Job Application Form

Please complete all parts of this form. Where boxes appear, please tick those that apply.

Starting Point Recruitment, Challenge Building, Hatherton Road, Walsall, WS1 1XS If you require assistance in completing this form or need the form in a different format please contact us:

Tel: 01922 422 480 Fax: 01922 622 133 Email:

Part 1 - Personal Details

Job Title: Machine%20Operator Job Reference: SPRP042
Surname: First Name(s): Title:
Address Line 1:
Address Line 2:
Address Line 3: Postcode:
Daytime Telephone Number (including STD code): Evening Telephone Number (including STD code):
Mobile Telephone Number:
Email address:
Date of Birth:
National Insurance Number:
Please indicate the type(s) of work you are looking for:
This organisation is committed to safeguarding and promoting
the welfare of its candidates.
Please be aware that depending on the type of work you are
looking for you may be required to undertake a Criminal Record Check. This will be discussed with you at interview.
Taking into account the type of work you are looking for, please list any criminal convictions or proceedings against you.
Under the Rehabilitation of Offenders Act 1974 some convictions can
be considered spent and therefore do not need to be declared, but please refer to your 'How To Apply' booklet for more information
or contact us for guidance.
Criminal Convictions:
Do you require a work permit to take up work in the UK?:
Yes No
If yes, does your permit need extending?
Yes No
All applicants will be asked to provide proof of their eligibility to work in the UK at interview.
Do you have a current driving licence?
Yes No
If yes, please specify type and any driving endorsements you may have:
Expected wage per hour £:
The date from when you would be able to start work:
Where did you hear about Starting Point Recruitment?
Job Fair/Event: Internet: Word of Mouth: Newspaper: Other:

Part II - Education and Training

Please list details of your qualifications and any training courses that you have attended, starting with the most recent. Continue on a separate sheet if necessary.

Establishment Qualifications/Training Course Grade
(if applicable)

Part III - Work and Work Related Experience

Please list all your periods of work and work related experience, starting with the most recent. You should cover a minimum of 10 years' employment, or all your employment history if it is less than 10 years since you left school. This can include temporary jobs, voluntary work, work for charities, clubs and societies as well as periods of permanent employment. Continue on a separate sheet if necessary.

Name of Organisation
and Nature of Business
Dates Position Held/
General Duties
Salary Reason for Leaving
From To Start Finish

Part IV - Hobbies and Interests

Part V - Skills and Abilities

Please outline those skills and abilities, which you feel may support your application. You may want to refer to past experiences. Continue on a separate sheet if necessary.

Part VI - Additional Information

Please detail any additional information which you feel is important in supporting your application. Continue on a separate sheet if necessary.

Part VII - References

Please provide details of two work-related referees to cover a minimum of the last 2 years, one of these should be your present or most recent employer. Should you be applying for a social care related role you will be required to provide referees covering at least the last 5 years of your employment history. If you are unable to give a present or previous employer, please provide details of someone who can give evidence of your abilities and experience, such as a college tutor.

Present/Last Employer
Please tick this box should you prefer your present employer not to be contacted prior to interview.
Relationship to Referee:
Relationship to Referee:
Dates Covered:
From To
Dates Covered:
From To
Address Line 1:
Address Line 1:
Address Line 2:
Address Line 2:
Address Line 3:
Address Line 3:
Email Address:
Email Address:
Telephone Number:
Telephone Number:

Part VIII - Declaration

I certify that the information I have given is correct and that I have not omitted any relevant information.

I understand that any information, which I have provided, will be held securely and in accordance with the Data Protection Act 1998. The information may be disclosed to your parent company Steps to Work (Walsall) Ltd in support of my search for work. The information may also be disclosed to the following third parties; survey and research organisations, organisations that monitor the improper use of public funds, local government authorities, central government authorities, law enforcement authorities and prospective assignments. I understand that any information passed to a third party will be held securely by that party, in accordance with the Data Protection Act 1998.

I understand that the information given as part of this application form will also be used to monitor the effectiveness of Starting Point Recruitment policies and practices, and in particular its Equal Opportunities in Employment Policy and that this monitoring is for statistical purposes only and I will not be identifiable from this process.

Application forms of unsuccessful candidates will be destroyed within twelve months of registration.


Part IX - What Happens Next

Once we receive your application we will write to you to confirm that we have your details.

Your application will then be reviewed by our team of consultants, and depending on your application and the work we have available you will be invited to attend an interview. Please do not be concerned if you do not hear from us straight away.

Interview Requirements

To ensure we are able to meet your needs please use this space to tell us if you have any special requirements in the event that you are called for an interview, for example access requirements, interpreter, hearing loop etc.

Please indicate those days that you will be available for an interview.

Monday Tuesday Wednesday Thursday Friday

Please note that depending on the type of work you are applying for the interview may include a skills test, for example a typing test for office work. For more details on our interviews please refer to your 'How To Apply' booklet


We welcome applications from all members of the community. For us to be able to monitor our recruitment and selection practices we would ask you complete this page and return it to us with your application form. The information you provide is for statistical purposes only.

Under the Disability Discrimination Act 1995 the definition of a disability is: 'A person has a disability for the purpose of this Act if s/he has a physical, mental or sensory impairment which has a substantial and long term effect on his/her ability to carry out normal day to day activities'.

Do you have such a disability? Yes No Prefer not to say

Ethnic Origin Religion or Belief
Asian or Asian British - Bangladeshi
Asian or Asian British - Indian
Asian or Asian British - Other
Asian or Asian British - Pakistani
Asian or Black British - African
Asian or Black British - Caribbean
Asian or Black British - Other
Gypsy / Roma
Mixed - Other
Mixed - White & Asian
Mixed - White & Black African
Mixed - White & Black Caribbean
White - British
White - Irish
White - Other
Prefer not to say
Jehovahs Witness
No religion
Prefer not to say
Marital Status Sexual Orientation
Prefer Not To Say
Gay man
Gay woman / lesbian
Heterosexual / straight
Dont Know
Prefer not to say
Employment on Entry
Permanent Employment
Temporary Employment
Unemployed not Claiming Benefits
Unemployed Claiming Benefits
*Benefits Claimed: