<p> M I T I E I S A N E Q U A L O P P O R T U N I T I E S E M P L O Y E R</p><p>MITIE Facilities Services Apprenticeship Application Form:</p><p>Deadline: 30 th June, 2012</p><p>Key Information: </p><p>Name</p><p>Address and Post Code</p><p>Telephone Number Mobile Number Date of Birth *: _ _/_ _/ _ _ _ _ National Insurance Number: * Please note for health and safety reasons you must be 16 or over on the day you commence your apprenticeship.</p><p>Education/ Qualifications </p><p>Date Date Schools/ College attended Qualifications obtained (including From to predicted grades) Present Position (if applicable) </p><p>Name of employer: Present position: Salary: Period of notice required: Date of appointment: </p><p>Experience </p><p>Please give a brief outline of your experience and personal qualities that you consider make you a suitable applicant for this appointment (including present duties and responsibilities).</p><p>Why should MITIE choose you? Previous Employment</p><p>Approximate Approximate Name of Position Held Reason for Date From Date To Employer and leaving responsibilities </p><p>Driving License </p><p>Do you hold a current driving license? Yes/No</p><p>Do you have any current endorsements, fines, Yes/ No disqualifications etc? If yes please give full details: </p><p>Health </p><p>Are you in good health? Yes/ No Are you registered disabled? Yes/ No RDP No: </p><p>General: </p><p>Interests/ hobbies/ member of voluntary organisations?</p><p>Have you ever been convicted of any criminal offences? If so please give full details including date of conviction, nature of offence and penalty.</p><p>Do you need a permit to work in the UK? Yes/No </p><p>Please indicate your willingness to be subject Yes/No to vetting procedures where required What areas of Facilities Management are you interested in working in? </p><p>References: </p><p>Please provide two personal referees (not members of your family) to whom MITIE may refer regarding your character, capabilities, experience, etc. One should be your present or last employer, or a teacher. Name: Name: Address: Address:</p><p>Post Code: Tel No: Post Code: Tel No: Occupation: Occupation:</p><p>Data Protection: </p><p>In completing and returning this application form, you are giving your consent for personal information to be stored and processed for the purposes of a selection decision and future personnel information. The CV, application form and copies of all correspondence with unsuccessful external candidates will be retained by the HR Department for a period of 6 months and then securely destroyed. </p><p>Signature </p><p>I authorise the Company to obtain references to support this application once an offer has been made and Authorisation accepted and release the company and referees from any liability caused by giving and receiving information. I confirm that the information given on this form is, to the best of my knowledge, true and complete. Any Declaration false statement may be sufficient cause for rejection or, if employed, dismissal.</p><p>Signature: Date:</p>