Job Appying For

Tractor Driver Mechanic/ operator Minibus Driver Other Picker

Todays Date

31/07/2010

Personal Details

First Name			Surname
Date of Birth	July 2010 Mon Tue Wed Thu Fri Sat Sun 26 28 29 30 1 2 3 4 27 5 6 7 8 9 10 11 28 12 13 14 15 16 17 18 29 19 20 21 22 23 24 25 30 26 27 28 29 30 31 1 31 2 3 4 5 6 7 8 Clear Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec OK Cancel		Nationality	American Australian Austrian Belgian British Bulgarian Chinese Cypriate Czech Danish Dutch Estonian Fillipino Finnish French German Greek Hungarian Icelandic Irish Italian Latvian Lithuanian Maltease New Zealander Norwegian Polish Portugeuse Romanian Slovakian Slovenian South African Spanish Swedish Swiss
Gender	Male       Female
House Name/No			Street
Town			Region
Postal/Zip Code			Country	Australia Austria Belgium Bulgaria China Cyprus Czech Republic Denmark Estonia Finland France Germany Greece Holland Hungry Iceland Ireland Italy Latvia Liechtenstein Lithuania Luxemburg Malta New Zealans Norway Poland Portugal Romania Slovak Republic Slovenia South Africa Spain Sweden Switzerland United Kingdom USA
Home Telephone			Mobile Telephone
Email Address			Confirm Email Address
Passport Number			ID Card Number
Have you worked in Great Britain after 1st May 2004 ?
WRS Number			National Insurance Number

In Full Time Education		Spoken English Ability	None Poor Moderate Good
International Driving Licence		Tractor Driving Licence

Work Experience

Date Available To Work From

July 2010 Mon Tue Wed Thu Fri Sat Sun 26 28 29 30 1 2 3 4 27 5 6 7 8 9 10 11 28 12 13 14 15 16 17 18 29 19 20 21 22 23 24 25 30 26 27 28 29 30 31 1 31 2 3 4 5 6 7 8 Today Clear Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec OK Cancel

Date Available To Work To

July 2010 Mon Tue Wed Thu Fri Sat Sun 26 28 29 30 1 2 3 4 27 5 6 7 8 9 10 11 28 12 13 14 15 16 17 18 29 19 20 21 22 23 24 25 30 26 27 28 29 30 31 1 31 2 3 4 5 6 7 8 Today Clear Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec OK Cancel

Previous Farm Experience

If yes please give details

Pre-Employment Health Questionnaire

Asthma

Diabetes

Back Problems

Colour Blind

Allergies

Allergic to Bees / Wasps

Taking any Medication

If taking medication please give details

Criminal Convictions

Other than spent convictions (as defined under the Rehabilitation of Offenders Act 1974) and minor Motoring offence for which the penalty was a fine and / or a penalty points, have you been convicted of a criminal offence or are there any criminal charges outstanding against you, either in the UK or any other country?

Yes No

If yes please give details including any custodial sentence served

Equal Opportunities

We are totally committed and operate an equal opportunities policy within our employment regime. In this regard we are opposed to any form of less favourable treatment on the grounds of age or handicap, nor do we countenance any less favourable treatment in terms of financial reward, direct or indirect discrimination regarding nationality, gender or sexual orientation, creed, colour or ethnic origin. We do not tolerate harassment of any sort and are totally opposed to any form of discrimination or victimisation.

Declaration

I agree with the declaration above that the information provided in the application is true and complete to the best of my knowledge. Ticking the box below I confirm that the information provided in the application is true and complete to the best of my knowledge. I understand that any other employment or offer of employment may be refused, revoked or terminated should any information be found incorrect, or if important information will be withheld.

Please ensure the email address provided is correct before submitting your application as this will be used to update you of your application progress.

Where did you learn about the job opportunities at Withers Farm?

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