Please print this page and send it to:- Alan Simpson. General Manager. The Old Keswickian. Market Square, Keswick Cumbria CA12 5BD Please note:- Write clearly, and only send copies of CV’s and references as they cannot be returned. 1) Personal Information Forename……………………………………………………………… Surname ……………………………………………………………… Address ………………………………………………………………………………………………… ………………………………………………………………………………………………… Post Code ……………………………………………… Tel: Number ……………………………………………… Mob: Number ……………………………………………… 2) Present Employment Name, Address and Telephone number of present or most recent employer………………………… ………………………………………………………………………………………………………… Position held…………………………… Amount paid: hourly or weekly………………………… Date of employment from …………/……………/…………… To……………/…………/……………… Please briefly describe your work:…………………………………………………………………… ………………………………………………………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………………………………………………………… 3) Educational/Training/Development Please list the relevant qualifications that you have obtained in school, college or training institute. Dates: School/College/Training Name of coarse and qualifications achieved (from-to) Please continue on a separate sheet if necessary. 4) Health Is there anything in you medical history, such as serious illness, disability or injury which may affect your ability to work for us? If so, is there anything we could provide to assist you? Please give details…………………………………………………………………………………… ……………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………… Please continue on a separate sheet if necessary. 5) Car Details Do you have a current driving licence Yes/No Do you have the use of a car during working hours Yes/No 6) References Please provide the name or names, addresses and telephone numbers of referees, one of which should be your present or most recent employer. Please indicate in what capacity you know the referees. 1)………………………………… 2)…………………………………… …………………………………… …………………………………… …………………………………… …………………………………… …………………………………… …………………………………… …………………………………… …………………………………… …………………………………… …………………………………… …………………………………… …………………………………… 7) If selected when could you start work? ……/……/…… 8) Please sign to confirm that the information provided on this form is, to the best of your knowledge, true and accurate. Signature……………………………… Dated ……/……/