Application Form V1310 (Page 4 of 4) in pdf

Application Form V1310 Page 4

ADDITIONAL INFORMATION – Please provide here any additional information that you consider relevant to your

application (If required additional A4 page(s) will be accepted)

HEALTH

Have you had any serious illness, operation or accident? (Indicate as appropriate)

YES/NO

If yes please give details

Do you currently suffer from any serious illness? (Indicate as appropriate)

YES/NO

If yes please give details

Are you registered disabled (Indicate as appropriate)

YES/NO

If yes what is your registration number

DECLARATION

I declare that if employed, I agree to abide by the conditions and conform to all company regulations. I certify that the information given on this form is

factual and correct to the best of my knowledge and belief and understand that the deliberate provision of false information may result in the application

being withdrawn, an offer of employment being withdrawn or employment being terminated.

DATA PROTECTION STATEMENT FOR MCCALLS OF LISBURN LTD

The information on this form is required by the company for the purpose of processing your application. The information is covered by the

provisions of the Data Protection Act 1998. Your signature to the form is deemed to be an authorisation by you to allow the company to process

and retain the information for the purpose(s) stated.

Signature

Date