Ref: .

APPLICATION FOR EMPLOYMENT

This application pack includes an application form, health questionnaire and fair employment details.
Application packs will be rejected if not completed in full. CV's are not accepted as substitutes.

Job Applied for: Date .

1. PERSONAL DETAILS
TITLE: DATE OF BIRTH:
SURNAME: NATIONAL INSURANCE NUMBER:

FIRSTNAME: EMAIL:

ADDRESS: MOBLIE NUMBER:

POSTCODE: HOME NUMBER:

NEXT OF KIN DETAILS ADDRESS:
NAME:

RELATIONSHIP: CONTACT NUMBER:

2. EDUCATION AND QUALIFICATIONS (USE SEPARATE SHEET IF NECESSARY)

School / College Attended Dates Examinations / Subjects Taken Results/Awarding
Body

Page 1 of 9
3. EMPLOYMENT RECORD Must be fully completed in date order. Include relevant training etc.
Dates
Name & Address of Employer Position Held Responsibilities of post Reasons for leaving Salary /
Wage
FROM TO

Page 2 of 9
4. OTHER INFORMATION
Details of spare time
interests

Is apprenticeship served? YES NO

If ‘YES’, which craft?

Where served?

Please list other skills in support of application:

5. APPOINTMENT INFORMATION
Present period of notice:
Date available for starting MOYOLA:
Are you prepared to work: If “NO” please give reasons:
OVERTIME YES / NO
SHIFT WORK YES / NO
Dates unsuitable for interview:
Do you hold a current driving licence? YES / NO
Are you a car owner? YES / NO
Have you been dismissed from any type of employment? YES / NO

If ‘YES’ give details:

Have you ever received or claimed compensation for an injury of any kind? YES / NO
If ‘YES’ give details:

Where did you hear about this position?

6. GENERAL INFORMATION

Page 3 of 9
 7. REFERNECS Name and Address of two persons
who know you in a work or school capacity. If unemployed,
past employers or teacher may be given.

Reference One Reference Two

Name:
Address:

Telephone number:
Job Tile:

8. FAIR EMPLOYMENT DETAILS

Please complete attached form - MONITORING FORM

9. HEALTH QUESTIONNAIRE DETAILS

Please complete attached form – HEALTH QUESTIONNAIRE

10. PRIVACY NOTICE

Please read and sign attached notice – PRIVACY NOTICE

11. DECLARATION
I certify that the information given in this application form is accurate. I understand that to give false information
could result in withdrawal of job offer or dismissal from the company.

SIGNED: DATE .

PLEASE FORWARD THIS COMPLETED APPLICATION FORM TO:

edel@moyola.com or post to Office Administrator
Moyola Precision Engineering, 4-8 Curran Road, Castledawson, Magherafelt, Co. Londonderry Northern
Ireland BT45 8AF. Telephone +44 (0) 28 7946 8349 Fax: +44 (0) 28 7946 8941

FOR OFFICE USE ONLY

Interviewer 1: Date: .
Interviewer 2: Date: .
Interviewer 3: Date: .

Job Offer: YES / NO

Interview Notes

Page 4 of 9
 HEALTH QUESTIONNAIRE

Full Name, title (Mr, Mrs, Miss or Ms.) and address: Your Doctor’s name and address:

Date of Birth:

Position applied for:

Please answer the following questions by ticking the appropriate boxes:

Have you ever suffered from, had any symptoms of or been treated If the answer is YES, give full details of
for the following: dates, severity, duration, etc.
YES NO
1. Depression, anxiety, nervous illness or breakdown
2. General debility from work or any other cause
3. Headaches / migraines / fainting attacks / fits or any other
disease of the nervous system
4. Persistent cough, asthma, pleurisy, bronchitis or any
ailment of the lungs or chest
5. Rheumatism, arthritis, gout, backache, ‘disc’ trouble or
rheumatic fever
6. Palpitations, shortness of breath, chest pains, raised blood
pressure or other ailments of the heart or circulatory system
7. Persistent indigestion, diarrhoea, gastric or duodenal
ulcers, gall stones or any ailments of the stomach, intestines
or liver
8. Any ailments affecting the kidneys or bladder
9. Diabetes, anaemia, or any blood or gland condition
10. Ailment affecting the eyes, sight, ears or hearing
11. Varicose veins, ruptures or piles
12. Any accident, injury, operation or deformity
13. Skin disorder, dermatitis, other allergy
14. Any illness or complaint not mentioned above
15. Have you ever had any x-ray, special medical
investigation, cardiogram, or blood or urine test
16. Are you now or have you recently been taking any
tablets, medicine or other medication?
17. Have you ever had any illness or disease involving
treatment with Cortisone or other steroids?
18. Are you a registered disabled person? If so please give
your registration number and state the nature of your
disablement.
19. What is your weekly consumption of:
Alcohol: .
Tobacco: .
Drugs: .
Has it ever exceeded this amount:
20. Have you been absent from work in the past 12 months
due to medical issues? If so, please give full details.
21. Have you ever claimed for an industrial injury? If YES

Page 5 of 9
please give full details.
22. Are you colour blind? If YES please give full details.
23. During the last 2 years, have you been consulted or been
treated by:
A doctor or medical practitioner?
A physiotherapist?
A Chiropractor?
An Osteopath?
A psychiatrist?
Any other?
24. Have you ever been hospitalised during the last 5 years?
25. Do you know of any medical reasons why you should
need time off, not be a good timekeeper or not be fully
available for work, including overtime and shifts if relevant,
during the next 12 months?
Please give details.

DECLARION: (Please read carefully before signing)

1. I hereby confirm that the information given on this medicheck is complete and correct and I understand any
untrue, incomplete or misleading information will give Moyola Precision Engineering Ltd the right to terminate any
contract of employment given

2. I hereby authorise Moyola Precision Engineering Ltd to contact any doctor for any further and better details of
my medical records and state of health and hereby authorise my doctor to release such details as are necessary in
connection with this application for employment.

3. I hereby agree to have medical examination if required by Moyola Precision Engineering Ltd in connection with
this application for employment.

Signed: Date: .

PRIVATE AND CONFIDENTAL

Page 6 of 9
 Reference No: .

MONITORING INFORMATION

In order to comply with Fair Employment legislation, the Company is required to monitor the Perceived Community
Background of applicants and employees. You are consequently required to complete the following sections.
Please note that this information WILL NOT be made available to those involved in the recruitment.

Please mark an ‘X’ the appropriate boxes:

Gender: MALE FEMALE

Please indicate the community to which you belong by marking an ‘X’ the appropriate box below:

I am a member of the Protestant Community

I am a member of the Roman Catholic Community

I am a member of neither the Protestant nor the Roman Catholic Community

Page 7 of 9
 PRIVACY NOTICE

Job Applicant Privacy Notice (compliant with GDPR)

As part of any recruitment process, Moyola Precision Engineering collects and processes personal data relating to job
applicants. The organisation is committed to being transparent about how it collects and uses that data and to meeting
its data protection obligations.
What information do we collect?
Moyola Precision Engineering collects a range of information about you. This includes:
 your name, address and contact details, including email address and telephone number;
 details of your qualifications, skills, experience and employment history;
 information about your current level of remuneration, including benefit entitlements;
 Information about your health, including any medical condition, health and sickness including pre-employment
screening.; and
 information about your entitlement to work in the UK

Moyola Precision Engineering may collect this information in a variety of ways. For example, data might be contained
in application forms, CVs or resumes, obtained from your passport or other identity documents, or collected through
interviews or other forms of assessment.

We may also collect personal data about you from third parties, such as references supplied by former employers. We
will seek information from third parties only once a job offer to you has been made and will inform you that we are
doing so.

Data will be stored in a range of different places, including on your application record, in HR management systems
and on other IT systems (including email).

Why does Moyola Precision Engineering process personal data?

We need to process data to take steps at your request prior to entering into a contract with you. We may also need to
process your data to enter into a contract with you.

In some cases, we need to process data to ensure that we are complying with its legal obligations. For example, it is
mandatory to check a successful applicant's eligibility to work in the UK before employment starts.

Moyola Precision Engineering has a legitimate interest in processing personal data during the recruitment process and
for keeping records of the process. Processing data from job applicants allows us to manage the recruitment process,
assess and confirm a candidate's suitability for employment and decide to whom to offer a job. We may also need to
process data from job applicants to respond to and defend against legal claims.

Moyola Precision Engineering may process special categories of data, such as information about ethnic origin, sexual
orientation or religion or belief, to monitor recruitment statistics. We may also collect information about whether or
not applicants are disabled to make reasonable adjustments for candidates who have a disability. We process such
information to carry out its obligations and exercise specific rights in relation to employment.

If your application is unsuccessful, Moyola Precision Engineering may keep your personal data on file in case there
are future employment opportunities for which you may be suited. We will ask for your consent before it keeps your
data for this purpose, and you are free to withdraw your consent at any time.

Page 8 of 9
 Who has access to data?
Your information may be shared internally for the
purposes of the recruitment exercise. This includes members of the HR and recruitment team, interviewers involved in
the recruitment process, managers in the business area with a vacancy and IT staff if access to the data is necessary for
the performance of their roles.

Retention
Moyola will only retain your personal data for as long as necessary to fulfil the purposes for which it was collected.
Unsuccessful applicants’ personal data will usually not be stored for longer than six months from the date of
application.

In some circumstances we may anonymise your personal information so that it can no longer be associated with you,
in which case we may use such information without further notice to you. If you accept an offer of employment with
us then our employee privacy notice will govern how we process your personal information. Records will be retained
and destroyed in accordance with our records retention schedule.

Singed: Date: .

Page 9 of 9