Where did you hear about us? ................. application form Surname: Mr / Mrs / Miss / Ms First names: Previous name: Current address: Date of birth: Mobile no: Alt tel no: H First date available: Notice given in present job: Yes Postcode: Email: Email: Length of time at current address: Who should we contact in emergency? No National insurance no: Do you have a criminal record? Yes No If yes, please Em erge ncy cospecify ntact tel no: Name / Tel No: education training from ageor16 Do you have /any health conditions disabilities which are relevant to this application (hand, arm or back problems, eye strain, sight or hearing impairments, wheelchair user etc)? Dates, month/year (from - to): Yes No Examinations/qualifications gained (including grades) I Secondary school: Area: Contact name: College: University: Area: Contact name: personal references – fromUniversity: someone who has known you for at least 5 years, not relatives or former employers: Name: Occupation: Area: Name: Contact name: Occupation: Address: Address: Postcode: Postcode: Tel no: Tel no: Do you require any type of work permit? Yes No If yes, please specify: Do you have any restrictions on the work / hours you can do? Yes If yes, please specify No Please SULQW\RXUQDPHKere to confirm you have reDG a copy of our terms and conditionsDWZZZHYRUHFUXLWFRXNGRFVWHUPVSGI Print name: Date: 1 employment details – please please,list listbelow belowyour yourlast last34jobs jobs: Dates, month/year (from - to): Company name: Job title: Address: Name of supervisor: Reason for leaving: Notice period: Postcode: Tel no: Salary: office use only Date sent: Dates, month / year (from -to): Company name: Job title: Address: Name of supervisor: Date received: References may be obtained now? Yes No Reason for leaving: Notice period: Postcode: Tel no: Salary: office use only Date sent: Dates, month/year (from - to): Company name: Job title: Address: Name of supervisor: Date received: References may be obtained now? Yes No Reason for leaving: Notice period: Postcode: Tel no: office use only Date sent: Salary: Date received: References may be obtained now? Yes No equal opportunities Evolution Recruitment operates an equal opportunities policy, which means that we will not discriminate, directly or indirectly, against people on the grounds of their sex, marital status, age or disability or on the grounds of race, colour or national origin. Evolution Recruitment will not discriminate in advertising, selecting, offering training or providing benefits and services; every vacancy will be open equally to those who have the required qualifications. The following information is for monitoring purposes only and is voluntary. If you do not wish to complete this section it will in no way prejudice your application. White Black-African Other (please specify) Black-Caribbean Black-other Bangladeshi Indian Pakistani Chinese (please tick box) c confidentiality and references I understand that whilst on assignment with Evolution Recruitment I may have access to confidential information belonging to Evolution Recruitment or its clients. I will not disclose or use confidential information personally and I will not disclose confidential information to anyone else, either during or after my assignment with Evolution Recruitment. I authorise Evolution Recruitment to take up references and give its clients relevant information relating to my employment details or this application. I confirm that to the best of my knowledge the information given on this form is correct. Signature: 12 Date: 2 2 1 - 1-2 2 02 A:" 2 0- , 1 5/ 1 - 2 0- , < 5 01 ; ; 5 0 5 ;; 52 - 2 2 0- , 5- 2 2 7, 5 2 0- " : 5 1 5 ? 52 5 0 2 02, "; NOT REQUIRED 4 < 60- 8 & notes 3 notes Evolution Recruitment 11A Hillgate Place London SW12 9ER Tel: 020 8673 2211 Fax: 020 8673 3880 Email: [email protected]