SLA - Application Form

Application for *

Reference No. *

Title
First Name *
Surname *

House Name/Number *
Address Line 1 *
Address Line 2
Town *
County *
Country *
Post Code *

Email Address

Telephone (day) *

Mobile

Telephone (Evening) *

May we contact you at work? – We will do so discreetly. Yes No

This Act describes a disabled person as a person with a ‘physical' or mental impairment which has a substantial or long term affect on his/her ability to carry out normal day-to-day activities.

Using this definition, would you consider yourself to be disabled? (Tick as appropriate) Yes No

If YES, do you require any arrangements to be made to assist you if called for interview?

Please provide details.

(Max 500 characters)

Please give details of any unspent convictions. A conviction will not necessarily exclude you from employment with Stirk Lamont but will be taken into consideration when assessing your suitability for this particular position.

(Max 500 characters)

Please summarise your previous jobs starting with the most recent.

Employer 1

Employer 2

Employer 3

Employer 4

Employer 5

Current Notice required

Current Salary

Please give details of your education, qualifications and training relevant to the application.

Place of Education	Date	Course/Qualification Completed	Grade/Result

Please give details of any current professional qualifications you hold, or are in the process of obtaining.

Name Of Qualification

Date Attained

Please give details of any current professional bodies you are affiliated with, including level of membership.

Name Of Organisation

Date

Level

List experience, achievements, knowledge, personal qualities and skills which you feel are relevant for this position.

You may include paid and unpaid work, work within the home and leisure interests.

(Max 1800 characters)

Give details of two people who have knowledge of you in a working environment, paid or unpaid. (One referee must be your current or most recent manager). If you currently work, or volunteer, for Stirk Lamont or you have done so in the past, give your current/last Stirk Lamont manager. Your current manager will only be contacted with your permission. If you are a recent student give appropriate school or college references. Personal/Character references will not be accepted.

Referee 1

Referee 2

Name *

House Name/Number *
Address Line 1 *
Address Line 2
Town *
County *
Country *
Post Code *

House Name/Number *
Address Line 1 *
Address Line 2
Town *
County *
Country *
Post Code *

Telephone

Relationship to you *

Thank you for completing the application form. Please complete the following monitoring section. Information submitted is completely confidential and your response will only be seen by the Monitoring Officer in the location where you have applied to work.

I am from a Protestant Background

I am from a Roman Catholic background

I am neither from a Protestant nor a Roman Catholic background

Please select your ethnic origin.

If you selected Other please specify

Male Female

I confirm that the information on this form is correct and complete. I understand that to withhold, falsify or omit relevant material fact will lead to disciplinary action, including dismissal in the case of a successful applicant.

Yes

Please do not submit a CV, if a CV is submitted, it will be disregarded. Unless you receive notification within 3 weeks of the specified closing date, please assume that you have been unsuccessful.

Stirk Lamont & Associates, Thomas Andrews House, Queens Road, Belfast BT3 9DU
Tel: (028) 90 653 777 Fax: (028) 90 534 577
Email: hr@sla-ltd.com
www.sla-ltd.com

Copyright Stirk Lamont Associates