AFBlakemore - AFB > Careers > Application Form

Job Title
Job No.

Prepared to work (tick all that apply)	Full Time Part Time Evenings Weekends

Personal Information
Title
Surname
Forename
Address
Post Code

Telephone No.
Mobile No.
E-mail Address
Date of Birth	(dd/mm/yyyy)
National Insurance No.

Are you legally eligible for employment in the U.K?		Yes No
Do you have a current full driving licence?		Yes No
Endorsements?		Yes No
If Yes, Please give details

Name and address of Next of Kin :
Name
Address

Present or Most Recent Employment
Job Title
Date Appointed	(dd/mm/yyyy)
Notice Required
Present Salary	£
Employer
Address
Post Code
Describe the main duties of your present job:

Reason for leaving (if applicable)


Previous Employment

Employer
Position Held, Duties & Reason for leaving
Dates (dd/mm/yyyy)	From:	To:

Employer
Position Held, Duties & Reason for leaving
Dates (dd/mm/yyyy)	From:	To:

Employer
Position Held, Duties & Reason for leaving
Dates (dd/mm/yyyy)	From:	To:

Employer
Position Held, Duties & Reason for leaving
Dates (dd/mm/yyyy)	From:	To:

Employer
Position Held, Duties & Reason for leaving
Dates (dd/mm/yyyy)	From:	To:

Employer
Position Held, Duties & Reason for leaving
Dates (dd/mm/yyyy)	From:	To:

Job Related Training
Give details of any training courses attended: (E.g. Basic Food Hygiene, First Aid, Health & Safety or work based NVQ's)

Have you gained experience in any of the following? (Please tick relevant boxes - You will be required to produce a copy of any licences)
Order Picking Quality Checker Hygiene/Warehouse Operative Retail Experience	I.T. Experience Microsoft Word Microsoft Excel Microsoft Access Microsoft PowerPoint

Till Operation Shelf Filling Fresh Food Departments(e.g.Hot Food) Selling age restricted products (e.g.Alcohol)	Bank/Building Society Experience Evening or Weekend work Ordering Stock Post Office Experience

Do you hold a Fork Lift Licence?	Reach	C/Balance
Do you hold an LGV Licence?	Class 1	Class 2

Education

School/College Attended (Include Dates)	Please Specify Subjects and Grades

Health Declaration
Have you attended hospital or had a serious illness in the last 5 years?	Yes No
If 'Yes' please give details:

Are you currently taking any medication?	Yes No
If 'Yes' please give details:


Activities and Interests
Give details of any hobbies, interests or clubs of which you are a member.

Referees
Present Employer		Previous Employer
Name		Name
Company		Company
Address		Address

Equal Opportunities
A.F. Blakemore & Son Ltd is committed and working towards equal opportunity in employment. In order to monitor the progress of our recruitment and selection process we need you to complete the information in this section.

This information will be kept in the Personnel Department and will not be used during consideration of employment. Applicants are considered purely on their ability to do the job.

This information will be used only to support monitoring and statistical information in accordance with the Data Protection Act.

Where did you see this job advertised?
Internal Bulletin
Newspaper
Job Centre
Other. Please Specify

Gender	Male Female
Marital Status	Married Single
Age

Ethnic Origin

Disability
Under the Disability Discrimination Act 1995 the definition is: "A person has a disability for the purpose of this act if he/she has a medical impairment which has a substantial and long term adverse effect on his/her ability to carry out normal day-to-day activities".

Do you have such a disability?

Yes No

Declaration
By ticking this box I certify that the information given in the application form is correct and that no relevant information has been omitted.

A.F. Blakemore & Son Ltd. are seriously committed to the privacy and security of your personal information. We only collect information that is relevant and useful. Information we collect will be used solely by ourselves and will not be passed onto any outside party. We take every care to store your information securely and in conjunction with the Data Protection act.