APPLICATION FORM

PERSONAL INFORMATION

Personal details

Family name

First name

Contact details

Home postal address (including postcode and country)

Home email address

Home telephone number

Mobile telephone number

IMMIGRATION STATUS

Nationality

Do you require a work permit to work in the UK?

POSITION APPLIED FOR

Vacancy

Have you applied to R&Q before?

If yes, when and for what position?

CURRENT / MOST RECENT EMPLOYMENT

Current / most recent employer

Current / most recent salary Date current / most recent employment commenced

Please give details off your current role DIVERSITY MONITORING

This information is required for us to monitor our equal opportunity policies. We encourage you to complete these questions with your application. The information is used solely for monitoring in statistical reports.

Male Female Decline to answer

Ethnic origin (*)

White

British

Irish

Mixed

White and Black Caribbean

White and Black African

White and Asian

Asian or Asian British

Indian

Pakistan

Bangladeshi

Black or Black British

Caribbean

African

Chinese

Decline to answer

Other ethnic group

Any other background, please provide details below

DISABILITY INFORMATION

I identify myself as having a disability, i.e. a physical or mental impairment which has a substantial and long-term adverse effect on my ability to carry out normal day to day activities. These details are required by the company so that we may comply with Section 6 of the Disability Discrimination Act 1995.

Disability

Yes

No If yes, please provide details below

CRIMINAL CONVICTIONS

Have you any Court convictions other than a spent conviction under the Rehabilitation of Offenders Act, 1974, or do you have any proceedings pending?

Yes

No

If yes, please provide details below

Please indicate below if you have been referred by a current employee of R&Q.

Yes

No

If yes, please provide details