A Brambles Company

Cleanaway Limited

Head Office
The Drive, Warley
Brentwood, Essex CM13 3BE
Tel:

[phone]

Fax: [phone]
DX: 124281 Brentwood - 4
Email: [e-mail]
www.cleanaway.com

Please fill in clearly in your own handwriting. All information will be treated as confidential and no reference will be made
to your present employer without your prior permission.

Position applied for:

____________________________________________________________________________________________________________

How did you hear of the vacancy?______________________________________________________________________________

(Give name of newspaper, personal contact etc.)

Available to take up employment (date):_________________________________________________

Personal Details

Surname: _________________________________________

First name(s):___________________________________________

Address: ___________________________________________________________________________________________________

___________________________________________________

Telephone no: __________________________________________

Date of birth: _______________________________________

Nationality:_____________________________________________

Are you married, single, widowed, Give number ___________________________________________
divorced or separated? and ages of

(underline as appropriate)

all dependants _________________________________________

Do you have any relatives or friends either employed by Cleanaway Limited or employed in any organisation, public or
private, which directly or indirectly, through a subsidiary or associated company has any involvement in the transportation,
disposal or treatment of waste? If so, please give details:

____________________________________________________________________________________________________________

Do you: Own a car? YES/NO

Have a current driving licence?

Provisional

■

■

Full

■

■

LGV

■

■

No

■

■

Have any current endorsements? (give details): _________________________________________________________

Are you registered disabled? YES/NO RDP no: ______________________________________________________________

Please give details of any limitations to your licence to take account of any disabling condition:

____________________________________________________________________________________________________________

If you wish to do so, please give details of next of kin or person who can be contacted in an emergency.

Name: ________________________________________________

Relationship: ______________________________________

Address: ___________________________________________________________________________________________________

Telephone no: ___________________________________ (Business) ___________________________________________(Home)

Application for Employment - Staff

Mr.
Mrs.
Ms.
Miss

E1 01/02

Previous Employment

Please give dates and details of all positions you have held since you completed your full time education. Start with your
present, or most recent position. If more space is required, please continue on a separate sheet.

Interests/hobbies (Give details of pastimes, sports, etc.):

Offices held in social/sports clubs, etc.:

Public duties (JP, local councillor, etc.) undertaken:

Have you ever been convicted of a criminal offence? YES/NO (Declaration subject to the Rehabilitation of Offenders Act):

Do you need a work permit to work in the UK? YES/NO

Should you be offered this position will you continue to work elsewhere in any other capacity? YES/NO Give details:

Dates

from/to

(please state

month and year)

Employer’s name

and address

and nature of business

Brief description of
position and duties

Reason for

leaving

Current/

leaving

weekly

wage

Education

(Schools attended from age 11)

Dates

From

Further Education

Further Education

Please give any other information you think is relevant to your application, for example, why you want the job, your
ambitions for the future and your achievements to date.

Membership of Professional Associations:

Do you speak or read a foreign language? YES/NO Give details and fluency:

Place of education

Type of training

Qualifications

Other courses attended

Dates

From

To

To

Examinations (subject/results)

Continue on a separate sheet if necessary

Additional Personal Details

Applicants are requested to tick the relevant box below to enable the Company to monitor its equal opportunity policy. This
information is used for no other purpose and will be treated as confidential.

Ethnic Group:

African

■

■

Afro-Caribbean

■

■

Asian

■

■

European - UK

■

■

European - other

■

■

(please specify)

_____________________ Other

■

■

(please specify)

_____________________

Health Questionnaire

Please answer questions 1 - 7 below:

1.

If the category of the job, or your medical history, suggests it, you may be required by the Company to
undergo a medical examination. Would you object to this?

YES/NO

2.

Have you ever had to change the type of work you did or leave your employment even temporarily
because of ill health?

YES/NO

3.

Has illness or accident caused you to lose time for more than two weeks by being at home, in hospital or
by attending hospital?

YES/NO

4.

Are you under the care of your doctor, hospital specialist, or taking any pills, medicines or receiving any
specialist treatment?

YES/NO

5.

Are you allergic to anything? So you suffer from hayfever or do you have a rash or skin diseases
e.g. eczema or psoriasis?

YES/NO

6.

Do you suffer from fits, blackouts, or any physical disability, for instance in your back or limbs?

YES/NO

7.

Have you any difficulty in reading a number plate at 25 yards with each eye separately as required for a
driving test?

YES/NO

Recruitment Policy

It is the Company’s policy to employ the best qualified personnel and provide equal opportunity for the advancement of
employees including promotion and training and not to discriminate against any person because of race, colour, national
origin, sex or marital status.

I authorise the Company to obtain references to support this application once an offer has been made and accepted and
release the Company and referees from any liability caused by giving and receiving information.

Declaration: I confirm that the information given on this form, including the Health Questionnaire, is to the best of my
knowledge, true and complete. Any false statement may be sufficient cause for rejection or, if employed, dismissal.

Signature: _________________________________________________

Date: __________________________________________

To be completed by the Employing Manager before an offer of employment can be made:

I confirm that the Health Questionnaire on this application has been completed and that any positive replies have been fully
discussed with the Company Medical Adviser.

Name of Manager: _________________________________________

Signature of Manager: ___________________________

Please give the names and addresses of two people we can approach for reference (not members of your family); one must
be your present or most recent employer.

Name: _____________________________________________

Name: _____________________________________________

Address: ___________________________________________

Address:___________________________________________

___________________________________________________

___________________________________________________

Occupation: ________________________________________

Occupation:________________________________________

Telephone no:_______________________________________

Telephone no: ______________________________________