Application Form - Special Service Security

Personal Information

Full Name *

National Insurance Number *

Current Address *

UTR Number

Your Email Address *

Telephone Number *

Date of Birth *

Gender

Male
Female

Town of Birth *

Country of Birth *

Right to Work Information

Nationality *

Passport Number

Passport Country of Issue

Passport Expiry Date

Visa Number

Visa Expiry Date

Are you permitted to work in the UK? *

Yes
No

SIA Licence Information

SIA Number *

SIA Type

SIA Expiry *

Financial Checks

Give details of occasions you have been subject to immigration control. If none, write NONE: *

Give details of any cautions of convictions for criminal offences , which are not SPENT under the Rehabilitation of Offenders Act 1974, including pending actions. If none, write NONE: *

Give details of all bankruptcy proceedings and court judgements (including satisfied), financial judgments in the civil court made against you and individual voluntary arrangements with creditors from the previous six years. If none, write NONE: *

References

Referee 1 (Include full name, telephone number and email address) *

Please give the name and contact details of two references from persons of standing that have personal knowledge of you, from whom a written character reference can be obtained. These references should not be current or previous employers, relatives (by blood or marriage) and/or reside at the same address as you. These references will be asked to confirm the nature of their relationship with you and that they have known you for at least the most recent two years immediately prior to this application.

Referee 2 (Include full name, telephone number and email address)

Please give the name and contact details of two references from persons of standing that have personal knowledge of you, from whom a written character reference can be obtained. These references should not be current or previous employers, relatives (by blood or marriage) and/or reside at the same address as you. These references will be asked to confirm the nature of their relationship with you and that they have known you for at least the most recent two years immediately prior to this application.

Work History

You must include the company/companies you worked for and list the contact names and numbers of those employers.

Position 1 - Please cover a full 5 years from todays date *

Please give details of ALL periods, however brief of EDUCATION, EMPLOYMENT, UNEMPLOYMENT, SELF EMPLOYMENT, WORKING ABROAD, EXTENDED PERIODS OF ILLNESS and time spent in MILITARY SERVICES, covering the last 5 years as applicable of your history, or leaving full time education at 16. Please list the company name, address, telephone number, managers name, date started, date finished.

Position 1 Start *//

Position 1 Finish *

Position 2 - Please cover a full 5 years from todays date. If you have already accounted for 5 years put N/A in the box below *

Please give details of ALL periods, however brief of EDUCATION, EMPLOYMENT, UNEMPLOYMENT, SELF EMPLOYMENT, WORKING ABROAD, EXTENDED PERIODS OF ILLNESS and time spent in MILITARY SERVICES, covering the last 5 years as applicable of your history, or leaving full time education at 16. Please list the company name, address, telephone number, managers name, date started, date finished.

Position 2 Start//

Position 2 Finish//

Position 3 - Please cover a full 5 years from todays date. If you have already accounted for 5 years put N/A in the box below *

Please give details of ALL periods, however brief of EDUCATION, EMPLOYMENT, UNEMPLOYMENT, SELF EMPLOYMENT, WORKING ABROAD, EXTENDED PERIODS OF ILLNESS and time spent in MILITARY SERVICES, covering the last 5 years as applicable of your history, or leaving full time education at 16. Please list the company name, address, telephone number, managers name, date started, date finished.

Position 3 Start//

Position 3 Finish//

Position 4 - Please cover a full 5 years from todays date. If you have already accounted for 5 years put N/A in the box below *

Please give details of ALL periods, however brief of EDUCATION, EMPLOYMENT, UNEMPLOYMENT, SELF EMPLOYMENT, WORKING ABROAD, EXTENDED PERIODS OF ILLNESS and time spent in MILITARY SERVICES, covering the last 5 years as applicable of your history, or leaving full time education at 16. Please list the company name, address, telephone number, managers name, date started, date finished.

Position 4 Start//

Position 4 Finish//

Position 5 - Please cover a full 5 years from todays date. If you have already accounted for 5 years put N/A in the box below *

Please give details of ALL periods, however brief of EDUCATION, EMPLOYMENT, UNEMPLOYMENT, SELF EMPLOYMENT, WORKING ABROAD, EXTENDED PERIODS OF ILLNESS and time spent in MILITARY SERVICES, covering the last 5 years as applicable of your history, or leaving full time education at 16. Please list the company name, address, telephone number, managers name, date started, date finished.

Position 5 Start//

Position 5 Finish//

Position 6 - Please cover a full 5 years from todays date. If you have already accounted for 5 years put N/A in the box below *

Please give details of ALL periods, however brief of EDUCATION, EMPLOYMENT, UNEMPLOYMENT, SELF EMPLOYMENT, WORKING ABROAD, EXTENDED PERIODS OF ILLNESS and time spent in MILITARY SERVICES, covering the last 5 years as applicable of your history, or leaving full time education at 16. Please list the company name, address, telephone number, managers name, date started, date finished.

Position 6 Start//

Position 6 Finish//

Bank Information

Account Number *

Sort Code *

Bank Name *

Next of Kin Information

Next of Kin Name *

Next of Kin Telephone Number *

GDPR Agreement *

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