Foremost Rail Solutions Ltd - Job Application Form - Civils, Signalling and Safety Critical Personnel

All fields marked with an * must be completed.

Name*:
Address:
Email Address*:
Tel No*:	Mobile No:
Date of Birth:	Nat Ins No:
Nationality:	Gender:	Male Female

Are you a British subject or a national of any EU country?:	Yes No
If not, do you have (a) the right to work in the UK? and (b) a current work permit?:	Yes No
If so, please state the expiry date of your right to work in the UK and/or your work permit:
To comply with the Asylum & Immigration Act 1996, if you are invited to attend an interview, you must bring with you evidence of your eligibility to work in the UK, preferably an official document that includes your national insurance number, such as P45 or P60, also your current passport.

Details of position you are interested in:
Experience:

Do you currently have any of the following		Expiry Date	Sentinel card number
PTS competence:	Yes No
Lookout competence:	Yes No
COSS competence:	Yes No
LXA competence:	Yes No
HSM competence:	Yes No
ES competence:	Yes No

A Full Driving licence:	Yes No
Have you any motoring endorsements within the past 5 years?:	Yes No
If yes, please give details

How many days absence have you had from work in the past two years?:

Do you consider yourself to have a disability?
Please indicate below if you have a disability or a long term health problem likely to last 12 months
Person with disability:	Yes No
Visual:
Hearing:
Mental health:
Learning difficulties:
Speech:
Co-ordination, dexterity, mobilty:
Other:
Please specify:

Do you need glasses to correct your vision:	Yes No
If so, do you wear contact lenses:	Yes No

Do you suffer from colour blindness:	Yes No
Have you ever failed medical or drug & alcohol screen?:	Yes No
If yes, please give details:

Are you currently taking any prescribed medication?:	Yes No
If yes, please give details:

Employment History: Current / Most recent employer
Company Name:
Position held:	from:	to:
Brief description of tasks/responsibilities:
Reason for leaving:
Reference can be obtained from
Name:	Position:
Telephone No:

Previous Employer:
Company Name:
Position held:	from:	to:
Please provide a brief description of duties/responsibilities:
Reason for leaving:
Reference can be obtained from
Name:	Position:
Telephone No:

Rehabilitation of Offenders

Do you have any criminal convictions you are obliged to disclose by law?:

Yes No

If yes, please give details:

Foremost Rail Solutions Ltd is an equal opportunities employer

If you are unsuccessful we would like to keep a record of your information for future reference. If you do not wish us to do this, please tick this box.

Medical Questionnaire:

Please complete all parts of this questionnaire.

Have you consulted a doctor in the past 2 years

Yes

If YES, please give full details

Height:

Weight:

Have you ever:

Yes

If YES, please give full details

Had an operation?

Been seriously ill?

Received in-patient treatment for a
physical or mental condition?

Been refused or dismissed from
employment for health reasons?

Had a head injury?

Do you suffer from or have you ever had any of the following

	No	Yes		No	Yes
Arthritis			Eye trouble
Asthma			Epilepsy / fits
Back trouble			Fainting or dizziness
Blackouts			Hay fever
Blood pressure			Headaches (frequent)
Chest trouble			Heart trouble
Colour Blindness			Rheumatic fever
Cough (frequent)			Shortness of breath
Diabetes			Skin rashes / eczema
Ear / hearing trouble			Stress or depression

Yes

If yes please give details

Do you take medicine regularly?

Are you currently on any medication?

Do you suffer from any other ailment?

If yes to any of the above, please give full details below

Upload Your CV:

Declaration

I declare that the information on this form is correct to the best of my knowledge and I note that the withholding, falsification or omission of relevant information by a successful candidate are grounds for disciplinary action which may lead to dismissal. Under the Data Protection Act 1998 I understand that if I am appointed, personal information about me may be held on or verified by computer for personnel/administration purposes including statutory returns.

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