The Fairlawns at Aldridge

Job Application Form
Name:  
Address:  
NI Number  
Tel No. (mob):  
Email:  
Wage/Sal Anticipated:  
     
Why are you interested
in this opportunity?		  
How do you propose
to get to/from Fairlawns?		  
What is your
current situation?		  
HOURS WHEN YOU WILL BE AVAILABLE FOR WORK - PLEASE TICK
    07:00 - 12:00 hrs 12:00 - 18:00 hrs 18:00 - 24:00 hrs
Monday  
Tuesday  
Wednesday  
Thursday  
Friday  
Saturday  
Sunday  
         
PRE –EMPLOYMENT MEDICAL QUESTIONNAIRE

In order to ensure that you are able to carry out the job safely and without risk to yourself and others we ask you to provide certain information. This also helps us determine whether we may need to make any reasonable adjustments to assist you in performing the job in accordance with the requirements of the D.D.A.
If you have experienced any of the following then please list below:- Circulatory problems, heart problems, respiratory problems, diabetes, epilepsy, skin disorders, recent operations, bone fractures, back trouble, arthritis, rheumatism, injuries joint tendons, eye problems, hearing difficulties, food poisoning, prolonged diarrhoea:
Are you currently on medication? Yes    No
Have you ever made a claim for industrial disease or injury? Yes    No
If you have detailed medical problems above then we may ask you to complete a more detailed health declaration, seek your written permission to approach your Doctor or to refer your application and proposed Job Description to the Company Doctors who offer us an Occupational Health Screening Service.
 
MANY OF THE JOBS AT FAIRLAWNS REQUIRE TEAM MEMBERS TO BE ON DUTY ON SPECIAL DAYS. ARE YOU PREPARED TO WORK ON THE FOLLOWING DAYS?
Bank Holidays Christmas Day New Years Eve
Mothering Sunday Boxing Day New Years Day
PLEASE GIVE BRIEF DETAILS OF YOUR LAST THREE JOBS OR ANY WORK EXPERIENCE YOU HAVE UNDERTAKEN: (You may like to attach further information on a separate sheet)
         
Employer/Job      
From      
To      
Reason for Leaving      
         
Employer/Job      
From      
To      
Reason for Leaving      
         
Employer/Job      
From      
To      
Reason for Leaving      
         
Please give details of your education and any examination successes or further training you have received
 
Please give details of your interests and hobbies
 
Any further details which may assist us with your application?
 

Press "Submit" to send your details.
  

          
 
All information disclosed will be treated in the strictest confidence and will be used only for the the purposes detailed in the Data protection Act. It is the policy of Fairlawns that there shall be no discrimination in respect of sex, colour, religion, race, ethnic origin or nationality and that equal opportunities shall be given to all applicants and employees.

 

 

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