Kickstart Placement Application Form

Kickstart Placement Application
Please complete this online form to apply for kickstart employment with Eboracum®. If you have any questions, feel free to call the team on 0800 644 1660.
Position/Role applied for:
EG. Admin staff, Security, Stewart, etc
Full Name:

PrefixFirst NameMiddle NameLast Name
Date Of Birth*

DayMonthYear
Date of birth.
Age*
Place of birth*
Telephone number(s):*
E-mail Address:*
Current Address:*

Street Address

Street Address Line 2

CityCounty

Post Code
Please upload a photograph or copy of your proof of address (ie. a Drivers License, Utility Bill, Bank Statement, etc). This can be done at a later date.

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Proof of address can be a drivers license, utility bill, bank statement, letter(s) from local authority/HMRC, etc. Cancelof
Please upload a photo or copy of your photographic identification if not already provided above.

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National Insurance Number:

Job Skills & Training
Describe your skills:*

Right to work compliance.
Do you have a right to work in the United Kingdom?*
Are you subject to immigration control?*
If you have any restrictions, please provide details here:
Please upload photos/copies of your right to work documents (Ie. a Passport.)*

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We will need to physically check these documents too if you are successful in your application. Cancelof

Criminality Declaration
Have you, ever been fined, cautioned, sentenced to imprisonment or placed on probation for a criminal act (subject to the Rehabilitation of Offenders Act)? *
Are there any alleged offences outstanding against you? *
If you have answered YES to any of the above two questions, please give details below:
Please sign to confirm that the criminality declaration information is accurate and correct.*

Clear

Other Declarations
Have you, ever been made bankrupt or have any Court Judgments against you, whether satisfied or not, within the last 6 years? *
Has any order been made against you by a Civil or Military Court or Public Authority?*
If you have answered YES to any of the above two questions, please give details below:

Personal Reference and Employment Verification
Please read this section carefully before signing the application form.

Declaration: I understand that employment with the company is subject to reference and security screening in accordance with BS7858 and/or other standards applicaple to the role that I am applying for.

I undertake to cooperate with the company in providing any additional information required to meet these criteria, I authorise the company to make a consumer information search with a credit reference agency, which will keep a record of that search and may share that information with other credit reference agencies.

I authorise the company and/or its nominated agent to approach previous employers, schools/colleges, character referees 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 held on a computer and some or all will be held in manual records.

I consent to the companies reasonable processing of any sensitive personal information for the purpose of establishing my medical condition and future fitness to perform any duties.

I accept that I may be required to undergo medical examination where requested by the company. Subject to the access of medical record act 1988, I consent to the results of such examinations to be given to the company.

I understand and agree that if so I will make a statutory declaration in accordance with the provisions of the statutory declarations act 1835, in conformation of previous employment or unemployment. I hereby confirm and clarify that, to the best of my knowledge; the details I have given in this application form are complete and correct.

I understand that any false statement or omission to the company or its representatives may render me liable to dismissal without notice and/or prosecution If appropriate.
Signature*

Clear
Name*

First NameLast Name
Date*

DayMonthYear
Date

Data Protection Notification
The information you have provided in completing this form will be used to process your application for employment. The company will keep this information confidential and will not divulge any part to third parties, except where required by law, or where we have retained the services of a third party representative to act on your/our behalf.

The company will store your personal details on electronic and hard copy format. Some of the details you provide will be input onto web based software to create online schedule/training accounts. You have a right to request any information held about you and can do so by contacting the Data Controller on 0800 644 1660 to begin the subject access process.

I have read the data protection notification and understand & agree to the use of my personal data in accordance with the data protection act 1998 / General Data Protection Regulation after 28th May 2018.
Declaration
I declare that the information I have given in this application is correct to the best of my knowledge. I understand that if I am employed by the company and it is later discovered that I have withheld or falsified relevant information, disciplinary action may be taken up to and including dismissal. I agree that should I be employed but leave within 60 days of employment through my own accord, Eboracum may deduct a fee of £15.00 to cover any vetting admin charges connected with my application.
Signature*

Clear
Full Name*
Date*

DayMonthYear
Date
Please take/upload a recent head shot photograph of yourself (This may be printed on your company ID if employed).

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Please make sure that this is a recent photograph and a true representation of yourself at the time of this application. Cancelof
Eboracum Contact Email
example@example.com
Should be Empty: