DHL AVIATION (UK) LTD

APPLICATION FORM

Name:

Dominic J. Walker de Roeck

 DHL AVIATION (UK) LTD
APPLICATION FORM
SECTION 1 (APPLICANT DETAILS)

FORENAME(S) (in full):

Dominic Johannes

Walker de Roeck
SURNAME:

EMA IT work experience

PREFERRED LOCATION: POSITION APPLIED FOR:

ARE YOU AVAILABLE FOR SHIFT WORK?: NIGHT WORK: YES NO

WEEKEND WORK: YES NO

DAY SHIFT ONLY: YES NO

14/11/22
WHEN WOULD YOU BE ABLE TO START WORK WITH US?

207 standhill road nottingham

ADDRESS:

ng4 1le
POSTCODE:

CONTACT NUMBER:
07311265848 MOBILE NUMBER:
65848

dominicwalkerderoeck@gmail.com NATIONAL PJ923452A

EMAIL ADDRESS:
INSURANCE NUMBER:

ARE YOU LEGALLY ENTITLED It is our statutory obligation in accordance with the Immigration, Asylum and Nationality Act 2006 that we must ask
TO WORK IN THE UK? YES NO
for proof that you are entitled to work in the UK.

SHOULD YOU BE INVITED TO ATTEND AN INTERVIEW YOU WILL NEED TO BRING PROOF OF ELIGIBILITY TO WORK IN THE UK ALONG WITH YOU.

SECTION 2 (DRIVING LICENCE DETAILS)

If you are applying for a position which may require driving a vehicle on behalf of the company, please complete this section. Tick the category of vehicle you are entitled to drive,
and bring your licence(s) with you to any interview.

LICENCE CATEGORY TICK (√): LICENCE NUMBER: EXPIRY DATE:

CAR CI C C+E MOTORCYCLE

Please give detail of any:

ENDORSEMENTS:

OTHER DRIVING CONVICTIONS THAT DO NOT CARRY ENDORSEMENTS, INCLUDING THOSE THAT ARE PENDING:

BLAMEWORTHY ACCIDENTS IN THE LAST 3 YEARS:

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SECTION 3 (YOUR REFERENCES / YOUR QUALIFICATIONS / MEMBERSHIP OF PROFESSIONAL BODIES)
DHL International Application Form 3

All employment offers at DHL are subject to satisfactory references. We require full contact details for the last 5 years of employment and education. Please also include
any temporary and voluntary community work, work experience, weekends and evening jobs etc, and also state whether you were self-employed or whether the company you
previously worked for is no longer trading.
Can we approach your current employer for a reference? (Please tick) Yes No

If at any time during this period you were unemployed or in education, please detail the reasons and dates using the “Gaps in Employment & Education” on page 4,
including any period of travelling and claiming benefits.
Note: If you are already providing a service to us via an agency or have previously worked for us as a service partner / self-employed contractor, please provide details below.

JOB EMPLOYMENT HISTORY PRESENT (OR MOST RECENT) EMPLOYMENT

COMPANY NAME / Nottingham College Student

EDUCATIONAL ESTABLISHMENT: POSITION HELD:

REFEREE Isaac Oyeyiola REFEREE JOB TITLE: lecturer

NAME:

ADDRESS: 111 Canal Street, Nottingham

POSTCODE: NG1 7HB

CONTACT NUMBER: 0115 9 100 100

DATE FROM: 05D 09D 2M 0M 2Y 2Y DATE TO: D D M M Y Y

REASON FOR LEAVING:

JOB TITLE & RESPONSIBILITIES: (Max 350 characters)

CONTACT EMAIL: isaac.oyeyiola@nottinghamcollege.ac.uk

PREVIOUS EMPLOYMENT

COMPANY NAME / Carlton Academy Student

EDUCATIONAL ESTABLISHMENT: POSITION HELD:

REFEREE Reception REFEREE JOB TITLE: Reception

NAME:

ADDRESS: Coningswath Rd, Carlton, Nottingham

POSTCODE: NG4 3SH

CONTACT NUMBER: 0115 955 0010

DATE FROM: 04D 09D 2M 0M 1Y 4Y DATE TO: 01D 04D 2M 0M 2Y 1Y

REASON FOR LEAVING: Graduation

JOB TITLE & RESPONSIBILITIES: (Max 350 characters)

CONTACT EMAIL: office@theacademycarlton.org

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SECTION 3 (YOUR REFERENCES / YOUR QUALIFICATIONS / MEMBERSHIP OF PROFESSIONAL BODIES)
4 DHL International Application Form

Please use the additional notes pages at the back of this application form if required.

PREVIOUS EMPLOYMENT

COMPANY NAME /
EDUCATIONAL ESTABLISHMENT: POSITION HELD:

REFEREE
REFEREE JOB TITLE:
NAME:

ADDRESS:

POSTCODE:

CONTACT NUMBER:

DATE FROM: D D M M Y Y DATE TO: D D M M Y Y

REASON FOR LEAVING:

JOB TITLE & RESPONSIBILITIES: (Max 350 characters)

CONTACT EMAIL:

PREVIOUS EMPLOYMENT

COMPANY NAME /
EDUCATIONAL ESTABLISHMENT: POSITION HELD:

REFEREE
REFEREE JOB TITLE:
NAME:

ADDRESS:

POSTCODE:

CONTACT NUMBER:

DATE FROM: D D M M Y Y DATE TO: D D M M Y Y

REASON FOR LEAVING:

JOB TITLE & RESPONSIBILITIES: (Max 350 characters)

CONTACT EMAIL:

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SECTION 3 (YOUR REFERENCES / YOUR QUALIFICATIONS / MEMBERSHIP OF PROFESSIONAL BODIES)
DHL International Application Form 5

PREVIOUS EMPLOYMENT

COMPANY NAME /
EDUCATIONAL ESTABLISHMENT: POSITION HELD:

REFEREE
REFEREE JOB TITLE:
NAME:

ADDRESS:

POSTCODE:

CONTACT NUMBER:

DATE FROM: D D M M Y Y DATE TO: D D M M Y Y

REASON FOR LEAVING:

JOB TITLE & RESPONSIBILITIES: (Max 350 characters)

CONTACT EMAIL:

Additional References: Please also use the notes pages at the back of this application form if required.

GAPS IN EMPLOYMENT & EDUCATION

Please detail below any gaps in your employment and education history over the past 5 years. Please note that if claiming Jobseeker's Allowance, you will need to submit
proof of this if your application is successful. Please use the notes pages at the back of this application form if required.

REASON: DATE FROM DATE TO

(DD/MM/YYYY): (DD/MM/YYYY):

GAP REASON 1:
01/09/2021 14/09/2022
gap year

GAP REASON 2:

GAP REASON 3:

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 PERSONAL REFEREE
6 DHL International Application Form
PLEASE PROVIDE DETAILS OF TWO PERSONAL REFEREES WHO CAN BE CONTACTED TO VERIFY ANY GAPS IN EMPLOYMENT OR EDUCATION.

CRITERIA OF PERSONAL REFEREE

- Must have known applicant for a minimum of 5 years
- Cannot be related to the applicant (i.e. by birth, marriage, adoption)
- Cannot reside at the same address

PERSONAL REFEREE 1

REFEREE NAME:
Harry Barnfather

10 Hawthorn Walk, Nottingham

ADDRESS:

NG3 6NS
POSTCODE:

CONTACT NUMBER:
07826 229634 EMAIL:
harrybarnfather123@gmail.com

HOW LONG HAVE YOU 7 years HOW DO YOU from school

KNOWN THE REFEREE? KNOW EACH
OTHER?

PERSONAL REFEREE 2

Mattew Pedwell
REFEREE NAME:

43 Lower Parliament Street, Nottingham

ADDRESS:

NG1 1EE
POSTCODE:

CONTACT NUMBER:
07597373417 EMAIL:
matthew04johnson@gmail.com

HOW LONG HAVE YOU 7 years HOW DO YOU from school

KNOWN THE REFEREE? KNOW EACH
OTHER?

QUALIFICATIONS/MEMBERSHIP OF PROFESSIONAL BODIES

Please detail below any additional qualifications that you hold, for example forklift license, NVQs, CIPD, etc. Please use the additional notes pages at the back of this application
form if required.

PROFESSIONAL BODY QUALIFICATION & SUBJECT

N.B. If you have a CV please feel free to attach a copy along with your application.

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SECTION 4 (OTHER INFORMATION)
DHL International Application Form 7

The amendments to the Exceptions Order 1975 (2013) provide that certain spent convictions and cautions are ‘protected’ and are not subject to disclosure to employers, and cannot
be taken into account. All guidance and criteria on the filtering of these cautions and convictions can be found in the DBS filtering collection. Conviction of a criminal offence may
prevent you being considered for certain positions.

DO YOU HAVE ANY CONVICTIONS, CAUTIONS, REPRIMANDS OR FINAL WARNINGS THAT ARE NOT
YES NO
'PROTECTED' AS DEFINED BY THE REHABILITATION OF OFFENDERS ACT 1974 (EXCEPTIONS) ORDER
1975 (AS AMENDED IN 2013). IF YES, PLEASE PROVIDE DETAILS BELOW:

CONVICTIONS

DATE OF APPEARANCE: DATE OF APPEARANCE:

DATE OF OFFENCE: DATE OF OFFENCE:

NAME OF COURT: NAME OF COURT:

SENTENCE / DISPOSAL: SENTENCE / DISPOSAL:

CAUTIONS, REPRIMANDS OR FINAL WARNINGS

DATE OF CAUTION: DATE OF CAUTION:

OFFENCE: OFFENCE:

NAME OF POLICE FORCE: NAME OF POLICE FORCE:

HAVE YOU A COURT HAVE YOU A COURT

APPEARANCE PENDING? APPEARANCE PENDING?

SECTION 5 (DECLARATION)

HAVE YOU PREVIOUSLY WORKED FOR DHL? YES NO

IF YES, PLEASE ADVISE: POSITION: DIVISION:

I declare that this information is accurate, and I accept that should any statement made by me in connection with this application be found to be false, the application
shall be void and as a result any Contract of Employment arising may be terminated by the Company at any time and in appropriate cases criminal charges could be
pursued.

The information provided on this form will be used as part of our selection process. It will be retained for a period after the selection process has been completed.

I authorise DHL to contact all relevant companies/organisations, including but not limited to, current and previous universities contained in this application for the
purposes of referencing and conducting necessary background checks. I understand that any offer of employment will be subject to satisfactory references and
background checks.

(a) a declaration that the information given is complete and accurate;

(b) a declaration that the person being recruited has no criminal convictions other than any treated as spent under the provisions of the Rehabilitation of Offenders Act 1974
and those disclosed on the form;
(c) a declaration of acceptance that any misrepresentation of the facts is a ground for refusal of Employment or disciplinary proceedings (and, in appropriate cases, criminal charges);
(d) an authorisation for approaches to be made to former employers, educational establishments, government agencies and personal referees for verification of the information;
(e) their national insurance number; and
(f) in the case of persons to be deployed on an activity listed under Schedule 11–3, a declaration of acceptance that the CAA or its agents will carry out a
CTC and that deployment on such activities is conditional on a satisfactory result of such a check.

A copy of your criminal record check will be kept on file for the Civil Aviation Authority.

Should you wish to withdraw your consent to DHL processing you application please contact DHL on ukavihr@dhl.com.

Digitally signed by Dominic J. Walker de Roeck

Dominic J. Walker de Roeck Dominic J. Walker de DN: cn=Dominic J. Walker de Roeck,
NAME: SIGNATURE: email=dominicwalkerderoeck@gmail.com, c=GB
Roeck Date: 2022.10.31 21:01:06 Z

DATE: 03D 11D 2M 0M 2Y 2Y

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 SECTION 6 (EQUAL OPPORTUNITIES)
8 DHL International Application Form
In line with UK legislation and good practice guidelines, we are asking everyone to complete this section. You are not obliged to provide any of the information below,
but if you do so, it will enable us to monitor our business processes and ensure that we provide equality of opportunity to all.

I WOULD DESCRIBE MY ETHNIC ORIGIN AS

BANGLADESH: BLACK OTHER:

CHINESE: INDIAN:

WHITE OTHER: PAKISTANI:

BLACK AFRICAN: WHITE EUROPEAN:

BLACK CARIBBEAN:

OTHER (please specify):

I WOULD DESCRIBE MY RELIGION AS

BAHÁ’I: HINDU: SIKH:

BUDDHIST: JEWISH: NOT RELIGIOUS:

C OF E: ISLAM:

CATHOLIC: PARSI:

CHRISTIAN: RASTAFARIAN:

OTHER (please specify):

RECRUITMENT SOURCE

HOW DID YOU LEARN ABOUT THIS VACANCY? Please tick appropriate box:

LOCAL PRESS: NATIONAL PRESS: DHL EMPLOYEE:

If yes, please provide details:
JOB CENTRE: DHL WEBSITE: EMPLOYEE NAME:
Ryan Elliott
E-RECRUITMENT: CAREERS FAIR / OPEN DAY:
RELATIONSHIP:

Partner
DIVISION:

IT

OTHER (please specify):

Do you know anyone who works within the DHL Network?

EMPLOYEE NAME: RELATIONSHIP: DIVISION:

Ryan Elliott Partner IT

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JOB APPLICANT PRIVACY NOTICE
DHL International Application Form 9
DHL Aviation UK (Ltd) is a "data controller". This means that we are responsible for deciding how we hold and use personal information about you. You are being provided a
copy of this privacy notice because you are applying for work with us (whether as an employee, worker or contractor). It makes you aware of how and why your personal data
will be used, namely for the purposes of the recruitment exercise, and how long it will usually be retained for.
We will comply with data protection law and principles, which means that your data will be:
• Used lawfully, fairly and in a transparent way.
• Collected only for valid purposes that we have clearly explained to you and not used in any way that is incompatible with those purposes.
• Relevant to the purposes we have told you about and limited only to those purposes.
• Accurate and kept up to date.
• Kept only as long as necessary for the purposes we have told you about.
• Kept securely.
How we collect and use your data
In connection with your application for work with us, we will collect, store, and use the following categories of personal information about you:
• The information you have provided to us in your curriculum vitae and covering letter.
• The information you have provided on our application form, including name, title, address, telephone number, personal email address, date of birth, gender, employment
history, qualifications
• Any information you provide to us during an interview.
We may also collect, store and use the following "special categories" of sensitive personal information:
• Information about your race or ethnicity, religious beliefs, sexual orientation and political opinions.
• Information about your health that you notify us of
• Information about criminal convictions and offences.
We may collect personal information about candidates from the following sources:
• You, the candidate.
• Recruitment agency
• Background check provider or credit reference agency
• Disclosure and Barring Service in respect of criminal convictions.
• Your named referees,
• Publicly accessible source
We will use the personal information we collect about you to:
• Assess your skills, qualifications, and suitability for the role
• Carry out background and reference checks, where applicable.
• Communicate with you about the recruitment process.
• Keep records related to our hiring processes.
• Comply with legal or regulatory requirements
Having received your CV and covering letter or your application form we will then process that information to decide whether you meet the basic requirements to be shortlisted
for the role. If you do, we will decide whether your application is strong enough to invite you for an interview. If we decide to call you for an interview, we will use the
information you provide to us at the interview to decide whether to offer you the role. We may also take up references and carry out a criminal records check [and any necessary
background checks] where applicable.
If you fail to provide information when requested, which is necessary for us to consider your application (such as evidence of qualifications or work history), we will not be able
to process your application successfully.
We will use your particularly sensitive personal information in the following ways:
• We will use information about your disability status to consider whether we need to provide appropriate adjustments during the recruitment process, for example whether
adjustments need to be made during a test or interview.
• We will use information about your race or national or ethnic origin, religious, philosophical or moral beliefs, or your sexual life or sexual orientation, to ensure meaningful
equal opportunity monitoring and reporting.
For some roles it may be necessary to process information about criminal convictions to satisfy ourselves that there is nothing in your criminal convictions history which makes
you unsuitable for the role. We have in place an appropriate policy document and safeguards which we are required by law to maintain when processing such data.
Data sharing
We will only share your personal information with third parties for the purposes of processing your application. All our third-party service providers and other entities in the
group are required to take appropriate security measures to protect your personal information in line with our policies.
Data security
We have put in place appropriate security measures to prevent your personal information from being accidentally lost, used or accessed in an unauthorised way, altered or
disclosed. We have put in place procedures to deal with any suspected data security breach and will notify you and any applicable regulator of a suspected breach where we
are legally required to do so.
Data retention
We will retain your personal information for a period of 12 months after we have communicated to you our decision about whether to appoint you to the role. We retain your
personal information for that period so that we can show, in the event of a legal claim, that we have not discriminated against candidates on prohibited grounds and that we
have conducted the recruitment exercise in a fair and transparent way. After this period, we will securely destroy your personal information in accordance with applicable laws
and regulations.
Your rights in connection with personal information
If you want to review, verify, correct or request erasure of your personal information, object to the processing of your personal data, or request that we transfer a copy of your
personal information to another party, please contact ukavihr@dhl.com in writing.
When you applied for this role, you provided consent to us processing your personal information for the purposes of the recruitment exercise. You have the right to withdraw
your consent for processing for that purpose at any time. To withdraw your consent, please contact ukavihr@dhl.comfollowing which we will no longer process your application
and, subject to our retention policy, we will dispose of your personal data securely.
If you have any questions about this privacy notice or how we handle your personal information, please contact ukavihr@dhl.com. You have the right to make a complaint at
any time to the Information Commissioner's Office (ICO), the UK supervisory authority for data protection issues.

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 NOTES
10 DHL International Application Form

9
NOTES
DHL International Application Form 11

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 12 DHL International Application Form

DHL Aviation (UK) Ltd

EMA Cargo West
East Midlands Airport
Castle Donington
Derbyshire
DE74 2TR
ukavihr@dhl.com

www.dhl.com

HRAF/EMA0518v1