in a chronological order. For any periods of unemployment (in excess of 31 days), state the address of the Unemployment Benefit Office to which you reported.

Employers Details:	Employment Details:	From: DD/MM/YY	To: DD/MM/YY	Reason for leaving:
Name:	Position:
Address:
Manager:
Postcode:
Tel No:	Salary:
Email:

Employers Details:	Employment Details:	From: DD/MM/YY	To: DD/MM/YY	Reason for leaving:
Name:	Position:
Address:
Manager:
Postcode:
Tel No:	Salary:
Email:

Employers Details:	Employment Details:	From: DD/MM/YY	To: DD/MM/YY	Reason for leaving:
Name:	Position:
Address:
Manager:
Postcode:
Tel No:	Salary:
Email:

Employers Details:	Employment Details:	From: DD/MM/YY	To: DD/MM/YY	Reason for leaving:
Name:	Position:
Address:
Manager:
Postcode:
Tel No:	Salary:
Email:

Employers Details:	Employment Details:	From: DD/MM/YY	To: DD/MM/YY	Reason for leaving:
Name:	Position:
Address:
Manager:
Postcode:
Tel No:	Salary:
Email:

Declarations

I certify that to the best of my knowledge, the information that I have given in my application for employment is true and complete and understand that any false statement or omission to Diligence Security Solutions Ltd or its representatives may render lead to termination of employment without notice.

I understand and agree that if so required I will make a Statutory Declaration in accordance with the provisions of the Statutory Declarations Act 1835 in confirmation of previous employment or unemployment.

I authorize Diligence Security Solutions Ltd or its nominated agents to carry out financial history check /credit check and approach Government agencies, former employers, educational establishments, criminal justice agencies and personal referees for information relating to and verification of my employment/unemployment record.

I consent to Diligence Security Solutions Ltd reasonable processing of any personal information obtained for the purposes of establishing my medical condition and future fitness to perform my duties. I accept that I may be required to undergo a medical examination where requested by Diligence Security Solutions Ltd Subject to the Access to Medical Reports Act 1988, I consent to the results of such examinations to be given to Diligence Security Solutions Ltd and authorize Diligence Security Solutions Ltd to make a consumer information search with a credit reference agency, which will keep a record of that search and may share that information with other credit reference agencies.

I further declare that any documents that I provide as proof of my identity, proof of address, proof of right to work and any other documents that I provide are genuine and give my consent for these documents to be examined under a UV scanner or similar device. I acknowledge that any falsified documents may be reported to the appropriate authority.

Data Protection Act 1998

Diligence Security Solutions Ltd will use the information you have given on your application form (together with any information which we obtain with your consent from third parties) for assessing your suitability for employment. It may be necessary to disclose your information to our agents and other service providers. By returning this form to Diligence Security Solutions Ltd you consent to our processing personal data about you where this is necessary, for example information about your credit status, ethnic origin or criminal offences. You also consent to the transfer of your information to your current and future potential employers where this is necessary (this may be to companies operating abroad if you apply for work outside of the United Kingdom).

Your information will be held on our computer database and/or in our paper filing systems. By signing below you agree to this process and confirm that you do not have a criminal record subject to the current Rehabilitation of Offenders Act and any amendments. You have the right to apply for a copy of your information (for which we may charge a small fee) and to have any inaccuracies corrected.

Disclosure

You are applying for a position of trust and in the event of being offered employment by Diligence Security Solutions Ltd we may apply for a Disclosure. However, having a criminal record does not necessarily bar you from employment. For more information ask a member of staff for a copy of the CRB Code of Practice/Disclosure Scotland and/or Company our policy statement regarding ex-offenders. Disclosure information is treated in a sensitive way and is restricted to those who need to see it to make a recruitment decision. By signing this document you allow Diligence Security Solutions Ltd to see a copy of the Disclosure. The Disclosure information is not retained i.e. it is disposed of within the timescales recommended in the CRB Code of Practice. By signing below you agree to this process.

Screening

Any offer of employment is subject to satisfactory screening, that the applicant consents to being screened and will provide information as required. That the information provided is correct, and the applicant acknowledges that any false statements or omissions could lead to termination of employment.

I confirm that my consent is explicit, fully informed and freely given for the purposes of this job.

Applicant Name: _______________________________________ NI Number: _________________________

Applicant Signature: ____________________________________ Date: ______________________________