Application Form
Position Applied For Surname First Names Title Address Email address:
Contact telephone (Home): Post code: numbers: (Mobile):
Education/Training Names of educational Dates Examinations taken and results or establishments attended From To qualifications achieved School
College / University
Other Formal Training
Details of apprenticeship served
Professional qualifications and membership of professional institutions (with dates and membership no)
Previous employment or work experience Salary & Full name & address of Position & Brief From To reason for employer description of duties leaving
Continue on separate sheet if necessary Supporting information Please state below why you are applying for this post, focusing on how your skills, experience and competencies match the requirements detailed in the Job Description and Person Specification.
Are there any reasonable adjustments which you feel should be made to the recruitment process to assist you in your application for the job? The Immigration and Asylum Act places a legal duty on employers to ensure that all employees are entitled to work in the United Kingdom. Pullman Rail will therefore require proof of your entitlement to work in the UK in accordance with the requirements of the Act. If you are invited to attend an interview, or are offered employment with Pullman Rail Ltd, you will be required to produce specific original documents prior to starting. Pullman Rail cannot accept photocopies of documents. In the event of an offer of employment being made and supporting documents not being produced, Pullman Rail may withdraw the offer of employment.
National Insurance No:
Do you need a permit to work in the UK? YES / NO
If yes, please provide details:
If you do not have a national insurance number and do not require a work permit, please state the grounds on which you are entitled to work in the UK:
YES / NO Do you have any holidays booked in the next 12 months? Dates:
How did you find out about the vacancy:
Are you related to, or do you know someone who is, or has been, an employee of Pullman Rail? If so, please give YES / NO details:
Are you subject to any current or outstanding disciplinary procedures or legal action? If so, please give details:
References Please provide details of two people, one of which must be your current or last employer who will provide references covering the last five years. Character references from friends or relatives are not acceptable.
References will not be taken up before interview; however, satisfactory references will be required prior to commencement of employment.
Name: Name:
Company: Company:
Address: Address:
Postcode: Postcode:
Tel no. Tel no. Relationship Relationship to you: to you: Length of Length of time known: time known:
DECLARATION BY APPLICANT - Please read this section carefully before signing.
1. I declare that the statements I have made on this application form are, to the best of my knowledge, true and complete. I understand that the company reserves the right to withdraw any offer of employment, or to terminate any employment already commenced, if the information given by me is inaccurate or misleading in any way. 2. I agree that my normal hours of work may be extended according to the needs of the business. 3. I agree that the company may alter the department in which I am employed.
Signature Date
Please email your completed application form to:
Post to:
Human Resources Pullman Rail Limited Train Maintenance Depot Leckwith Cardiff CF11 8HP
Please note: we will accept CVs only with a completed application form. Equal opportunities monitoring information
Pullman Rail is committed to the implementation of its Equal Opportunities Policy in all aspects of its work, including the recruitment, promotion and training of staff and the delivery of services.
It would assist us greatly if you would complete the monitoring form so that we can monitor the effectiveness of our Equal Opportunities Policy and to find out whether there are any particular minority needs within our workforce. Please return this form even if you do not intend to return your application.
Post Title: Title (e.g. Mr /Mrs /Miss /Ms /(other): Guidelines – Ethnic Origin Please tick the boxes that you feel most comfortable with. If you do not feel any of the boxes are appropriate, please tick ‘other’ and describe in your own words.
Ethnic Origin How would you describe your ethnic group? (please tick):
White Mixed/multiple ethnic groups Welsh/English/Scottish/Northern Irish/ White and Black Caribbean British White and Black African Irish White and Asian Any other Mixed/multiple ethnic Any other White background - background – describe below describe below
Asian/Asian British Black/African/Caribbean/Black British Indian African Pakistani Caribbean Bangladeshi Any other Black/African/Caribbean Chinese background – describe below Any other Asian background - describe below Other Ethnic Group Undisclosed Arab Do not wish to answer Any other ethnic group – describe below
Gender I am (please tick) Male Female
Age My date of birth is:
What is your age group?
16 - 24 25 – 59 60 or over
Guidelines – Disability We understand that many employees do not declare a disability because of possible discrimination against them by employers in the selection process and many people do not register as disabled for the same reason. However, we would like to know how many disabled people we attract to Pullman Rail Limited so that we can monitor the effectiveness of our policies towards disabled people.
Disability The Disability Discrimination Act 1995 defines disability as “a physical or mental impairment which has a substantial and long-term adverse effect on your ability to carry out normal day-to-day activities.” This includes people with physical impairments, people with sight loss and partially sighted people, people who are hard of hearing or deaf, people with learning difficulties including people with specific learning difficulties like dyslexia, people with mental health needs and people living with a health condition e.g. HIV, multiple sclerosis, cancer. Do you consider yourself to be a disabled person? Yes No
If you are registered disabled please give your registration number
Do you have any special requirements which we can help you with in order to make the application process easier for you? Yes No
Please provide details
We would like to know if we are reaching all disabled people. Please can you tick the relevant impairment (disability) group below and you are welcome to tick more than one box if appropriate.
Physical impairment Sight loss or partially sighted Hard of hearing Deaf (non BSL user) Deaf BSL user Learning difficulties Specific learning difficulties such as dyslexia Mental and emotional distress Health condition e.g. HIV, multiple sclerosis, cancer Do not wish to answer
Medical history Are you currently experiencing any health issues or do you have a disability that may affect your ability to perform the activities as outlined in the job description? YES/NO
If yes, please describe:
a) During the last three years have you suffered from::
Heart Disease Yes No
High Blood Pressure Yes No
Diabetes Yes No
Epilepsy / fits Yes No
Back complaint Yes No
Ear disorder Yes No
Eye disorder Yes No
Skill disease or allergy Yes No
Anxiety / depression Yes No
Arthritis Yes No
Asthma / chest or lung complaint Yes No
Other – please provide details Yes No
Have you ever been:
Refused employment or dismissed on health grounds Yes No
Made ill or injured at work Yes No Guidelines – Sexual Orientation
We appreciate that some people may find the question on sexual orientation to be an extremely personal one and we must therefore reiterate that you are under no obligation to answer it. However, Pullman Rail Limited aims to work towards promoting policies which actively work against such discrimination, and so, it is important that we attract gay and lesbian people to work with us.
Sexual orientation I would describe myself as (please tick):
Heterosexual Lesbian Do not wish to answer Gay Bisexual
Transgender
Do you identify as transgender?
Yes No Do not wish to answer
What is your religion or belief? (Each category includes all denominations and sects)
Buddhist Christian Hindu Jewish Muslim Sikh Any other religion or belief (Please describe): No religion Do not wish to answer
The information will be kept in a database in accordance with the provisions of the Data Protection Act 1998 (which allows for sensitive personal data to be held where necessary to monitor organisations Equal Opportunity Policies). Access to information that identifies individuals will be restricted and used only for implementation of Equal Opportunities policies.
Thank you for your co-operation in completing this form.