APPLICATION FORM

ALL questions are to be answered in BLOCK CAPITALS in your own handwriting and using BLACK INK.
SECURITY SCREENING WILL NOT BEGIN IF YOU FAIL TO FULLY COMPLETE THIS APPLICATIO FORM.

If a question or section does not apply to you insert NO or N/A.

Position applied for: Employment start date (if known):

DECLARATION
I understand that employment with the Company is subject t-0 satisfactory references and security screening in
accordance with BS 7858
Signed: Date:

PERSONAL DETAILS

Mr Mrs Miss Ms Other SURNAME:

Forenames:

Date of Birth: Place of Birth: Nationality:

Address:

Post Code: Telephone No.

Mobile No. Email:

Any other names you have been given officially (Deed poll birth):

Date of Name Change: Mothers Maiden Name:

Place of entry into the UK (if applicable): Date of entry (if applicable):

Are you permitted to work in the UK? Yes No Visa expiry date (if applicable):

National Insurance Number:

SIA LICENCE INFORMATION

SIA Licence: Yes No N/A SIA Licence Type: DS CP N/A

Date of Expiry: Licence Number:

BJT Certificate Number:

Conflict Management Certificate Number:

Have you made a previous application to COASTAL SECURITY SERVICES LIMITED for employment? Yes No
1. Do suffer from Epilepsy or fits?

2. Have you ever had blackouts, recurrent dizziness or conditions causing incapacity?

3. Do you get discomfort or pain in the chest or shortness-of breath e.g when climbing
stairs?

4. Do you have any difficulty in moving rapidly over short distances including steps and
slopes?

5. Do you have any difficulty in hearing normal conversation with either ear?

6. Are you taking any medication?

7. Have you taken any none prescribed drugs or abusive substances in the la.st year?

8. Have you had any alcohol related illness in the last year?

9. Do you have any physical disability we need to concider?

10. Do you have any learning difficulties that you may need us to concider?

11. Are you able to see clearly over a distance of 35 meters (with spectacles if necessary?).

12. Are you able to smell smoke, fire and harmful gases?

13. Do you have any form of hearing difficulty?

14. Is there anything in your medical history or social circumstances that would predjudice
you working normal rotating night duties?

Note: Alertness and reasonable physical fitness are essential to carry out the duties of a security officer. When you declare
'No' to the following question, you must be aware that you are accepting a degree of responsibility for your own safety.

ADMINISTRATION BANKING INFORMATION

PAY AND CONDITIONS ARE SET OUT IN YOUR CONTRACT OF EMPLOYMENT. WAGE PAYMEWNTS ARE
BY "BACS" TRANSFER
YOU MUST PROVIDE THE FOLLOWING INFORMATION:

BANK NAME AND ADDRESS:

ACCOUNT NAME:

BANK SORT CODE:

ACCOUNT NUMBER:

Please supply a copy of the following WITH THIS APPLICATION form: (Tick if enclosed)

Utility Bill (Last 3 month) Bank Statement

ADDITIONAL IDENTIFICATION (Tick if enclosed)

Photographic EU Driving Licence Passport

Work Permit or Visa or Accession State Worker Registration Scheme Registration Card

Service Discharge documents SIA Licence

DECLARATION

I agree to co-operate with the company in providing any additional information required to meet these criteria.
I will followed by the rules and conditions of service as laid down in the Companies Terms and Conditions of
Employment and Company
Submit my driving licence for inspection in intervals required by the company.

Authorize the company and or it's nominated agent, INNOVATION GROUP PLC to approach previous employers,
schools/colleges, character reference or Government agencies to verify that the information I have provided is correct.

I will permit my photograph to be taken for identification purposes.

I authorize the company to make a consumer information search with a credit reference agency, which will keep a
record of that search and that information with other credit reference agencies.
I agree to be medically examined by the company doctor, as and when requested.
I agree to credit reference checks being made by the company.
I agree to, and will submit to a search of my person, property and dwelling if required to do so with regards to my
duties and employment with company.
I DO/ DO NOT agree to my present employment being approached. I understand that if I am employed and it is revealed
that I have made statement to this application form, it will be concidered cause for instant dismissal and possible
prosecution as mentioned above.
I understand and agree that if so required I will make a statutory declaration in accordance with the provisions of the
Statutory declaration 1835, in confirmation of previous employment or unemployment.

I understand that some of the information I have provided in this application will be help in a computer and some or all
will be in manual.

I consent to the Company's reasonable processing of any sensitive personal information obtained for the purposes of
establishing my medical and future fitness to perform my duties. I accept that I may be required to undergo medical
examination where requested by the Company to the Access to Medical Records Act 1988, I consent to the results of
such examination to be given to the Company.

Authorisation to Work in the UK & Points-Based System To comply with the immigration and Nationality Act 2006,
we are require your eligibility t d work io the UK. Please confirm that you are entitled work in the UK and on request
will be able provide evidence. Support this Yes No

I hereby certify that, to the best of my knowledge, the details I have given in the application form are complete and
correct.

CANDIDATES SIGNATURE:

PRINT NAME: DATE:

IMPORTANT NOTE: YOU MUST ENSURE THATYOC HAVE GIVEN ALL THE INFORMATION REQUESTED IN
FULLEST DETAIL, ESPECIALLY ADDRESSES AND C01'T.\CT INFORMATION. IT WILL DELAY OR NEGATE YOI
APPLICATION IF WE CANNOT VERIFY THE INFORMATION GIVEN.