Seiko Timing Services Division

SEIKO TIMING SERVICES DIVISION SC HOUSE VANWALL ROAD MAIDENHEAD BERKSHIRE SL6 4UW TELEPHONE: +44 (0) 1628 7702001 FACSIMILE: +44 (0) 1628 798113

FREELANCER ROLE

PERSONAL DETAILS

Surname: Forenames: Address:

Post code: Home Telephone Number: Mobile Telephone Number: Email Address: National Insurance Number: Nationality: Do you hold a current passport with at least 6 months validity? If so please provide passport number, expiry date and place of issue. Do you require a work permit? If yes, please give details including expiry date:

Do you hold a valid driving licence? If yes, please provide driver number, expiry date and details of any endorsements. Have you ever been convicted of any civil, criminal or military offence? (Please note you do not have to declare convictions that are “spent” under the Rehabilitation of Offenders act 1974). If yes, please give dates and details. How did you hear of the position? Availability: (Exact dates/timings to be advised).

REGISTERED IN ENGLAND: No 1032911 REGISTERED OFFICE: SC HOUSE VANWALL ROAD MAIDENHEAD SL6 4UW SECONDARY EDUCATION

Name and address of school:

Qualifications obtained: Qualification Grade

FURTHER EDUCATION (College, university etc. full or part time) Name and address of educational establishment: Qualifications obtained: Qualification Grade

VOCATIONAL QUALIFICATIONS (Including apprenticeships, professional qualifications etc.) Name and address of educational establishment: Qualifications obtained: Qualification Grade

Details of memberships of any professional bodies: Details of other qualifications, skills (e.g. languages, IT skills including competency levels), membership of sporting clubs, societies etc:

EMPLOYMENT HISTORY Please start with your most recent employment and work backwards, including any service with the

REGISTERED IN ENGLAND: No 1032911 REGISTERED OFFICE: SC HOUSE VANWALL ROAD MAIDENHEAD SL6 4UW armed forces, and explaining any gaps in your employment history. Employer’s name, Start and end Job Title & duties Salary & Reason for leaving address, nature of Date: benefits business, approximate number of employees:

May we contact your previous employers? Yes No

RELEVANT EXPERIENCE Please use this space to provide any experience in support of your application

DECLARATION

I confirm that the above information is accurate and correct. I understand that if it transpires that I have made any misleading statement or deliberate omission on this form, any subsequent contract of employment may be summarily terminated.

Signature: Date:

REGISTERED IN ENGLAND: No 1032911 REGISTERED OFFICE: SC HOUSE VANWALL ROAD MAIDENHEAD SL6 4UW