Application Form

Surname: _____________________________________________
First name: ____________________________________________

PASSPORT
000PICTURES

Address: ______________________________________________
Telephone no: __________________________________________
E-mail address: _________________________________________
How did you hear about the company? _______________________

Applicants willing to start as soon as possible should please enclose a photocopy of

their passport, a utility bill and a photocopy of a recent bank statement.
A photocopy of the personal details section of a UK or an EU passport should be
satisfactory. Applicants with other passports should have a photocopy of the personal
details section of their passport and the visa section.
In instances where the passport is not available or in the Home Office, a letter from
the Home Office, showing eligibility to work in the UK should be enclosed.
Completed form and supporting documents should be sent to:
FSL, 18 Waldstock Road, London, SE28 8SF
Section 1
Previous Surnames: _______________________________________________
Date of Birth: ___________
Male

Female

Place of Birth:__________________________

Nationality: _________ N.I Number ______________

Height: ________________
Are you registered disabled?

Weight: _________
YES

NO

If YES please give details: ____________________

Are you currently receiving medical attention?
Are you:

YES

NO

Single/ Married / divorced / separated / widowed

Spouses Employment: ___________________ No. Of Children: ____

Section 2
Bank Name: ___________________________________________
Bank Address: _________________________________________
Sort Code: ____________________________________________
Account Number: _______________________________________
Section 3
YES

Have you ever been declared bankrupt?

NO

Have you any outstanding County Court Judgements against you? YES/NO
Have you ever been fined, sentenced to imprisonment, placed on probation,
discharged on payment of costs or had any order made against you by a criminal, civil
or military court or public authority, or is any prosecution pending or been cautioned
for any criminal offence?
YES
NO
Section 4
Do you posses a current Driving License?

YES

NO

Please state any endorsement: _____________________________

How long held? _____________________________________
Do you own the vehicle?

YES

NO

YES

NO

Section 5
Have you ever served in H.M. Force?

Regiment: ____________________________________________
Branch or Division: _____________________________________
Rank: ______________________________
Date joined: _ _ _ _ _ _

Date discharged: _ _ _ _ _ _

Section 6
Do you possess an SIA licence?
If yes, what is the number? _ _ _ _

Yes
_ _ _ _

No
_ _ _ _

_ _ _ _

Section 7
Educational, professional or technical qualifications including First Aid training:
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Section 8
Please give details of two persons that you have known for a minimum of five years
that we can contact for a character reference. They must not be relatives or work for
Firstcall Services Ltd.
Reference 1
Name______________________________________________________
Address: ___________________________________________________
Occupation: _________________________________________________
How long known: _____________________________________________

Reference 2
Name: _____________________________________________________
Address: ____________________________________________________
Occupation: _________________________________________________
How long known______________________________________________

Section 9
Please list in the boxes below details of your employment history spanning the last 10
years. If unemployed through any period please give dates applicable. Please start
with your current employment.

Employer
Name &
Address

Person to
whom you
report

Period
worked

Position held

Please use supplement sheets if need be.

Section 10
Next of Kin: ___________________________________________
Relationship: ____________________________________________
Address: _______________________________________________
Telephone Number: ______________________________________

Reason for leaving

Physical Examination Health Checks

Officers Name: ______________________________________________
Officers Signature: ___________________________________________
Date of Check: _______________________________________________
Please answer the following questions:
Have you ever had any back or joint injuries?

YES/NO

Have you ever had a heart condition, high blood pressure, stroke, palpitations or chest
pain?
YES/NO
Has your mother, father, brother or sister had any heart problems prior to the age of
60?
YES/NO
Have you ever had asthma, arthritis, epilepsy, dizziness, hernia or circulatory
problems?
YES/NO
Are you currently taking any prescribed medication?

YES/NO

Do you take part in regular exercise?

YES/NO

Declaration
I certify that any information given in this document is correct to the best of my
knowledge and belief and that I am the person named herein.
I acknowledge that any misrepresentation of the information provided shall constitute
misconduct sufficient to warrant immediate termination of my employment and may
render me liable to criminal prosecution under section 16(2) (b) theft acts 1968
(Obtaining employment by deception)
I certify that I have never been convicted of a criminal offence nor have I been
dismissed from employment for misconduct.
I hereby certify that I have completed this Application Form myself and I give
permission for the Company to collect, retain and process information about me and
understand that this will be held on a computer and some or all will be held in manual
records.
Signature of Applicant: _______________

Date: ___________

Witness/Interviewing Officer: ___________

Date: ___________