| Convictions |
Part A – to be completed if you are applying for chartered or certified accountancy positions only (whether trainee or qualified):
The post you have applied for is exempted from the provisions of the Rehabilitation of Offenders Act 1974 (exceptions) Order 1975 (SI 1975 No 1023). You are therefore required to provide full details of all convictions including those regarded as spent under the Rehabilitation of Offenders Act 1974 in response to the questions below. |
| Have you ever been convicted of a criminal offence? |
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| If yes, please give full details: |
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| Failure to declare a conviction may disqualify you from appointment to the position applied for or result in your subsequent summary dismissal. |
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| Part B – to be completed if you are applying for any position not covered by Part A above: |
| Have you ever been convicted of a criminal offence that is not regarded as spent under the Rehabilitation of Offenders Act 1974? |
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| If yes, please give full details: |
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| Failure to declare a conviction which is not regarded as spent under the Rehabilitation of Offenders Act 1974 may disqualify you from appointment to the position applied for or result in your subsequent summary dismissal. |
| MEDICAL QUESTIONNAIRE |
| Name |
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Please contact us if you require any assistance in completing this form.
The medical questionnaire is separated from the application form when received and is not used for short listing purposes.
Any applicant who believes they have a disability within the meaning of the Disability Discrimination Act 1995 (DDA) should indicate so below and give an indication of what adjustments may be required to either the role they are applying for or the workplace, for them to be able to fulfil the job requirements. Where a disability is indicated, the criteria for selection and the selection process will be adjusted as required by the DDA, for that particular individual in order to give them an equal chance of success in their application.
Applicants should understand that before you commence work you must disclose any medical problems which may affect your ability to perform the work for which you have been appointed. Failure to do so may result in your contract being terminated.
Please rest assured that any information provided by you on this questionnaire will be treated in the strictest of confidence. Should you wish to discuss any concern you may have with regard to confidentiality please telephone Sarah Hough. |
| How many days have you been absent from work due to sickness during the last 12 months? |
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| In the last 5 years, have you ever been off work for in excess of 6 consecutive weeks (excluding maternity parental leave)? |
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| If yes, please give full details: |
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| Do you have any medical condition or recurring illness(es) / injuries (e.g. repetitive strain injuries, back injuries, depression) that might affect your ability to do the job for which you have applied, or your likely attendance levels at work? |
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| If yes, please give full details: |
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| Are you aware of any circumstance, such as a planned operation, which may result in you being absent from work for in excess of two weeks during the next 12 months? |
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| If yes, please give full details: |
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| Do you have a disability / illness or any physical / mental limitation (e.g. asthma, dyslexia, memory loss etc.)? |
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| If you answered Yes, please give details and state whether there are any adjustments to equipment and the tasks of the job you would need to be made in order for you not to suffer a detriment at interview and also in order for you to do this job |
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| Have you ever resigned / been dismissed from a Company for reasons of ill health or incapability? |
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| If yes, please give full details: |
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| Is there any other information regarding your physical and mental health or abilities that the Company should be aware of, or anything that you would like to include on this questionnaire? |
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| If yes, please give full details: |
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| Do you suffer from any allergies? |
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| If Yes, please give details (especially life threatening allergies) |
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| Would you need to absent yourself periodically from work to undergo treatment for any condition? |
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| If yes, please state nature of treatment and state if this treatment would temporarily affect your ability to carry out your duties (e.g. regular monthly injections for arthritis which results in the inability to drive for a few hours afterwards): |
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Applicants may be required to undergo a medical examination by a Company appointed doctor. Such examinations will always be at the expense of the Company.
Please note that during your employment should you start to take any medication which may result in drowsiness or begin to suffer from any serious physical or medical condition, including pregnancy, this must be immediately reported to your manager so that risk assessment can be carried out and any necessary adjustments made to your workplace.
This questionnaire will be kept on personal files for successful applications. The information provided may be used for monitoring purposes. |
