Application Form

Energy Technology & Control Limited Tel: +44 1 273 480667 25 North Street, Lewes, East Sussex, BN7 2PE Fax: +44 1 273 480652

Please complete all this form in type or black ink and use only the same size paper (A4) as continuation sheets.

Job Details

Job Title: Full Time / Part Time (delete as appropriate)

Personal Details

Surname: Address:

E mail address

First Names: Correspondence Address (if different from above)

Telephone Number: Daytime: Mobile: Home:

Present Employment

Name and address of employer: (including County) Job Title: Date started current post: Date commenced with employer: Salary/Wage/Benefits: Notice Required: Briefly describe your present job; its main purpose and your responsibilities:

Page | 1 June 14 Previous Employment

Please list in chronological order (most recent first). Include permanent and temporary work, service with HM Forces, voluntary work, and work experience

Name & Address From / To Position and Salary Reason for leaving (including County and nature of business) (exact dates)

Education & Qualifications From Age 11 onwards, and please state whether full (F) or part (P) time Name of School, College, From / To F/P Subjects studied University etc (with grades and year taken)

Page | 2 June 14 Training

This includes government training schemes, apprenticeships, short courses, projects and secondments. Please also include trade/professional training and give date of completion. Course Title Organisation From / To

Membership of Professional Institutes

Please indicate whether membership is by examination Institute Level of Membership Year of Award

Other Experience

Please describe all time spent since leaving full-time education. Full details should be given for any period not accounted for by full-time employment, education and training. This would include for example unemployment or voluntary work. Please state this information in chronological order. Experience From / To

Driving Licence

Do you hold a current Driving Licence? Yes No If YES, please state the type of licence you hold: Do you have any current endorsements? Yes No If YES, please specify:

Page | 3 June 14 Why are you applying for this job?

Please mention any specific skills or experiences that meet the requirements of the job description. These skills may have been gained in relation to your current or previous employment, education, training, domestic activities, voluntary work or leisure interests. (Use a separate sheet if necessary)

Page | 4 June 14

Asylum and Immigration Act 1996

It is a criminal offence to employ persons whose immigration status prevents them from working in this country. The Act does not affect citizens of the UK, Ireland, European Economic Area and the Commonwealth, provided they have a right of abode in the UK. You will be required to provide evidence, prior to appointment, of a National Insurance number, passport or other document on the approved list to satisfy Energy Technology & Control that the Asylum and Immigration Act 1996 is being complied with.

References

One of whom must be your present employer, or last employer where applicable. Name: (give present/last employer) Name: Course Tutor: (if applicable)

Address: Address: Address:

Tel No: Tel No: Tel No:

Occupation: Occupation: Occupation:

If you do not wish us to contact your references prior to interview, please tick the boxes above. Note: We reserve the right to seek references at any point in the recruitment process and from any previous employers listed in ‘Previous Employment’ on page 2 of this form. A job / position offer will not be made without 2 references.

Page | 5 June 14 Rehabilitation of Offenders Act 1974

The post for which you are applying carries exempt status under the provisions of the Act regarding “spent” convictions. You are therefore required to declare below any convictions (including bind-over’s and cautions) you have had regardless of whether or not the time limit has elapsed. Have you ever been convicted of a criminal offence? Yes No Are there any alleged offences outstanding against you? Yes No

If YES to either, please give details below or, if you prefer, attach details in a sealed envelope marked ‘strictly confidential’. Failure to disclose any information relating to criminal convictions may disqualify your application or result in dismissal without notice.

Details:

Declaration I declare that the information given both on this application form and the attached equal opportunities monitoring form is true and correct. I understand that any false or misleading information, or omissions of information concerning canvassing or criminal convictions, may disqualify my application or may render my Contract of Employment, if I am appointed, liable to termination. Data Protection: If I accept employment with Energy Technology & Control Limited, I consent to my personal information being held by the company for the administration of my Contract of Employment. Signed: Date: Name:

Please tick box to indicate your consent if form has been completed electronically

In the interests of economy an acknowledgement will be sent only if you supply a stamped addressed envelope. We look forward to receiving your completed Application Form.

Please return your completed application form to: Energy Technology & Control Limited, 25 North Street, Lewes, East Sussex, BN7 2PE.

Page | 6 June 14