Consultant *

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First Name *

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Last Name *

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Address

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Postcode

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Email *

Please enter a valid email address.

Do you hold a valid driving license?

Yes No

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Do you have your own means of transport?

Yes No

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Do you hold a Disclosure Barring Certificate (DBS)?

Yes No

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Pronouns

He/Him She/Her They/Them Other Prefer not to say

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References

Please give the names and addresses of two recent employers. We reserve the right to contact any of your other previous employers within the last three years.

Reference 1 *

Ensure the following information is included (Name, Job Title, Organisation, Address, Contact Number, Email, How is this person known to you?)

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Reference 2

Ensure the following information is included (Name, Job Title, Organisation, Address, Contact Number, Email, How is this person known to you?)

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Please list up to 3 job roles you are interested in *

(Please only list jobs you have relevant experience in)

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What hours / days of work are you looking for?

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What are your salary expectations?

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Please list the locations in which you are seeking employment?

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Please provide any additional information regarding your experience in the roles you seek?

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Do you have any health issues including mental health, disabilities or pending operations that we need to be made aware of in relation to the roles you seek?

Yes No

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Criminal Convictions (Unspent criminal convictions?)

Yes No

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If yes, state convictions and dates

(NB Certain types of employment and professions are exempt from the Rehabilitation of Offenders Act 1974 and in those cases particularly where the employment is sought in relation to positions involving working with children or vulnerable adults, details for all criminal convictions must be given. The information given will be treated in the strictest of confidence and only taken into account where, in the reasonable opinion of [insert company name], the offence is relevant to the post to which you are applying. Failure to declare a conviction may require us to exclude you from our register or terminate an assignment if the offence is not declared but later comes to light)

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Declarations

I agree that Adkins & Cheurfi Ltd can create and maintain computer and paper records of my personal data and that this will be processed and stored in accordance with the Data Protection Act 1998.

You need to agree with the terms to proceed

I confirm that all the information given by me on this form is correct and accurate and I understand that if any of the information I have provided is later found to be false or misleading, any offer of employment may be withdrawn or employment terminated.

You need to agree with the terms to proceed

I can confirm that Adkins & Cheurfi Recruitment ltd has been authorised to hold my CV and approach companies as discussed with my agent on my behalf to find me permanent employment.

You need to agree with the terms to proceed

Additionally, I confirm that I have not applied directly to any of the companies that we agreed to approach, nor have I authorised any other Recruitment Agency or third party consultancy to submit my details for consideration for any of these position during the last 12 months.

You need to agree with the terms to proceed

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