Equal Opportunities Monitoring

Candidate ref number
Ethnic Group:
All candidates are requested to complete this information. The
information provided will remain strictly confidential and will not play a
part in your application. The purpose for which this data is collected
is to enable us to generate reports that summarise the data in broad
categories, without reference to individuals. Please use this section of
the form to indicate what you consider your ethnic group to be.
How would you categorise your ethnic origin? Please choose only
ONE section from 1 to 5, then tick the appropriate box to indicate your
cultural background.
1 Asian or Asian British
n Indian n Pakistani
n Bangladeshi
n Any other Asian background, please write in

2 Black or Black British
n Caribbean n African
n Any other Black background, please write in

3 Mixed
n White and Black Caribbean n White and Black African
n White and Asian
n Any other Mixed background, please write in
4 White
n British n Irish
n Any other White background, please write in

5 Chinese or other ethnic group
n Chinese
n Any other background, please write in


Disability:
Do you have a disability?
n Yes n No
Pre-Employment Application Form
Position Applied for …………………………………………….
IMPORTANT INFORMATION FOR CANDIDATES As part of our recruitment process, Johnson Matthey will use
information given in your application to carry out security checks. An external agency verifies the information you provide
and establishes whether you have any outstanding County Court Judgements. The agency will contact previous and
current employers and educational establishments. This process will ONLY be undertaken if we intend to make an offer of
employment. All offers depend on the outcome of our security checks. By signing the agreement at the end of this form, you
are giving us consent to carry out this process. We cannot accept applications from candidates who do not agree to this
stipulation.
Title
(please delete as applicable)
Miss / Mrs / Ms / Mr / Dr /
Other
Address




Postcode
Forenames Surname

Previous Surname (if applicable)

Telephone Numbers and E-mail
Home
Work
Mobile
E-mail
Qualifications
Education (Secondary)
Specify A levels / O levels / GCSEs (or equivalent) and grades obtained / City & Guilds / NVQ / Other certificates or diplomas
School / College Level and Subject Date Obtained Result
Personal References
Application for a reference may be made to any previous employer. Please give the names of TWO persons, NOT relatives to whom we
may apply for personal references. One of these must have known you in a professional capacity.
Name Address Connection
n Please place a tick in the box if you would prefer us not to contact your current employer before we make
an offer of employment.
Miscellaneous
Section 8 of the Asylum and Immigration Act 1996 requires all employers in the United Kingdom to make basic document checks on
every person they intend to employ. To comply with this legislation, all potential employees are required to provide original documents as
detailed in Lists 1 or 2 under Section 8 as proof of legal entitlement to work in the United Kingdom before commencing employment. (For
example you will need to show your passport, or birth certificate and proof of National Insurance number)
Nationality:
Do you require a permit or certification to work in the United Kingdom? Yes n No n If Yes, please give details

Do you have a driving licence? Yes n No n
Where did you see this post advertised?
Have you ever applied to Johnson Matthey before?
If so, please state the position you applied for and the date of application
If you have previously been employed by Johnson Matthey,
please give the dates of this employment
Do you have any relations who are currently employed by Johnson Matthey?
If so, please provide their name and work location
Statement
I certify that all the information on this form is true and accurate and I declare that I have no unexpired convictions for criminal offences
excluding motoring offences.
I understand that, as part of the recruitment process, I may be asked to make a subject access request in the form of a “basic
disclosure” in accordance with the Data Protection Act. I acknowledge that this will give details of any unspent criminal convictions
recorded by the Criminal Records Bureau. I understand that this will be requested if my application is short listed.
I authorise Johnson Matthey Plc, either itself or through its appointed agent, to verify the information contained in this application form,
subject to the Data Protection Act 1998. I understand that if I accept an offer of employment and any of the above information is found to
be incorrect or any material facts have been omitted, my employment may be terminated forthwith without notice or pay in lieu of notice.
Signed Date
Please Return to: OFFICIAL USE ONLY
Candidate ref number
Application Acknowledged
Shortlisted for Interview
Interview Date

Please continue to complete the application on the opposite page
Application Form Imposed.indd 2 24/9/05 10:13:57 am

Web: www.matthey.com
Additional Information
Why would this be the right position for you? Please include details of your key job-related skills relevant to this type of work, and give
an indication of how you believe your background, experience and career ambitions will fit this role. Continue on a separate sheet if
necessary.
Qualifications
Qualifications gained through Higher Education
(Include Bachelors Degrees, Masters Degrees, PhD etc)
Institution Level and Subject Date Obtained Result
Membership of Professional Institutions
Institution Qualification / Level of Membership Date Obtained Membership No.
Record of Employment (Since leaving full-time education - please give current or most recent employment first. Please also include
periods of unemployment, with the reason)
Name and Address Period of Job Title Brief Description of Duties Reason For Leaving
of Employer Employment and Salary
From To
General
Languages (Including degree of fluency)
IT and other
Leisure Interests and activities
Please see overleaf for Equal Opportunities Monitoring form Please continue to complete the application form overleaf
Application Form Imposed.indd 1 24/9/05 10:13:56 am
Web: www.matthey.com
Additional Information
Why would this be the right position for you? Please include details of your key job-related skills relevant to this type of work, and give
an indication of how you believe your background, experience and career ambitions will fit this role.
Qualifications
Qualifications gained through Higher Education
(Include Bachelors Degrees, Masters Degrees, PhD etc)
Institution Level and Subject Date Obtained Result
Membership of Professional Institutions
Institution Qualification / Level of Membership Date Obtained Membership No.
Record of Employment (Since leaving full-time education - please give current or most recent employment first. Please also include
periods of unemployment, with the reason)
Name and Address Period of Job Title Brief Description of Duties Reason For Leaving
of Employer Employment and Salary
From To
General
Languages (Including degree of fluency)
IT and other
Leisure Interests and activities
Please continue on a separate page if necessary Please continue to complete the application form overleaf
Application Form Imposed.indd 1 24/9/05 10:13:56 am
Equal Opportunities Monitoring
Candidate ref number
Ethnic Group:
All candidates are requested to complete this information. The
information provided will remain strictly confidential and will not play a
part in your application. The purpose for which this data is collected
is to enable us to generate reports that summarise the data in broad
categories, without reference to individuals. Please use this section of
the form to indicate what you consider your ethnic group to be.
How would you categorise your ethnic origin? Please choose only
ONE section from 1 to 5, then tick the appropriate box to indicate your
cultural background.
1 Asian or Asian British
n Indian n Pakistani
n Bangladeshi
n Any other Asian background, please write in

2 Black or Black British
n Caribbean n African
n Any other Black background, please write in

3 Mixed
n White and Black Caribbean n White and Black African
n White and Asian
n Any other Mixed background, please write in
4 White
n British n Irish
n Any other White background, please write in

5 Chinese or other ethnic group
n Chinese
n Any other background, please write in


Disability:
Do you have a disability?
n Yes n No
Pre-Employment Application Form
Position Applied for …………………………………………….
IMPORTANT INFORMATION FOR CANDIDATES As part of our recruitment process, Johnson Matthey will use
information given in your application to carry out security checks. An external agency verifies the information you provide
and establishes whether you have any outstanding County Court Judgements. The agency will contact previous and
current employers and educational establishments. This process will ONLY be undertaken if we intend to make an offer of
employment. All offers depend on the outcome of our security checks. By signing the agreement at the end of this form, you
are giving us consent to carry out this process. We cannot accept applications from candidates who do not agree to this
stipulation.
Title
(please delete as applicable)
Miss / Mrs / Ms / Mr / Dr /
Other
Address




Postcode
Forenames Surname

Previous Surname (if applicable)

Telephone Numbers and E-mail
Home
Work
Mobile
E-mail
Qualifications
Education (Secondary)
Specify A levels / O levels / GCSEs (or equivalent) and grades obtained / City & Guilds / NVQ / Other certificates or diplomas
School / College Level and Subject Date Obtained Result
Personal References
Application for a reference may be made to any previous employer. Please give the names of TWO persons, NOT relatives to whom we
may apply for personal references. One of these must have known you in a professional capacity.
Name Address Connection
n Please place a tick in the box if you would prefer us not to contact your current employer before we make
an offer of employment.
Miscellaneous
Section 8 of the Asylum and Immigration Act 1996 requires all employers in the United Kingdom to make basic document checks on
every person they intend to employ. To comply with this legislation, all potential employees are required to provide original documents as
detailed in Lists 1 or 2 under Section 8 as proof of legal entitlement to work in the United Kingdom before commencing employment. (For
example you will need to show your passport, or birth certificate and proof of National Insurance number)
Nationality:
Do you require a permit or certification to work in the United Kingdom? Yes n No n If Yes, please give details

Do you have a driving licence? Yes n No n
Where did you see this post advertised?
Have you ever applied to Johnson Matthey before?
If so, please state the position you applied for and the date of application
If you have previously been employed by Johnson Matthey,
please give the dates of this employment
Do you have any relations who are currently employed by Johnson Matthey?
If so, please provide their name and work location
Statement
I certify that all the information on this form is true and accurate and I declare that I have no unexpired convictions for criminal offences
excluding motoring offences.
I understand that, as part of the recruitment process, I may be asked to make a subject access request in the form of a “basic
disclosure” in accordance with the Data Protection Act. I acknowledge that this will give details of any unspent criminal convictions
recorded by the Criminal Records Bureau. I understand that this will be requested if my application is short listed.
I authorise Johnson Matthey Plc, either itself or through its appointed agent, to verify the information contained in this application form,
subject to the Data Protection Act 1998. I understand that if I accept an offer of employment and any of the above information is found to
be incorrect or any material facts have been omitted, my employment may be terminated forthwith without notice or pay in lieu of notice.
Signed Date
OFFICIAL USE ONLY
Candidate ref number
Application Acknowledged
Shortlisted for Interview
Interview Date

Please continue to complete the application on the opposite page
Application Form Imposed.indd 2 24/9/05 10:13:57 am
Equal Opportunities Monitoring
Candidate ref number
Ethnic Group:
All candidates are requested to complete this information. The
information provided will remain strictly confidential and will not play a
part in your application. The purpose for which this data is collected
is to enable us to generate reports that summarise the data in broad
categories, without reference to individuals. Please use this section of
the form to indicate what you consider your ethnic group to be.
How would you categorise your ethnic origin? Please choose only
ONE section from 1 to 5, then tick the appropriate box to indicate your
cultural background.
1 Asian or Asian British
n Indian n Pakistani
n Bangladeshi
n Any other Asian background, please write in

2 Black or Black British
n Caribbean n African
n Any other Black background, please write in

3 Mixed
n White and Black Caribbean n White and Black African
n White and Asian
n Any other Mixed background, please write in
4 White
n British n Irish
n Any other White background, please write in

5 Chinese or other ethnic group
n Chinese
n Any other background, please write in


Disability:
Do you have a disability?
n Yes n No
Pre-Employment Application Form
Position Applied for …………………………………………….
IMPORTANT INFORMATION FOR CANDIDATES As part of our recruitment process, Johnson Matthey will use
information given in your application to carry out security checks. An external agency verifies the information you provide
and establishes whether you have any outstanding County Court Judgements. The agency will contact previous and
current employers and educational establishments. This process will ONLY be undertaken if we intend to make an offer of
employment. All offers depend on the outcome of our security checks. By signing the agreement at the end of this form, you
are giving us consent to carry out this process. We cannot accept applications from candidates who do not agree to this
stipulation.
Title
(please delete as applicable)
Miss / Mrs / Ms / Mr / Dr /
Other
Address




Postcode
Forenames Surname

Previous Surname (if applicable)

Telephone Numbers and E-mail
Home
Work
Mobile
E-mail
Qualifications
Education (Secondary)
Specify A levels / O levels / GCSEs (or equivalent) and grades obtained / City & Guilds / NVQ / Other certificates or diplomas
School / College Level and Subject Date Obtained Result
Personal References
Application for a reference may be made to any previous employer. Please give the names of TWO persons, NOT relatives to whom we
may apply for personal references. One of these must have known you in a professional capacity.
Name Address Connection
n Please place a tick in the box if you would prefer us not to contact your current employer before we make
an offer of employment.
Miscellaneous
Section 8 of the Asylum and Immigration Act 1996 requires all employers in the United Kingdom to make basic document checks on
every person they intend to employ. To comply with this legislation, all potential employees are required to provide original documents as
detailed in Lists 1 or 2 under Section 8 as proof of legal entitlement to work in the United Kingdom before commencing employment. (For
example you will need to show your passport, or birth certificate and proof of National Insurance number)
Nationality:
Do you require a permit or certification to work in the United Kingdom? Yes n No n If Yes, please give details

Do you have a driving licence? Yes n No n
Where did you see this post advertised?
Have you ever applied to Johnson Matthey before?
If so, please state the position you applied for and the date of application
If you have previously been employed by Johnson Matthey,
please give the dates of this employment
Do you have any relations who are currently employed by Johnson Matthey?
If so, please provide their name and work location
Statement
I certify that all the information on this form is true and accurate and I declare that I have no unexpired convictions for criminal offences
excluding motoring offences.
I understand that, as part of the recruitment process, I may be asked to make a subject access request in the form of a “basic
disclosure” in accordance with the Data Protection Act. I acknowledge that this will give details of any unspent criminal convictions
recorded by the Criminal Records Bureau. I understand that this will be requested if my application is short listed.
I authorise Johnson Matthey Plc, either itself or through its appointed agent, to verify the information contained in this application form,
subject to the Data Protection Act 1998. I understand that if I accept an offer of employment and any of the above information is found to
be incorrect or any material facts have been omitted, my employment may be terminated forthwith without notice or pay in lieu of notice.
Signed Date
Please Return to: OFFICIAL USE ONLY
Candidate ref number
Application Acknowledged
Shortlisted for Interview
Interview Date

Application Form Imposed.indd 2 24/9/05 10:13:57 am

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