Application for employment

Note: Please answer ALL questions

Position Applied For*

Title (Mr, Mrs, Miss, etc.)*

Surname*

Full Forename(s)*

Surname at Birth (if different)

Home Phone*

Address*

Street Address Address Line 2 City Post Code Country

Mobile Telephone*

National Insurance Number*

Email*

Have you previously been employed by CIS NW?*

Yes

Do you have a valid full UK Driving Licence?*

Yes

Are you willing to work and lodge away from home at very short notice on projects in the UK, Ireland and Europe?*

Yes

The company operates 11-day+ continuous working patterns, backshifts, night work, etc., (plus other additional patterns as per contract/site requirements). Are you agreeable to work such shift patterns?*

Yes

Have you ever been graded with the Joint Industry Board (JIB)?*

Yes

If Yes Grade

Years of Experience

Do you have a valid Joint Industry Board (JIB) ECS grade card displaying CSCS Holograms? https://www.ecscard.org.uk/card-types*

Yes

If Yes, Number

Expiry Date

Have you worked for the company before?*

Yes

If Yes, Dates

Leave Reason

Training & Competence

Do you have a valid CCNSG Scheme Safety Passport? http://www.ccnsg.com/*

Yes

If Yes, Number

Expiry Date

Do you have a valid CPCS Scheme Plant Operators Licence? https://www.citb.co.uk/*

Yes

If Yes, Number

Expiry Date

Do you have a valid other type of CSCS card? https://www.cscs.uk.com/*

Yes

If Yes, Number

Expiry Date

List any other qualifications (NVQ’s, C&G’s, etc.,) or other training certificates (IPAF, PAL, Confined Space, etc,)

Employment History/Reference Check

Company 1

Company Name and Address

Your Position

Reason For Leaving

Full Dates Employed (from)*

Full Dates Employed (to)*

May we contact for a reference prior to Interview?*

Yes

Company 2

Company Name and Address

Your Position

Reason For Leaving

Full Dates Employed (from)

Full Dates Employed (to)

May we contact for a reference prior to Interview?

Yes

UK Immigration Act

Do you have the right to work in the UK?

Yes

Are you subject to Immigration Control?

Yes

Additional Information

Do you have any long or short term medical conditions that could have a substantial adverse effect on your ability to undertake the intrinsic related functions of the day to day job, i.e. heavy manual handling activities, work at height (including using harnesses and lanyards), work in confined spaces (using breathing apparatus), work in tunnels, occasional lone working, etc.?

Yes

If you have answered YES please let us know of any reasonable adjustment(s) we may be able to make to assist you with your normal day to day activities so you are able to work within the Intrinsic related functions of the job;

Note: A pre-employment Occupational Health Assessment may be required if you have answered Yes.

Please attach any relevant additional information here:

Max. file size: 2 MB.

Data Protection Privacy Notice for Recruitment

If you take up a position with the company, the information provided will be used in the administration of your employment with the company. If there is a complaint or legal challenge relevant to this recruitment process, the information collected may be checked with third parties or against other information held by the company.

The company may also use or pass to certain third parties information to prevent or detect crime, to protect public funds, or in other ways as permitted by law. By submitting the application form you agree to the processing of personal data in accordance with the company’s registration with the Information Commissioner’s Office (ICO – registration number: Z1247237) and GDPR 2018.

Declaration:

I confirm the information provided in this application is correct and true and I have been made aware of the Data Protection Privacy Notice for Recruitment. I also understand that for some employment positions the company may need to apply for CRB checks through the Disclosure and Barring Service (DBS) and Disclosure Scotland (DS) and I agree to such checks.

I understand that if any information is found to be false or if I withhold relevant details that any offer of employment may be withdrawn or subsequent employment with the company may be terminated without notice. I further confirm that if an offer of employment is made I am prepared to work a twelve-week temporary trial period* from date of commencement.

Signed*

Date*

All application forms must be fully completed and signed and dated.

*If you are selected for an interview and have any special requirements, please contact us to in advance to discuss your needs. Thank-you for applying to join CIS.*

Training & Competence

Employment History/Reference Check

UK Immigration Act

Additional Information

Data Protection Privacy Notice for Recruitment

Declaration:

All application forms must be fully completed and signed and dated.

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