Internal Role Application FormJob DetailsPost applied for:Date of interview:* DD slash MM slash YYYY Personal DetailsFamily Name:* Last Name Forename(s): First Name Middle Name Preferred title (eg Mr/Mrs/Miss/Ms/Dr/Other (Please state):* Title Mr.Mrs.MissMs.Dr.Prof.Rev. Full address (including county and postcode) :* Street Address Address Line 2 City County / State / Region ZIP / Postal Code Home telephone number:Mobile number:*Work telephone number:Email:* Marital Status:*Asylum and Immigration You will be required to demonstrate that you are entitled to work and reside in the UK in compliance with current legislation.Do you require a work permit to work in the UK?* Yes NoReference 1Reference 1Name: First Last Job Title:Name of Organisation:Address: Street Address Address Line 2 City County / State / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Tel No:Email Address: How long have you known this person and in what capacity?:Please note that referees will not be contacted prior to interviews. References will be taken up once an offer has been accepted.Reference 2Name: First Last Job Title:Name of Organisation:Address: Street Address Address Line 2 City County / State / Region ZIP / Postal Code Tel No:Email Address: How long have you known this person and in what capacity?:Please note that referees will not be contacted prior to interviews. References will be taken up once an offer has been accepted.Present or Most Recent EmploymentName of Employer:Address of Employer: Street Address Address Line 2 City County / State / Region ZIP / Postal Code Job Title:Dates employed:Current or final salary:Period of notice required:Please give a brief outline of your main responsibilities:Other ExperienceDetails should be given for any period not accounted for by full-time employment, education and training, e.g. unemployment or voluntary work.Experience including From/To:eg. Charity Shop Support work from December 2019 - December 2021Information in Support of Your ApplicationDriving Licence:Please give details of any “unspent” convictions as defined in the Rehabilitation of Offenders Act 1974. :Additional InformationRehabilitation of Offenders Act 1974Do you hold a current driving licence? Yes/No:* Yes NoIf YES, please state the type of licence you hold:Are you a car owner?* Yes NoIf NO, do you have access to a car? Yes NoDo you have any current endorsements?* Yes NoIf YES, please specify:DeclarationDeclaration* I declare that the information contained in the application form is true and correct. I understand that any false or misleading information, or omissions concerning criminal convictions, may disqualify my application or may render my Contract of Employment, if I am appointed, liable to dismissal without notice.Data Protection:* If I accept employment with ePayMe Limited, I consent to my personal information being held by ePayMe Limited for the administration of my Contract of Employment.Name:Date: MM slash DD slash YYYY SignatureCAPTCHA
