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Jubilee Application Form

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Candidate ID
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Candidate Unique Key*
Name and Login Details
Please confirm your name*
Title First Last
Email*
Note: any uppercase characters will be converted to lowercase for your login
Enter Email Confirm Email
Password*
Enter Password Confirm Password
Contact Details and Address
Telephone #1*
e.g. The main number you use - mobile for most people
Telephone #2
e.g. Your home number
Telephone (Work)
Address*
Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

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About you
Date of Birth*
DD dash MM dash YYYY
Gender*
- Male
- Female
Number of Dependants
Marital Status*
Nationality*
Ethnic Origin*
Religion*
Sexual Orientation*
Any unspent convictions?*
- Yes
- No
Please specify details, of your unspent convictions*
Driving Details
- Full Licence
- Licence with no points
- Car owner
- Own other transport
Where did you hear about us (Jubilee)*

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Where to pay you
National Insurance Number*
Bank Name*
Bank Branch*
Account Name*
Sort Code*
Account Number*
Please double-check these Bank Details. Jubilee will not be held responsible for incorrect bank details.

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Your References
It is important we collect three references before you can start work. This is mandatory for some of our clients, make sure all information is accurate. Speak to your referees to ensure swift response.
Reference One
Company Name*
Employed from*
DD dash MM dash YYYY
Employed To
Leave blank if you are still employed here
DD dash MM dash YYYY
Reference Contact Name*
Reference Phone Number
Reference Email*
Your Job Title*
Your Job Details*
include your salary at the time of leaving (or current salary if you are still employed here)
Reference Two
I do not have any further employment history
If you have only ever had one employed position you may use a personal reference from a suitable person (i.e. Professor or Teacher)
- Use a personal reference
Company Name*
Employed From*
DD dash MM dash YYYY
Employed To*
DD dash MM dash YYYY
Reference Contact Name*
Reference Phone Number
Reference Email*
Your Job Title*
Your Job Details*
include your salary at the time of leaving (or current salary if you are still employed here)
Reference Job Title / Position within Community*
Relationship with Reference*
Please describe your relationship with your referee. It is important to detail a date range of how long they will have known you for.
Temporary Assignments
Have you had any recent temp work with an agency?
- Yes
Agency Name*
Agency Contact Name*
Hourly rate / renumeration*
Type of work*
Please give details of the client you worked for and the nature of your work for them

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Sector
Sector*
What sector are you looking to work within?
Work Criteria
Notice Period / Availability (Days)*
Hours (per week) you are available to work*
Distance (in miles) you are prepared to travel*

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Your Health and Wellbeing
Health Conditions
Do you, or have you ever suffered from any of the following health conditions?
Colour Blindness / Eye Problems / Migraines
- Yes
Hearing Loss - wearing of hearing aid
- Yes
Back / Leg pain or injury
- Yes
Shoulder / Arm / Hand Pain or injury
- Yes
Pleurisy / Bronchitis / asthma / Hay Fever
- Yes
Heart problems / High blood presure
- Yes
Diabetes
- Yes
Eczema / Psoriasis / Dermatitis / Skin Problems
- Yes
Chronic indigestion / Stomach ulcers
- Yes
Alcohol related health problems
- Yes
Nervous breakdown / Depression / Anxiety
- Yes
Fainting Attacks / Giddiness / Epilepsy
- Yes
Ruptures
- Yes
Pneumonia
- Yes
Kidney trouble
- Yes
Varicose veins
- Yes
Recurring stomach problems
- Yes
Bowel problems
- Yes
Vision problems
- Yes
Neck trouble
- Yes
Have you taken time off work in last 3 years due to illness or injury?*
- Yes
- No
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Please give details about your time off work in last 3 years due to illness or injury*
Currently taking drugs, medicine that may affect work?*
- Yes
- No
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Please give details about how your current taking drugs and/or medicine may affect your work*
Do you suffer from any condition or disability that may affect your work?*
- Yes
- No
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Please give details on how your condition or disability may affect your work*
Are you a current smoker?*
- Yes
- No
Are you registered disabled?*
- Yes
- No
Please give details here*
Your Doctor
Doctors Name
Name of Surgery
Surgery Contact Number
Surgery Address
Next of Kin / Emergency Contact Details
Name*
Best contact number*
Alternative Contact Number
Relationship*
Comments
This field is for validation purposes and should be left unchanged.

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