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ALL questions are to be answered in BLOCK CAPITALS in your own handwriting and using BLACK INK.
SECURITY SCREENING WILL NOT BEGIN IF YOU FAIL TO FULLY COMPLETE THIS APPLICATIO FORM.
DECLARATION
I understand that employment with the Company is subject t-0 satisfactory references and security screening in
accordance with BS 7858
Signed: Date:
PERSONAL DETAILS
Forenames:
Address:
Any other names you have been given officially (Deed poll birth):
Place of entry into the UK (if applicable): Date of entry (if applicable):
Are you permitted to work in the UK? Yes No Visa expiry date (if applicable):
Have you made a previous application to COASTAL SECURITY SERVICES LIMITED for employment? Yes No
1. Do suffer from Epilepsy or fits?
2. Have you ever had blackouts, recurrent dizziness or conditions causing incapacity?
3. Do you get discomfort or pain in the chest or shortness-of breath e.g when climbing
stairs?
4. Do you have any difficulty in moving rapidly over short distances including steps and
slopes?
5. Do you have any difficulty in hearing normal conversation with either ear?
7. Have you taken any none prescribed drugs or abusive substances in the la.st year?
8. Have you had any alcohol related illness in the last year?
10. Do you have any learning difficulties that you may need us to concider?
11. Are you able to see clearly over a distance of 35 meters (with spectacles if necessary?).
12. Are you able to smell smoke, fire and harmful gases?
14. Is there anything in your medical history or social circumstances that would predjudice
you working normal rotating night duties?
Note: Alertness and reasonable physical fitness are essential to carry out the duties of a security officer. When you declare
'No' to the following question, you must be aware that you are accepting a degree of responsibility for your own safety.
PAY AND CONDITIONS ARE SET OUT IN YOUR CONTRACT OF EMPLOYMENT. WAGE PAYMEWNTS ARE
BY "BACS" TRANSFER
YOU MUST PROVIDE THE FOLLOWING INFORMATION:
ACCOUNT NAME:
ACCOUNT NUMBER:
Please supply a copy of the following WITH THIS APPLICATION form: (Tick if enclosed)
DECLARATION
I agree to co-operate with the company in providing any additional information required to meet these criteria.
I will followed by the rules and conditions of service as laid down in the Companies Terms and Conditions of
Employment and Company
Submit my driving licence for inspection in intervals required by the company.
Authorize the company and or it's nominated agent, INNOVATION GROUP PLC to approach previous employers,
schools/colleges, character reference or Government agencies to verify that the information I have provided is correct.
I understand that some of the information I have provided in this application will be help in a computer and some or all
will be in manual.
I consent to the Company's reasonable processing of any sensitive personal information obtained for the purposes of
establishing my medical and future fitness to perform my duties. I accept that I may be required to undergo medical
examination where requested by the Company to the Access to Medical Records Act 1988, I consent to the results of
such examination to be given to the Company.
Authorisation to Work in the UK & Points-Based System To comply with the immigration and Nationality Act 2006,
we are require your eligibility t d work io the UK. Please confirm that you are entitled work in the UK and on request
will be able provide evidence. Support this Yes No
I hereby certify that, to the best of my knowledge, the details I have given in the application form are complete and
correct.
CANDIDATES SIGNATURE:
IMPORTANT NOTE: YOU MUST ENSURE THATYOC HAVE GIVEN ALL THE INFORMATION REQUESTED IN
FULLEST DETAIL, ESPECIALLY ADDRESSES AND C01'T.\CT INFORMATION. IT WILL DELAY OR NEGATE YOI
APPLICATION IF WE CANNOT VERIFY THE INFORMATION GIVEN.