THE ATTACHED APPLICATION FORM MUST BE COMPLETED

WITH ALL INFORMATION REQUESTED.

PLEASE NOTE: PERIODS OF EMPLOYMENT, UNEMPLOYMENT OR SELF

EMPLOYMENT MUST BE SUPPLIED BY YOU FOR THE PREVIOUS 5 YEARS;
FAILURE TO DO SO MAY RESULT IN EMPLOYMENT BEING REFUSED.
To enable us to commence the screening process and offer you
Employment we require you to supply us with the following documents

Accepted Proofs of ID Documents to be verified in person

Birth Certificate SIA LICENCE (If Applicable)
Valid Passport DBS Certificate (If Applicable)
Driving Licence

Two official proofs of address

Utility Bill, (Gas, Electricity, BT Phone Bill, Satellite/Cable TV)
Note: - Mobile phone bills are not acceptable
Bank Statement /Credit Card Statement (dated within last 3 months)
Council Tax Notification
Rent Payment Book

Right to work
Documents showing leave to remain and work in the UK, if non-UK citizen, if
non-UK passport holder, Home Office letter (Original)
Proof of National Insurance Number

Evidence of employment history

Use the link below to request your employment history
HMRC Personal tax account link: https://www.gov.uk/personal-tax-account
Use your Universal Credit Portal to confirm all periods of
unemployment: https://www.gov.uk/sign-in-universal-credit
THIS IS MOST IMPORTANT

Additional Requirements
4 passport sized photographs or send in a digital passport photo
School Record of Achievements/Certificates if just left school
Proof of dates from college/university

QCD/HR/001 Confidential Issue No: 12

Issued By: Managing Director Date: Nov 2023
Page 1 of 14
 Application for Employment
K2 Services Limited
2 The Broadway
PHOTO Dudley
West Midlands
DY1 4QB

POSITION APPLIED FOR:

DECLARATIONS I certify that to the best of my knowledge, the information that I have given in my
application for employment is true and complete and understand that any false statement or omission to
the Company or its representatives may render lead to termination of employment without notice. I
understand and agree that if so required I will make a Statutory Declaration in accordance with the
provisions of the Statutory Declarations Act 1835 in confirmation of previous employment or
unemployment. I authorize the Company or its agents to approach Government agencies, former
employers, educational establishments, criminal justice agencies and personal referees for information
relating to and verification of my employment/unemployment record. I consent to the Company’s
reasonable processing of any personal information obtained for the purposes of establishing my medical
condition and future fitness to perform my duties. I accept that I may be required to undergo a medical
examination where requested by the Company. Subject to the Access to Medical Reports Act 1988, I
consent to the results of such examinations to be given to the Company and authorize the Company to
make a consumer information search with a credit reference agency, which will keep a record of that
search and may share that information with other credit reference agencies. I further declare that any
documents that I provide as proof of my identity, proof of address, proof of right to work and any other
documents that I provide are genuine and give my consent for these documents to be examined under a
UV scanner or similar device. I acknowledge that any falsified documents may be reported to the
appropriate authority. I can confirm that I will disclose any information which may affect my ability to
perform my duties and explain the reasonable adjustment required in order for me to carry out my role to
the standards required.

GENERAL DATA PROTECTION REGULATIONS The Company will use the information you have given
on your application form (together with any information which we obtain with your consent from third
parties) for assessing your suitability for employment. It may be necessary to disclose your information to
our agents and other service providers. By returning this form to the Company you consent to our
processing personal data about you where this is necessary, for example information about your credit
status, ethnic origin or criminal offences. You also consent to the transfer of your information to your
current and future potential employers where this is necessary (this may be to companies operating
abroad if you apply for work outside of the United Kingdom). Your information will be held on our
computer database and/or in our paper filing systems. By signing below, you agree to this process and
confirm that you do not have a criminal record subject to the current Rehabilitation of Offenders Act and
any amendments. You have the right to apply for a copy of your information (for which we may charge a
small fee) and to have any inaccuracies corrected.

SCREENING Any offer of employment is subject to satisfactory screening, that the applicant consents to
being screened and will provide information as required. That the information provided is correct, and the
applicant acknowledges that any false statements or omissions could lead to termination of employment.
I understand that a total payment of £120 will be deducted from my wages, at a rate of £10 per week.
This deduction is my contribution towards screening fees, in accordance with the Terms and Conditions
of my Employment Contract.

PRINT NAME:

SIGNATURE:

DATE:

QCD/HR/001 Confidential Issue No: 12

Issued By: Managing Director Date: Nov 2023
Page 2 of 14
1. This Application Form, when completed, contains the basic information from which a candidate is
assessed.
2. Please answer all questions in BLOCK CAPITALS in your own handwriting and using black ink. If a question
or section does not apply to you, insert ‘NO’ or ‘N/A’. Please attach a recent passport size photograph.

TITLE: Mr. / Mrs / Miss / Ms (circle) SURNAME:

Surname at Birth: FORENAMES:

(If different from above)
Address: How long have you lived at your present address?

Post Code: Owner / Rented / with parents / lodging / other (circle)

Mobile No: Email:

Previous Address: From: To: Date of Birth:
Place of
Birth:
Nationality:
Post Code: Date and Place of entry into the UK:
(If applicable)
Are you permitted to work in the UK? YES / NO Right to work visa expiry date: (If applicable)

National Insurance No: Passport No:

Do you hold an SIA YES / NO Security Door Close
Licence? Please circle all CCTV
Guarding Supervision Protection
that apply
SIA Licence No/s:
Marital Status: Single / Married / Separated / Divorced / Widow / Widower (circle)
Person to contact in an emergency / next of Kin
Name: Next of Kin Relationship:
Address:
Their telephone No. (work):

Post Code: Their telephone No. (home):

GP’s Details
Name: Telephone Number:
Address:

Postal Code:
Bank Details
Bank Name: Branch Address:

Sort Code: Account Number:

QCD/HR/001 Confidential Issue No: 12

Issued By: Managing Director Date: Nov 2023
Page 3 of 14
 DRIVING LICENCE

QCD/HR/001 Confidential Issue No: 12

Issued By: Managing Director Date: Nov 2023
Page 4 of 14
 Driving Licence. Full / Provisional / None icence No: Car / Motorcycle

L
Own Transport: YES / NO Have you ever been disqualified from driving? YES / NO
Enter details of any motoring convictions or endorsements in the last 5 years

OFFENCES, CAUTIONS AND CONVICTIONS

1. Have you ever been Cautioned by the YES / NO

Police?
2. Have you ever been convicted, fined or had any order made against you by a Criminal, Civil or YES / NO
Military Court?
3. Are you aware of any Police investigations in which you may be involved? YES / NO
If the answer to either question 1, 2 or 3 above is YES, give details

NB. Disclosure is not required where there is a conviction to which the provisions of the Rehabilitation of
Offenders Act 1974 applies. Failure to disclose an unspent conviction may result in summary dismissal. If you are
unclear about any of these questions ask the interviewer.
FINANCIAL LIABILITIES

Have you any outstanding debts or attachments of earnings? YES / NO

If YES, give details
Have you ever been declared bankrupt / insolvent? YES / NO
If YES, give details
Are you the subject of any County Court proceedings? YES / NO
If YES, give details
SECONDARY EDUCATION RECORD - Please provide documentary evidence from your school to verify your dates of
attendance, if you do not have that information please contact them and provide the evidence to us.
School attended: From To Qualifications:

FURTHER EDUCATION RECORD - Please provide documentary evidence from your college/University to verify your
dates of attendance, if you do not have that information please contact them and provide the evidence to us
College / University attended: From To Qualifications:

RECORD SERVICE

Services: ARMY / ROYAL NAVY / RAF / FIRE / POLICE / OTHER (specify)

Unit or Regiment: Rank: Service No.
From: To: Conduct Assessment on discharge:
Are you a member of any reserve that will require annual training or service? YES/ NO
If YES give details

QCD/HR/001 Confidential Issue No: 12

Issued By: Managing Director Date: Nov 2023
Page 5 of 14
 SELF-EMPLOYMENT REFERENCES – UNIQUE TAX REFERENCE No: TAX OFFICE:

If you have been self-employed, please give references of people who can confirm the details.
TRADE ACCOUNTANT
Name: Name:
Address: Address:

Post Code: Post Code:

UN-EMPLOYMENT RECORD
State all periods of unemployment, incapacity benefits, or pension payments within the last 5
years or since leaving school.

IT IS YOUR RESPONSIBILITY TO PROVIDE PROOF OF ALL PERIODS WHERE YOU HAVE RECEIVED STATE
BENEFITS.
To obtain your unemployment / benefits history you must contact your local Job Centre or Benefits
Office and provide us with the documentary proof obtained from them

Start with present situation.

Dates Dates Dates Dates Dates Dates
MM/YY MM/YY MM/YY MM/YY MM/YY MM/YY
From From From From From From

To To To To To To
From From From From From From
To To To To To To
From From From From From From
To To To To To To
From From From From From From

QCD/HR/001 Confidential Issue No: 12

Issued By: Managing Director Date: Nov 2023
Page 6 of 14
 EMPLOYMENT RECORD

State all periods of employment and self-employment for the last 5 years or since leaving school.

You can assist us with your screening by requesting your 5 Year employment history from
HMRC by ringing the following number 0300 200 3300 and providing us with the
documentary proof obtained from them.

Start with present situation.

Employers Details Employment/Unemployment Details Dates
(BLOCK CAPITALS) MM/YY
Name: Position Held: From
Address: Work No.:
Reporting To: To
Salary / Wage Per Week:
Tel No.: Reason for Leaving:

Name: Position Held: From

Address: Work No.:
Reporting To: To
Salary / Wage Per Week:
Tel No.: Reason for Leaving:
Name: Position Held: From
Address: Work No.:
Reporting To: To
Salary / Wage Per Week:
Tel No.: Reason for Leaving:
Name: Position Held: From
Address: Work No.:
Reporting To: To
Salary / Wage Per Week:
Tel No.: Reason for Leaving:
Name: Position Held: From
Address: Work No.:
Reporting To: To
Salary / Wage Per Week:
Tel No.: Reason for Leaving:
Name: Position Held: From
Address: Work No.:
Reporting To: To
Salary / Wage Per Week:
Tel No.: Reason for Leaving:

QCD/HR/001 Confidential Issue No: 12

Issued By: Managing Director Date: Nov 2023
Page 7 of 14
 This section is optional

I understand that under the Working Time Regulations my hours of work are restricted to a maximum of 48 hours
per week unless I state otherwise. As part of my application for employment with the Company I agree to work in
excess of 48 hours. Furthermore, I understand there is a specific exemption in the Regulations for the security industry
relating to rest breaks after 6 hours' continuous work; for working a maximum of 8 hours at night; to rest periods of 11
hours in every 24 hours and 24 hours rest in every 7 days, provided that compensatory rest is arranged. I
therefore consent to waive my entitlement to such compensatory rest. I understand that I may revoke this
waiver if I choose by giving written notice of at least 30 days.

SIGNATURE:

PRINT NAME:

DATE:

QCD/HR/001 Confidential Issue No: 12

Issued By: Managing Director Date: Nov 2023
Page 8 of 14
MEDICAL HEALTH QUESTIONNAIRE

Please answer all the following questions by circling the appropriate word: if the answer is
yes, circle yes; if it is no, circle no.

1 Do you have any physical or mental impairment that could be classed as a Yes No
disability under the Equality Act 2010?

2 Have you ever received compensation or a disability pension? Yes No

3 Are there any medical reasons why you should not do shift work? Yes No

Are you able to carry out strenuous physical work including climbing ladders,
4 Yes No
working from scaffolding, bending, lifting and carrying?

5 Have you ever had to give up any previous job for medical reasons? Yes No

Have you been off work continuously for more than a month during the last
6 Yes No
five years?

Have you ever had any operations requiring hospital admission for five or more
7 Yes No
days?

8 Is your eyesight normal (with glasses if worn)? Yes No

9 Is your hearing normal? Yes No

10 (a)Do you regularly take tablets or medicine? Yes No

(b) If so, what do you take?

11 Have you ever had any of the following?

Diabetes Yes No

Tuberculosis Yes No

Angina Yes No

Any other heart trouble Yes No

Raised blood pressure Yes No

Peptic, gastric, or duodenal ulcer Yes No

QCD/HR/001 Confidential Issue No: 12

Issued By: Managing Director Date: Nov 2023
Page 9 of 14
 Indigestion for more than one week Yes No

Back trouble, lumbago, sciatica, "slipped disc" Yes No

Epilepsy, recurring blackout or fits Yes No

12 Have you ever had any of the following during the past five years?

Bronchitis, asthma, pneumonia Yes No

Dermatitis, eczema or any other skin trouble Yes No

13 Do you suffer from any of the following?

Migraine or severe recurring headaches Yes No

Anxiety, depression or any other nervous complaint Yes No

Fainting attacks or giddiness Yes No

Ear trouble, discharging or infected ear Yes No

Kidney trouble or urinary infection

QCD/HR/001 Confidential Issue No: 12

Issued By: Managing Director Date: Nov 2023
Page 10 of 14
 If you have circled any answers as Yes for questions 1 to 13, please give very
14
brief details below:

Have you ever had any other serious illness? If yes, please give very brief details
15 Yes No
below.

16 Have you consulted a doctor about your health during the past 12 months? If Yes No
yes, please give very brief details below.

Declaration

I declare that the information given in this questionnaire is to the best of my knowledge complete and
correct. I declare that any health information that is required to be disclosed in the interests of health and
safety to myself and others in the role I am undertaking, is detailed above.

Employee's signature:

Date:

QCD/HR/001 Confidential Issue No: 12

Issued By: Managing Director Date: Nov 2023
Page 11 of 14
HMRC
NICO
Benton Park View
Newcastle on Tyne
NE98 1ZZ

REQUEST FOR DATA UNDER DATA PROTECTION ACT

I herewith request a copy of my personal data, as held on the National Insurance Recording
System Computer, in accordance with my subject access rights under the Data Protection Act
1984 (sections 21 & 34 (60) (b), to be sent to my home address as shown below.

I understand that my National Insurance record includes references to all periods of

employment, periods of registered unemployment and to periods of non-liability for contributions
(for example; periods of full-time education, periods spent abroad or in legal custody).

Title

Surname

Forenames

Address

Postcode

Date of Birth

National Insurance Number

Signed …………………………………… Dated ……………………………………

QCD/HR/001 Confidential Issue No: 12

Issued By: Managing Director Date: Nov 2023
Page 12 of 14
 Contract of Employment
I have read and understood the contents of the Contract of Employment and agree with the
terms and Conditions within.

EMPLOYEE SURNAME:

EMPLOYEE CHRISTIAN NAMES:

ADDRESS:

EMPLOYEE SIGNATURE: DATE:

QCD/HR/001 Confidential Issue No: 12

Issued By: Managing Director Date: Nov 2023
Page 13 of 14
This Confidentiality Agreement is entered into between

Name: (Employee)
and
K2 Services Ltd (Employer)

1. The Employee understands that the confidential information and Proprietary Data are
trade secrets of the Employer and must always take reasonable steps in order to
protect the confidentiality of said information.

2. The Employee understands that K2 has an obligation under the General Data
Protection Regulations (GDPR) and is committed to protecting client and staff data.

3. The Employee agrees that he or she will not disclose to any person or entity, either
directly or indirectly, confidential Information held by K2 Services Ltd. Any use or
disclosure of confidential information or Proprietary Data is cause for disciplinary or
legal action.

Employee’s Name:

Employee’s Signature:

Date Signed:

QCD/HR/001 Confidential Issue No: 12

Issued By: Managing Director Date: Nov 2023
Page 14 of 14