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Application Form

Your addresses need to cover the past five years, please list additional addresses in the box below if necessary.

Do you have any relatives in this company?
Have you previously applied for a job within this company?

If you have answered "YES" to the above, please state when and for what position

Do you own a motor vehicle?
Do you possess a full driving license?
Have you any alleged offences outstanding against you?
(In accordance with BS 7858 and BS 7499 you are required to declare any current or pending county court judgement against you)

Your Doctor's Details

Please give details of two people, other than family, and not connected with school/college or your employment that we may approach for character references. Your character referees cannot live at the same address as you. They must have known you for at least two years Immediately prior to this application.

First character reference

Second character reference

Record your total employment history - including details of self-employment, military service and part-time work. Be sure to give full addresses and dates, service/payroll numbers, branch, trade or regiment. If there are any periods of unemployment, give the address of the Unemployment Benefit Office to which you reported.

Give details of your present or most recent employment first, then your preceding employment, finishing with your earliest job (going back 10 years).

May we approach your present employer for a reference now?

In the case of periods of self-employment, please give references or name and address of someone who can confirm the details:

Please ensure you fully read and understand the following prior to submitting this application.


If offered employment you will be appointed on probation for a period of 16 weeks.

I authorise Securi-Guard to obtain all details of employment and unemployment periods from previous employers. I understand that any appointment made will be subject to satisfactory references and a credit check (in compliance with the Data Protection Act) being received by the Company.

I certify that, to the best of my knowledge, the information that I have given is true and complete. I certify that I have never been convicted of any criminal offence (other than a conviction that is 'spent' under the terms of the Rehabilitation of Offenders Act 1974), declared bankrupt or been dismissed from any previous employment for dishonesty or misconduct. I am not the subject of any Police enquiry that could result in my being charged with a criminal offence.

I understand that any false statement or omission may render me liable to dismissal without notice. I accept that I may be required to undergo a medical examination where requested by the Company and I consent to the results of such examinations being given to a Company Director.

The information provided on the application form will remain private and confidential and will only be used for the purposes of selection/recruitment or for subsequent employment administration if the application is successful.



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