Application Form Pioneer Quality Services, Almond House, Broad Lane, Betteshanger, Deal, Kent, CT14 0LX
Basic Personal Information
First Name		Surname
Date Of Birth		Marital Status	Married Single Widowed Divorced Comman Law Partner
Address(Line1)		Phone No.
Address(Line2)		Mobile No.
Postal Code		Email Address
Are you a UK resident or have a Valid UK Work Permit ?	Yes No	If NO, Please Give Details Of immigration status
Tax Reference/UTR
Do you currently have any relatives working for us?	Yes No	If Yes, Please Provide Details
Position Applied for/Reference Number
Education Training
Name of School/s attended after age 11
Further education (e.g. technical college, evening classes)
Details and results of any examinations taken.
Qualification Grade		Qualification Grade
Qualification Grade		Qualification Grade
Qualification Grade		Qualification Grade
Qualification Grade		Qualification Grade
Details of any other skills or experience that may be relevant
Enter Details
Criminal Convictions
Have you ever been convicted of any criminal offence that is not spent under the Rehabilitation of Offenders Act 1974? Or have any convictions pending INCLUDING motoring offences ?			Yes No  If yes, Please provide details.
Detail 1
Detail 2
Detail 3
Availability to Work
How Many days are you able to work		Early Morning	Yes No
Evenings	Yes No	Weekends	Yes No
Do you have transport?	Yes No
Next of Kin		Contact Number
Equal Opportunities
In order to comply with the recommendations of the Commission for Racial Equality, and to help ensure that its Equal Opportunity Policy is upheld, PLEASE IDENTIFY YOUR ETHNIC ORIGIN BY SELECTING THE APPROPRIATE ONE.
Ethnic Origin	Black African Black Caribbean Bagladeshi Chinese White Indian Pakistani Irish	Black Other
		Other
Employment History
Please provide the names and addresses of both you current and previous employers NOTE: No approach will be made to your present employer before an offer of work is made to you.
Current Employer
Name
Address
Phone
Job Title
Duties
Rate of Pay
Start Date		End Date
Reason for Leaving
Previous Employer
Name
Address
Phone
Job Title
Duties
Rate of Pay
Start Date		End Date
Reason for Leaving
DECLARATION BY APPLICANT - Please read this section carefully before signing or ticking the Electronic Signature Box. 1. I declare that the statements I have made on this application are, to the best of my knowledge, true and complete. I understand that Pioneer Quality Services reserves the right to withdraw any offer of employment or work, or to terminate any employment or work already commenced, if the information given by me is deliberately false, inaccurate or misleading in any way. 2. I understand that this position is a self employed appointment, and as such I am responsible for ensuring any Income Tax and National Insurance are paid to the Inland Revenue. We will submit on request all pay information to the authorities. 3. I understand that my engagement is subject to the receipt of satisfactory references if an offer of work is made and accepted. 4. I agree to undergo a medical examination should this be considered necessary. 5. I hereby give Pioneer Quality Services permission to take up references with my previous employers and any other referees I may nominate. 6. I agree that my normal hours of work may be extended according to the needs of the business e.g. Christmas, Late nights, year end etc. 7. I agree that Pioneer Quality Services may alter the location in which I am working.
I Agree that all the information provided above is true.