East Lancashire Railway Job Application Form Question Title * 1. Email Address OK Question Title * 2. Role Applying For OK Question Title * 3. We would like to get to know you a little more. Please tell us why you would like to work for the ELR and provide details of your availability as much as possible. OK Question Title * 4. Preferred title Mr Mrs Ms Lord Lady Dr OK Question Title * 5. Surname OK Question Title * 6. Forename(s) OK Question Title * 7. House Number/Name OK Question Title * 8. Street Name OK Question Title * 9. Town/City OK Question Title * 10. County OK Question Title * 11. Postcode OK Question Title * 12. Contact Number OK Question Title * 13. How did you find out about this role? OK Question Title * 14. Marital Status OK Question Title * 15. Do you consider yourself to have a disability/impairment as defined in the Disability Discrimination Act 1995 Yes No OK The Disability Discrimination Act 1995 defines a disabled person as someone with a physical or mental impairment, which has substantial and long-term adverse effect on his/her ability to carry out normal day to day activities. OK Question Title * 16. If yes, do you consider yourself to have any of the following disabilities/impairments as defined in DDA? Physical Disability Learning Disability Mental Health Problems Head Injury Visual Disability Hearing Disability Musculoskeletal Disability Cardio-vascular Disability Other OK References OK Please give the name of two referees, one of which should be your current or last employer if you have been employed recently. If you have not been employed recently refer to the guidance notes. You may choose your second referee. OK Referee 1 OK Question Title * 17. Name OK Question Title * 18. Job Title OK Question Title * 19. Address OK Question Title * 20. Postcode OK Question Title * 21. Email Address OK Question Title * 22. Telephone Number OK Referee 2 OK Question Title * 23. Name OK Question Title * 24. Job Title OK Question Title * 25. Address OK Question Title * 26. Postcode OK Question Title * 27. Email Address OK Question Title * 28. Telephone Number OK Present Employer OK Question Title * 29. Job Title OK Question Title * 30. Name of Employer OK Question Title * 31. Address of Employer OK Question Title * 32. Postcode OK Question Title * 33. Date Started OK Question Title * 34. Salary/Wage OK Question Title * 35. Notice Required OK Question Title * 36. Description Of Your Current Role OK Previous Employment OK Please list in date order, starting with the most recent any previous employers, including company name and address. Please detail your role, its responsibilities and the date you commenced and finished employment. OK Question Title * 37. Please list in date order, starting with the most recent any previous employers, including company name and address. Please detail your role, its responsibilities and the date you commenced and finished employment. OK Education OK Please list any Schools/Academies attended from high school and any appropriate qualifications. OK Question Title * 38. Please list places attended and qualifications gained OK Further Education OK Please indicate college and university courses, any training related to your employment and qualifications (including grades). OK Question Title * 39. Please list any Colleges/Universities, dates attended and relevant qualifications OK Other Training OK (Please list any training and development that you have undertaken in the last 5 years that is relevant to your application) OK Question Title * 40. Please give details of any other training relevant to the post you are applying for not covered in previous sections (e.g. short courses) OK Relevant Skills, Knowledge and Experience OK Question Title * 41. Tell us why you are applying for this role and what you think you will bring to the ELR OK Question Title * 42. What relevant work experience (paid or unpaid), background knowledge and or/relevant skills do you have? OK General Information OK Question Title * 43. Are you in possession of a current driving licence? Yes No OK Criminal History OK Question Title * 44. Have you ever been convicted of a criminal offence? Yes No OK Declaration subject to the requirements of the Rehabilitation of Offenders Act. OK Question Title * 45. If yes, please give details: OK Right to Work in the United Kingdom OK Question Title * 46. Do you need a permit to work in the UK? Yes No OK Declaration OK Data Protection Act 1998: The Company maintains a Register Entry in respect of Staff Administration. Personal information provided by you on this form and any others in connection with your application is treated in confidence and complies with the requirements of the Act. OK Verification of Information: The Company may verify information you have provided on the Application form (e.g. Qualifications, Skills, Knowledge, Experience and Salary) either prior to the interview or as part of the appointment process. This may involve contacting organisations or persons you have named on the form. You will have the opportunity to make representations should any checks produce discrepancies. OK Asylum and Immigration Act 1996: It is a criminal offence to employ a person who is subject to immigration control, unless they have documentation which permits them to work in the UK. You should therefore be aware that we will make checks to ensure that you are eligible to work in the UK. OK Question Title * 47. I have read the above and agree to the contents Yes No OK Question Title * 48. Today's Date Date / Time Date OK SUBMIT