Title

Select Title Mr Mrs Miss Ms

Date of Birth

Surname:

Forename:

Address:

City

Postcode:

Tel No (Home):

Mobile No:

Email:

Position applied for:

Salary Expected:

Which location are you applying for?

Select Location Leicester Northampton Nottingham Slough Wakefield Welwyn Garden City West Midlands

Are you authorised to work in the UK as either a citizen or by holding a valid permit to work in

the UK?

Have you ever applied for a job at BPX before?

Yes No

If so, when?

Where did you hear about the vacancy?

Have you been referred by an Employments/ Recruitment Agency?

No

Yes

If so, whom?

When would you be able to start?

Have you any outstanding holiday commitments? If so, please give details

Do you Hold a current driving licence?

Yes No

Please state any accidents or convictions over the past five years or any convictions that may be pending::

Do you have any criminal convictions or any pending? If so, please state below:

Do you keep in good health?

Approximately how many days sick leave have you taken over the past two years?

Do you suffer from any long-term illnesses or conditions that could affect your ability to fulfil your job responsibilities? If so, please state below:

Do you smoke?

Yes No

Please detail any relevant experience:

Please detail your appropriate qualifications:

Why would you be an ideal candidate for this position?