Personal History Form

Position(s) Applied For

Date of Application

Employer company name

Referral Source

Name of Source (if applicable)

Personal Details

Name

Address

Postcode

Telephone

Mobile

Nat Insurance Number

Are you legally eligable for employment in the UK? yes no

If not a UK or European National

Next of Kin

Address

Postcode

Telephone:
Day

Night

Relationship to employee

Educational Background

A: List last 3 Schools/Colleges/Universities attended, starting with most recent. B: List years of attendance. C: Indicate qualifications earned, if any (eg. degrees, diplomas, A Levels, GCSEs, etc.). D: grades.

School/College/University 1

Years: from/to

Qualifications

Grades

School/College/University 2

Years: from/to

Qualifications

Grades

School/College/University 3

Years: from/to

Qualifications

Grades

List any foreign language(s) you know and tick the boxes to describe your skill level.

Language Speak Some Speak Fluently Read Write

Skills and Qualifications

Summarise your special training or experience, skills, licenses or certificates which you feel may support your application

Do you currently hold a valid licence to drive a motor vehicle? yes no

(If job related) Do you hold a valid licence to drive a commercial vehicle? yes no

Driver Licence Number

Equal Opportunities

The Company seeks to recruit employees on the basis of their general suitability for a position and aims to ensure that consideration of age, sex, marital status, sexual orientation, disability and racial or ethic origin should play no part in this process. In order to monitor the effectiveness of this commitment to equal opportunities it would be helpful if you could complete this section of the form. Completion is required and the information will be used for no other purpose than that as stated in this paragraph.

Marital Status

Sex

DOB

Ethnic Origin

Other

Disabilities/Impairments (please specify)

Employment History

Give details of your last two (2) work positions starting with the most recent. Include details of any military service.

ONE:

From/To

Employer

Telephone

Job Title

Address

Title of Immediate Supervisor

Summarise the nature of work performed and job responsibilities

Reason for leaving

Rate of pay/salary

TWO:

From/To

Employer

Telephone

Job Title

Address

Title of Immediate Supervisor

Summarise the nature of work performed and job responsibilities

Reason for leaving

Rate of pay/salary

Last time absent from work and why, list major accidents and illnesses over the last five years

References

May we contact a reference: At any time: yes no Only if we offer you a job

Name

Position

Contact Address (if known)

Telephone No.

Years Known

Name

Position

Contact Address (if known)

Telephone No.

Years Known

Personal Health Records

Are you in good health at present? yes no

Do you suffer from a recurring illness? yes no

Is yes, please give details

Additional Information

Have you at any time been convicted of a crime resulting in a prison sentence of 30 months or more (part of which may or may not have been suspended)? yes no

Have you been convicted of a crime:
A: in the last 10 years resulting in a prison sentence of between 6 and 29 months or in youth custody (part of which may or may not have been suspended)? yes no

B: In the last 7 years resulting in a prison sentence of up to 6 months or youth custody (part of which may or may not have been suspended)? yes no

Such convictions may be relevant if job related, but do not necessarily bar you from employment as such. If yes, please explain

List any additional information you would like us to consider

It is understood and agreed that any misrepresentation by me on this application form will be sufficient cause for cancellation of this application and/or termination from the employer's service if I have been employed.

I give the employer the right to investigate all references and to secure additional information about me, if job related. I hereby release from liability the employer and its representatives for seeking such information and all other persons, corporations or organisations for furnishing such information.

Name of Applicant

Date

upload CV

Online Application

Personal History Form

Personal Details

Educational Background

Skills and Qualifications

Equal Opportunities

Employment History

References

Personal Health Records

Additional Information