<p> APPRENTICESHIP APPLICATION FORM</p><p>CONFIDENTIAL ALLEVARD Springs Ltd Cambrian Industrial Park Clydach Vale Tonypandy Rhondda Cynon Taff CF40 2XX, UK. Telephone: 01443 424700 Fax: 01443 424736 (Administration/Technical) Fax: 01443 424737 (Production) Fax: 01443 424738 (Engineering)</p><p> This application form must be completed but you may attach your CV if required.  Please read and understand all the questions carefully.  When answering all the questions, please complete with ink using BLOCK capital letters.  All applicants will be considered on merit and ability.  Allevard Springs Limited accept all applications regardless of gender, race, age, disability, sexual orientation, religion or belief.  No approach will be made to your present employer before an offer of employment is made to you.</p><p>Please complete the following:</p><p>SURNAME FORENAME(S) DATE OF BIRTH</p><p>CURRENT ADDRESS AND POST CODE</p><p>FULL VALID DRIVERS LICENCE-YES/NO HOME TELEPHONE NUMBER MOBILE TELEPHONE NUMBER EMAIL ADDRESS NATIONAL INSURANCE NUMBER</p><p>QR 146 Page 1 of 6 Issue 2 Modification Number 2006-245 APPRENTICESHIP APPLICATION FORM</p><p>ARE YOU DISABLED? YES/NO IF YES PLEASE GIVE DETAILS AND SPECIFY WHETHER YOU REQUIRE ANY SPECIAL ARRANGEMENTS FOR INTERVIEW</p><p>HAVE YOU ANY CRIMINAL CONVICTIONS? YES/NO IF YES PLEASE GIVE FURTHER INFORMATION</p><p>EDUCATION AND TRAINING</p><p>Please complete the following from first to most recent qualification obtained.</p><p>FORM OF EDUCATION e.g. school, college, DATE DATE QUALIFICATION DESCRIBE ANY RESPONSIBILITIES OR ACTIVITIES WHEN university, part-time or web-based. FROM TO OBTAINED OR STUDYING eg PREFECT OR HEADBOY/GIRL EXAMINATIONS PASSED (include grades if possible)</p><p>QR 146 Page 2 of 6 Issue 2 Modification Number 2006-245 APPRENTICESHIP APPLICATION FORM</p><p>WORK EXPERIENCE</p><p>Please complete the following from first to most recent </p><p>EMPLOYERS NAME DATE DATE TYPE OF DESCRIBE ANY RESPONSIBILITIES OR ACTIVITIES FROM TO BUSINESS</p><p>REFERENCES</p><p>NAME / TITLE CONTACT NUMBER/ ADDRESS</p><p>QR 146 Page 3 of 6 Issue 2 Modification Number 2006-245 APPRENTICESHIP APPLICATION FORM</p><p>ADDITIONAL INFORMATION</p><p>Please write down any additional information that you feel may support your application. You can include any skills or experience you have acquired through interests and hobbies outside of the work place.</p><p>Do you require a work permit to work in the UK? Yes / No (please circle)</p><p>Thank you for taking the time to complete this application.</p><p>Please check that you have answered all the questions correctly and complete the declaration overleaf.</p><p>Failure to complete questions correctly may result in your application being delayed.</p><p>QR 146 Page 4 of 6 Issue 2 Modification Number 2006-245 APPRENTICESHIP APPLICATION FORM</p><p>DECLARATION</p><p>To be completed by all applicants</p><p>1. I declare that all the answers and statements on this application form are true to the best of my knowledge. If any information on this application form is found to be misleading or false in order to gain employment, I could be liable to disciplinary proceedings that may include dismissal.</p><p>2. I understand and accept that the information provided may be subject to a Criminal Records Bureau check (Subject to employment and rehabilitation of offenders act 1974)</p><p>3. I understand and accept that further medical information may be requested from my doctor if considered necessary, and be subject to an occupational health advisor obtaining my consent under the access to medical reports act 1988.</p><p>Signature of Applicant Date</p><p>………………………………...... ……………………</p><p>FOR OFFICE USE ONLY</p><p>Date and Question Reason for query Details given by applicant Time No.</p><p>QR 146 Page 5 of 6 Issue 2 Modification Number 2006-245 APPRENTICESHIP APPLICATION FORM</p><p>PLEASE ADDRESS ALL FORMS AND C.V.s TO Gareth Williams Allevard Springs Cambrian Industrial Park Clydach Vale Tonypandy Rhondda Cynon Taff CF40 2XX [email protected] Telephone 01443 424718 </p><p>QR 146 Page 6 of 6 Issue 2 Modification Number 2006-245</p>