Your Name (required)

Your Email (required)

SIA Licence Number

Address

Previous Address (if less than 3 years at current)

Phone Number

Mobile Number

National Insurance Number

Driving Licence held?
YesNo

Car owner?
YesNo

Place of birth (if not UK):

Marital Status
SingleMarriedDivorced

Height (cm)

Weight (kg)

Eye colour

Next of Kin
Next of Kin name

Next of Kin Relationship

Next of Kin Telephone

HAVE YOU EVER APPEARED BEFORE A COURT CHARGED WITH A CRIMINAL, CIVIL OR MILITARY OFFENCE AND BEEN CONVICTED INCLUDING ANY MOTORING OFFENCES?

YesNo

HAVE YOU ANY ALLEGED OFFENCES OUTSTANDING?

YesNo

If yes, please give details below.

Personal Referees (not family & known for at least 2 of the last 5 years. Note we may contact these for a reference)

Referee 1 name

Referee 1 Address

Referee 1 Telephone

Referee 1 Period Known

Referee 2 name

Referee 2 Address

Referee 2 Telephone

Referee 2 Period Known

Personal History
Please provide your full work history in the box below, including (for each employer):

- employers' full name
- address
- telephone number
- the name of the person you reported to
- position in company
- employment dates
- reason for leaving

Have you ever been made bankrupt?

YesNo

Do you have any County Court Judgements (CCJs)?

YesNo

Do you consent to the Company running a credit check against your details?

YesNo

School History
Please provide the following details for the last school you attended:

- School name
- Town/City
- Month/year you left

College History
Please provide the following details for any college you attended in the last 10 years:

- College name
- Town/City
- Month/year you left

I CERTIFY THAT TO THE BEST OF MY KNOWLEDGE, THE INFORMATION IHAVE GIVEN IS COMPLETE AND CORRECT, AND I UNDERSTAND THAT MISREPRESENTATION OF FACTS IS GROUNDS FOR IMMEDIATE DISMISSAL AND RENDERS ME LIABLE FOR PROSECUTION. I AUTHORISE THE COMPANY TO APPROACH ANY GOVERNMENT AGENCIES, FORMER EMPLOYERS,CREDIT AGENCIES AND PERSONAL REFEREES TO VERIFY THE INFORMATION GIVEN, AND WILL SUPPLY A STATUTORY DECLARATION IF REQUIRED (I GIVE PERMISSION FOR MY PRESENTEMPLOYER TO BE APPROACHED).

FULL NAME: DATE:

Yes - I agree to the Sole Trader Terms & Conditions as outlined in this document.