YOUR CAREER YOUR CHOICE!

APPLICATION FOR EMPLOYMENT

Insure4Retirement
Which role are you applying for?

Personal details:
Title: Postal Address: First name: Middle name:

Please complete in block capitals

Last name:

Postcode: Home telephone: (inc. STD code) Your email: What date can you start? Mobile: National Insurance No: How much notice do you have to give?

If you are applying for a contact centre role please tick here to confirm you are over 18. We need this information to ensure we comply with the European Working Time Regulations and to ensure you are eligible to work to our shift patterns. Please contact us if you require any help with the application form or if you require any adjustments to be made during the interview process. Do you have any holiday or time off booked in the next three months? If Yes please enter the dates:
YES NO

Research: Thanks for helping us reach potential employees

How did you hear about the role? Where did you see it advertised? Where is the first place you look for a job to be advertised?

Right to work in the UK Please answer all of the following questions:

1: Are you eligible to work in the UK? 2: Do you require a work permit to work in the UK? 3: You are legally required to provide original identification, please tick which one of the following you are able to provide and ensure you bring this with you to interview: UK or EU Passport Passport with visa stamps to work or remain in the UK Long birth certificate and proof of National Insurance number
YES YES YES NO NO NO YES YES NO NO

Real opportunities Real prospects Real rewards Find out more about your next career move at www.insure4retirement.co.uk/careers

YOUR CAREER YOUR CHOICE!

APPLICATION FOR EMPLOYMENT
Previous employment information:
1: Have you ever been dismissed from a previous job? 2: Have you ever left an employer whilst under investigation or during a pending or ongoing disciplinary process? 3: Have you ever left a job during your probationary period? 4: Have you ever applied for a role at I4R or worked here previously? 5: Are you the Director of a company, group or organisation? 6: Are you a shareholder or do you hold an interest in any company, group or organisation? If you have answered yes to any of the above, please provide further details here:
YES YES YES YES YES YES NO NO NO NO NO NO

Insure4Retirement

Our business is regulated by the FSA Please answer all of the following questions:
1: In compliance with the Rehabilitation of Offenders Act 1974, do have any unspent criminal convictions? 2: Have you ever applied for a Criminal Records Bureau Disclosure? 3: Have been subject to bankruptcy or liquidation proceedings? 4: Do you have any knowledge of any allegations of negligence against you? 5: Have you any orders current or pending against you under the Companies Act or the Insolvency Act? 6: Do you have a High Court or County Court Judgement current or pending against you? 7: Do you have any criminal proceedings or convictions pending? 8: Have you ever had registration or enrolment either reused or terminated by a regulatory body such as the FSA? 9: Do you have a current or pending Attachment of Earnings order? 10: Do you have a current or pending IVA (Individual Voluntary Arrangement)? 11: Are you or have you ever been an FSA approved person or appointed representative? If you have answered yes to any of the above, please provide further details here:
YES YES YES YES YES YES YES YES YES YES YES NO NO NO NO NO NO NO NO NO NO NO

Real opportunities Real prospects Real rewards Find out more about your next career move at www.insure4retirement.co.uk/careers

YOUR CAREER YOUR CHOICE!

APPLICATION FOR EMPLOYMENT
Previous work history: Starting with current /last employer
Dates from - to Employer Job Title & Responsibilities Salary Reason for leaving
Insure4Retirement

If there are any gaps in your employment history, please detail and explain these here:

Education, training, development & membership of professional bodies:

Dates from - to Qualifications Course details School, College, University, Professional Organisation

Real opportunities Real prospects Real rewards Find out more about your next career move at www.insure4retirement.co.uk/careers

YOUR CAREER YOUR CHOICE!

APPLICATION FOR EMPLOYMENT
References
In the event of a job offer, up to two professional references will be required. Please give details of your current and previous employers. If this is your first job, please provide an alternative, ie Teacher / Tutor or similar. Current or last employer: Contact name: Job Title: Company: Address: Previous employer: Contact name: Job Title: Company: Address:
Insure4Retirement

Email: Telephone number: Relationship to you:

Email: Telephone number: Relationship to you:

Declaration
Please be aware that job offers are conditional, subject to completion of a satisfactory application, recruitment, identification and referencing process. Non compliance with any of the aforementioned or falsification of information on your part will result in; withdrawal of any pending job offer, disciplinary action or dismissal As part of our procedures for considering your application for employment, we may undertake certain checks or exchange information with third parties. This may include your agreement to complete a Criminal Records Bureau (CRB) check and/or for us to make checks with a licensed credit-referencing agency of which a record of this search will be made. By signing this application form, you are explicitly providing your authority and agreeing for us to undertake these checks as applicable. By signing this declaration you also agree to allow the Company to obtain references accordingly.

Signed:

Date:

Real opportunities Real prospects Real rewards Find out more about your next career move at www.insure4retirement.co.uk/careers