Confidential: This form must be completed in full by all candidates.
Personal information
Surname

First Name

Permanent Address

Postcode

Contact details
Home

Work

Mobile

Email address

Reference :
Two referees are required. One of these should be your present or most recent employer. These will not be contacted until after the interview.
Present/most recent employer
Name

Address

Email address

Mobile

Capacity in which known to you

Second referee
Name

Address

Email address

Mobile

Capacity in which known to you

Education
Please give here relevant details of education and qualifications including current/proposed courses.
School/University

Date

Qualification Dates

Employment
Present or most recent post (paid or unpaid.
Job Title

Salary

Name and address of present or most recent employer:

Reporting to

Date started

Date of leaving (if applicable)

Reason for leaving:

Please give a brief description of duties and responsibilities:

Additional information
Are there any dates when you would be unavailable for an interview?

Do you need a work permit to work in the UK?

If yes please specify:

Equal Opportunities Monitoring Form (Confidential)
In order to ensure that Bahay Kubo HA Ltd. continues to develop its commitment to equal opportunities, all applicants are asked to answer the questions below. This information will be treated as confidential and used solely for monitoring purposes. The form will be separated from the application form on receipt before short-listing of candidates takes place.
Type of Application

How did you find out about this vacancy? (please tick one box only)
National PressLocal PressLeaflet / Flyer / Email shotFriends in the communityOther (please describe)
I would describe my ethnic origin as
White BritishIrishAny other white background
Asian or Asian British IndianPakistaniBangladeshiAny other Asian background
Mixed White & Black CaribbeanWhite & Black AfricanWhite & AsianAny other mixed background
Black or Black British CaribbeanAfricanAny other Black background
Filipino or other ethnic group FilipinoAny other background
Please describe your religious group

How would you describe your sexual orientation?
HeterosexualGayLesbianBisexualNon BinaryOther (please describe)
Please indicate your age and gender
MaleFemalePrefer not say
Date of Birth

Age

Please indicate the number of days taken as sick leave from work in the last two years:

Please give reasons for such absences:

Have you had any hospital treatment in the last five years?
YesNo
If YES please give details:

Do you consider yourself to have a disability?
YesNo
If YES please give details:

Do you have any other health problem, which limits your daily activities or the work you can do?
YesNo
If YES please give details:

May we ask your GP for a medical reference before offering employment?
YesNo
Would you be willing to be medically examined at Bahay Kubo’s expense?
YesNo
Declaration
I declare that the information provided on this form, and on any accompanying documents, is true to the best of my knowledge and belief.
I agree that the content of this form and of any accompanying documents may be treated as part of any contract agreed between myself and Bahay Kubo HA Ltd.