Apply Now - Copeland Ashcroft

SECTION 1: GENERAL DETAILS

Position applied for:*

Date:

Surname:*

Forenames:*

Daytime contact phone No:

Evening contact phone No:

Mobile contact phone No:*

E-mail address:*

SECTION 2: QUALIFICATIONS AND EMPLOYMENT HISTORY

Please attach a copy of your Cover Letter and CV with this application:*

Drop files here or

Accepted file types: pdf, docx, doc, Max. file size: 64 MB.

Please give details:*

SECTION 3: LEGAL REQUIREMENTS

Please attach a copy of your work permit with this application:*

Max. file size: 64 MB.

Expiry Date of Work Permit:*

SECTION 4: DISABILITIES OR MEDICAL CONDITIONS

Note: The Human Rights Act 1993 defines disability as: physical disability or impairment; physical illness; psychiatric illness; intellectual or psychological disability or impairment; the presence in the body of organisms capable of causing illness; any other loss or abnormality of a body or mind function; and reliance on a guide dog, wheelchair or other remedial means.

Please provide details (please include any services or facilities which would allow you to carry out this role satisfactorily?*

Please give details:*

4e Please describe and indicate areas of injury or discomfort.

When did the injury occur?

What was the cause?

What treatment are you/have you been receiving:

SECTION 5: CRIMINAL AND BANKRUPTCY HISTORY

I understand that any record of criminal convictions I might have will automatically be concealed if I meet the eligibility criteria stipulated in Section 7 of the Criminal Records (Clean Slate) Act 2004.

Please give details:*

Declaration and acknowledgement

This information is being collected to enable Copeland Ashcroft to assess your suitability for this position and will be used for this purpose only. If you fail or refuse to provide the information requested, then your application may be rejected by Copeland Ashcroft. If you provide false or inaccurate information, this will be considered serious misconduct and may result in dismissal should you be employed by Copeland Ashcroft. Please also note that any false information given in Section Four, entitled Disabilities or Medical Conditions, may result in your loss of entitlement to earnings related compensation. The Privacy Act provides you with the right to request access to and/or correct the personal information about you held by Copeland Ashcroft.

Evaluation of Recruitment Advertising

Please tell us how you found out about this position.

Advertised in (please state which publication):

Word of mouth arising from advertising (please state which publication):

Other (please provide details):

CONSENT TO CONTACT REFEREES FORM:

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