Address: Parkway, Deeside Industrial Park, Deeside, Flintshire, CH5 2NL

04df1f6e5796d7c98926f84abc04332d.doc Contact: Katherine Brown Address: Parkway, Deeside Industrial Park, Deeside, Flintshire, CH5 2NL e-mail: [email protected]

REMSDAQ LIMITED

APPLICATION FORM

CONFIDENTIAL

Please complete the following pages as accurately as possible and return to the above address. The form can be handwritten and posted or filled in electronically and e-mailed, if filling in electronically. Use the tab key to jump to the next field. The form does not have to be reproduced in colour. Once completed the information will be held confidentially by the HR Department and will be used in the process of recruitment for current vacancies and future vacancies.

Thank you for your assistance in completing this form.

(If completing electronically, where you see a ‘tick box’ click any key to select this box)

Surname:

Names:

Date and place of Birth: Date: Place:

Position(s) Applied For: (List all that are of interest)

Job Reference Number: (if applicable)

Agency Name (if applicable):

Where did you see this vacancy advertised?

Remsdaq website Reed.co.uk Chester University Newspaper

Fish 4 Jobs RGEN Bangor University Agency

CV Register Job Centre Glyndwr University Apprenticeship

Other (please specify)

Due to the nature of our business, it is mandatory that all personnel at Remsdaq both Contract and Permanent are Security Cleared (via a minimum of Basic Disclosure) further information will be provided to you if you are offered a position. By signing you agree to the terms above.

Signature: Date:

ISSUE 13 Page 1 of 10 04df1f6e5796d7c98926f84abc04332d.doc Contact: Katherine Brown Address: Parkway, Deeside Industrial Park, Deeside, Flintshire, CH5 2NL e-mail: [email protected]

Personal Details

Details entered in this part of the form will be held in the HR department of the recruiting organisation and will be made available to the short-listing panel.

Address:

Postcode: Country:

Mobile Home Telephone: Telephone:

Email:

UK National Insurance No.:

If applicable do Are you a UK Citizen YES NO you have a work YES NO (proof of eligibility to work in the UK permit? will be required at interview stage if successful): Type of Permit: Expiry Date:

Basic (range): From: To: Salary Income Expectations: Overtime: Bonus:

Do you have security clearance? YES NO Details:

Have you applied for a position at YES NO Details: Remsdaq before? (give details)

Do you know anyone who works at Remsdaq or who has worked at YES NO Details: Remsdaq? (give details)

Personal Details (Continued)

Would you relocate to Deeside/Chester Preferred Location of Work: area (if applicable)?

1-2 Weeks 1 Month 1-3 Months 4-6 Months 6 Months + Prefer to stay local Would you work away from home?

Please give details if part-time preferred: Full Time Preferred Employment Type: Part Time

Do you hold a valid Driving licence? YES NO

Any other Driving licences (e.g.

FLT, MEWPS, HGV):

Copy of Curriculum Vitae attached? YES NO Already Submitted

Membership of Professional Bodies

Include in this section any relevant professional registrations or memberships.

Not required for this post I have applied for UK registration

I have current UK Registration I have not applied for UK registration

My Professional Registration status is:

If you are registered please enter the relevant details below.

Professional Body Membership or Registration Type Membership/Registration/PIN Expiry/Renewal Date

Education and Professional Qualifications

Include in this section all relevant qualifications, please also indicate subjects currently being studied.

Subject/Qualification Place of Study Grade/Result/Studying Year

Training Course Attended

Include in this section all relevant training courses that you have attended or details of courses that you are currently undertaking. ISSUE 13 Page 4 of 10 04df1f6e5796d7c98926f84abc04332d.doc Contact: Katherine Brown Address: Parkway, Deeside Industrial Park, Deeside, Flintshire, CH5 2NL e-mail: [email protected]

Course Title Training Provider Duration Date Completed

Employment History

Please record below the details of you current or most recent employer.

Employer Name:

Address:

Type of Business: Telephone:

Job Title:

Start Date: End Date:

Salary Starting: Salary Final: Current Basic Salary: Overtime payments earned: Bonus Payments Received: Annual Leave Entitlement: Type of Pension Scheme: List Benefits (i.e. Private Medical Insurance: BUPA/Pension/Car Does the Medical scheme cover Scheme) dependants: Car Scheme: Income Protection Scheme: Other benefits: Hours of work: Period of Notice:

Reason for Leaving:

Description of Duties and Responsibilities:

Previous Employment

Please explain any gaps in employment in the “Supporting Information” section. Please add additional employer’s information on a separate sheet.

Employer Name:

Address:

Job Title:

Salary Starting: Salary Final: Overtime payments earned: Bonus Payments Received: Annual Leave Entitlement: Type of Pension Scheme: List Benefits (i.e. Private Medical Insurance: BUPA/Pension/Car Does the Medical scheme cover

Scheme) dependants: Car Scheme: Income Protection Scheme: Other benefits: Hours of work:

Reason for Leaving:

Previous Employment (Continued)

Employer Name:

Address:

Job Title:

Salary Starting: Salary Final: Overtime payments earned: Bonus Payments Received: Annual Leave Entitlement: Type of Pension Scheme: List Benefits (i.e. Private Medical Insurance: BUPA/Pension/Car Does the Medical scheme cover

Scheme) dependants: Car Scheme: Income Protection Scheme: Other benefits: Hours of work:

Reason for Leaving:

Supporting Information

In this section please give your reasons for applying for this post and additional information to support your application. This can include relevant skills, knowledge, experience, voluntary activities and training etc. If relevant to the post for which you are applying you should include details about research experience or publications.

PLEASE NOTE: The information in this section will be taken into account when short listing candidates.

Supporting Information (Please continue on additional sheets if necessary):

References

Please give the names of the people who have agreed to supply references. For all positions you must provide 2 references. If you are, or have been, employed these should be your two most recent employers.

These may include your line manager or someone in a position of responsibility who can comment on your work experience, competence, personal qualities and suitability for the post. If you are a student please provide contact details of a tutor at your school, college or university.

Please note that personal references such as friends and relatives are not acceptable. For all posts written references obtained must cover the preceding 3 years of employment.

Job Title:

Address:

Postcode: Country:

Telephone: Fax:

Email:

Can the referee be approached prior to interview? Relationship: (Yes/no)

Job Title:

Address:

Postcode: Country:

Telephone: Fax:

Email:

Can the referee be approached prior to interview? Relationship: (Yes/no)

DECLARATION

The information in this form is true and complete. I agree that any deliberate omission, falsification or misrepresentation in the application form will be grounds for rejecting this application or subsequent dismissal if employed by the organisation.

I agree to the above declaration

Signature:

Name: Date:

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04df1f6e5796d7c98926f84abc04332d.doc Contact: Katherine Brown Address: Parkway, Deeside Industrial Park, Deeside, Flintshire, CH5 2NL e-mail: [email protected]

Equal Opportunities Monitoring

Data Protection Act 1998

For the purposes of compliance with the Data Protection Act 1998, I hereby confirm that by completing this form I give my consent to the Company processing the data supplied on this form for the purpose of equal opportunities monitoring.

Position Applied for (if speculative please state): Date: Under 18 40 – 49 Over 65 Age band: 18 – 29 50 – 59 Prefer not to say 30 – 39 60 – 65

Gender: Male Female Prefer not to say Heterosexual Homosexual Bisexual Sexual orientation: Transsexual Prefer not to say

Marital status: Married Single Prefer not to say White English Scottish Welsh Irish British Other white background (please specify)

Mixed White and Black Caribbean White and Black African Race/Nationality/ White and Black British White and Asian Ethnic Origin Other mixed background (please specify).

Asian Indian Pakistani Bangladeshi British Other Asian background (please specify)

Chinese Prefer not to say Other ethnic group (please specify)

Christian Jewish Sikh Rastafarian  Muslim Hindu Buddhist None Religion Prefer not to say Other religion(please specify)