• Positions: Speculative EnquiryFabrication
• Where did you hear about the vacancy at Roger Dyson:

• Surname:
• Forename:
• Address:
• Telephone Number:
• Mobile Number:
• Email Address: *
• National Insurance (NI) Number:

• Company Name:
• Company Address:
• Company Telephone Number:
• Length of Service:
• Job Title:
• Annual Rate:
• Duties and Responsibilities:
• Reason for leaving(if appropriate):

• School and Further Education(with address):
• Subject:
• Course Type(i.e. GCSE, NVQ):
• Grade:

(For example - First Aid, Manual Handling, Slinging, Welding ect)

• Training Organisation:
• Course attended:
• Length of course:
• Exam Type:
• Grade(if known):

Please record any additional information you feel would be useful in support of your application. This will help us to see how you feel your particular skills match up to the requirements of the job. It is therefore important that you tell us as much as possible about yourself in relation to all the items listed in the job description.

• Additional Information:

Please enter relevant licence numbers below

Forklift (please specify the relevant type and specify details inc. size)

• Full:
• Provisional:
• Motorcycle:
• HGV:
• Counter Balance:
• High Reach:
• Other:
• Do you have any points on your license? Yes: No:
• If Yes, please give details:
• Do you have your own transport? Yes: No:
• If Yes, what mode is it (car, bike)?
• If you do not have transport, how do you anticipate getting to work?

Please give details of two referees, if possible one needs to be a previous employer. You should have known the following people for at least two years, they cannot be family members and cannot share the same living accommodation as you.

Reference 1

• Full Name(Mr/Mrs/Ms):
• Address:
• Contact telephone number:
• Email Address:
• Relationship to you:

Reference 2

• Full Name(Mr/Mrs/Ms):
• Address:
• Contact telephone number:
• Email Address:
• Relationship to you:

I declare to the best of my knowledge and belief, all particulars I have given are complete and true. I understand that any false declaration or misleading statement or a significant omission may disqualify me from employment and render me liable to dismissal. I understand that any job offer is subject to references and (if the organisation believes appropriate) a medical report, all of which must be deemed satisfactory.

If applying online your signature will be required on this application form if you are invited to an interview.

• Please Type Name:
• Please Type Date:

Roger Dyson aims to be an equal opportunities employer and we select solely on merit irrespective of race, sex, disability etc. In order to monitor the effectiveness of our equal opportunities policy, we request all applicants to provide the information indicated. This form is confidential and will be kept separate from your application. It will not form part of the short listing process.

• Gender: Male: Female: Prefer not to say:
• Date of Birth:
• Ethnicity: Asian or Asian British - BangladeshiAsian or Asian British – IndianAsian or Asian British – PakistaniAsian or Asian British – Other Asian backgroundBlack or Black British – AfricanBlack or Black British – CaribbeanBlack or Black British – Other backgroundChineseMixed – Any other Mixed backgroundMixed – White and AsianMixed – White and Black AfricanMixed – White and Black CaribbeanWhite – BritishWhite – IrishWhite – Any other White backgroundOther ethnic groupPrefer not to say

The following information about your disability needs will help us to provide the support you require. Do you have any disability, health or learning problems which may affect the kind of work you can do? (this may include colour vision defects, asthma, dyslexia or hearing problems)

• Do you have any disability, health or learning problems? Yes: No:
• If Yes, please provide details:
• Do you require any special facilities to attend the interview: Yes: No:
• If Yes, please provide details:

I confirm that the information supplied regarding equal opportunities and rehabilitation of offenders is correct.

• Please Type Name:
• Please Type Date: