Staff Registration

Application Date

Salutation

First Name

Surname

Date of birth

Position applying for?

Please specify

Have you been a resident of United Kingdom since Birth?

Yes

Have you lived outside of the UK in the past 6 months?

Yes

Please give the date of entry into the United Kingdom

Phone Number

Full Address

City

State/Province

Zip/Postal

Country

Email Address

National Insurance Number

Unique Tax Reference UTR Number

Do you have right to work in the UK? Please be prepared to provide evidence if requested.

Yes

Visa information (If applicable)

Do you have a valid driving licence?

Yes

Please input driving licence number

Next of kin for emergency contact

Next of kin phone number

Next of kin relationship to you?

Any Medical conditions?

Are you taking any medications or undergoing any treatments?

Do you suffer from substance dependency, misuse or abuse?

Yes

Do you suffer from alcohol dependency, misuse or abuse?

Yes

Is there any further relevant information that could affect your ability to work? Please detail:

Do you hold a valid SIA issued licence?

Yes

Security Licence Number

Is this your first licence that has been issued?

Yes

How many previous licences have you been issued?

Have you completed the action counter terrorism course as required? (ACT)

Have you completed a medical course which is equal to or greater than the emergency first aid work qualification? (EFAW)

Do you have any criminal convictions within the last five years?

Yes

Please provide details, include conviction and date and any other relevant information regarding your conviction(s)

Do you hold any fire marshalling / Warden or higher certification?

Yes

Please provide further details

Previous address history in the past 5 years?

Name on account

Sort Code

Account Number

I agree to the terms and conditions and offer my services to Ardour security Group Ltd upon successful completion of my screening and vetting. I here by certify that to the best of my knowledge, the details I have given in this application form are complete and correct. I understand that it is a criminal offence to attempt to obtain employment by deception and that any miss presentation or omission of a material fact or deception will be cause for immediate termination of this agreement. The decisions made by the directors or senior management is final.

Applicants name

Applicants signature

Date of completion

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