Job Application Form

1. Full name: ________________________________

2. Job applied: ______________________________

3. Employment history (most relevant two employments only)

Employer Period Position held Summary of key Reasons for

(MM/YY) to contributions leaving
(MM/YY)

4. No. of years of relevant experience for the job applied: ____ years

5. Any medical conditions? Y / N

6. Have you been convicted of any crime(s)? Y / N

If Yes, please elaborate:

___________________________________________________________________________________
 Job Application Form

Acknowledgement by Job Applicant

☐ By checking this box and submitting this form, I acknowledge that I have read and understood
the Data Protection Notice for Job Applicants that has been sent to me and hereby consent to
sharing the above information to Xtremax for employment purpose(s) including reference checks.
I also declare that I will obtain the consent of my referees before disclosing their personal data to
Xtremax for reference checking purposes.

Signature: ___________________ Date signed: ____________________