Careers at JSR

Title*
Mr Mrs Miss Ms Other, please specify

First name(s) *	Surname *

Address *	Daytime phone number (inc. STD code) * Evening phone number (inc. STD code) * Email Address *

National Insurance Number *

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Do you have a full driving licence?*
Yes No     Date you passed your test? if after 01/01/97

Please give details of any driving offences currently under endorsement *

Give details of any unspent criminal convictions that you may have*
(as in accordance with the Rehabilitation of Offenders Act 1974)

Do you have any objections to moving home if necessary?*
Yes No

Schools/College/University etc attended	Date from	Date To	Qualifications gained or course studied
			*

Training Courses

Please give details of any post school training or professional qualifications achieved

 

Employers Name and Address	Position held and description of duties	Date from	Date To	Reason for Leaving	Salary

 

References - please give details of two referees. (It is preferable that one should be your present employer or someone who could comment on your suitability for the position applied for)

Referee One Name * Address * Position * Phone number *	Referee Two Name * Address * Position * Phone number *

Please state if you are happy for JSR to approach your Referees * Yes No

Hobbies/Interests (activities, sports, societies etc) *

Please give a brief summary of your aims and ambitions *

Please give a brief resume of your career adding any further relevant information, which you feel would assist you in acquiring this position *

We aim to be an equal opportunities employer, and as part of this we like to monitor certain information about job applicants.  This information does not form part of your application, though you are requested to complete this form.

 

Name *

Male or Female? * Male Female

Please tick the ethnic grouping that is relevant to you *

British Irish White & Black Caribbean White & Black African White & Asian

Indian Pakistani Bangladeshi Caribbean African

Chinese Other (Please specify)

We are committed to protecting employees from hazards involved in working within agriculture, and aim to ensure that all necessary measures are taken to support those who may require special treatment.   Please notify us, below, in confidence of any special considerations in respect of your application for employment.

Please tick if you suffer from the following or have suffered from in the past

Problems with your vision Migraine Asthma, bronchitis or Hay Fever Skin conditions (Eczema/Dermatitis) Back problems or any recent injury

Heart condition Fits e.g. epileptic Dyslexia Any major surgery or condition which might compromise your Immune status e.g. spleen removal

If you answered ‘yes’ to any of the above conditions – or if there is anything else in your medical history or circumstances that might affect our decision to offer you employment – please provide details below

Are you currently in good physical and mental health? *
Yes No

Have you been fully immunised (or had the full five doses) against Tetanus? *
If No see your GP or practice Nurse, they will be able to advise you about having a ‘catch-up’ injection
Yes No

Do you have any disability which would require us to make adjustments to your working conditions? *
Yes No

If yes please give details

Please give details of any serious work place injuries that you have suffered in the past *

I declare that to the best of my knowledge and belief the information provided in this application is correct and I consent to it being held on file

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