APPLICATION FORM COMMISSION OPERATOR

Transcription

1 APPLICATION FORM COMMISSION OPERATOR Please read all questions BEFORE you complete this application form. Complete each section as fully as possible using BLOCK CAPITAL LETTERS. All information will be treated in the strictest confidence. PERSONAL SECTION * please delete as appropriate *Mr/Mrs/Miss SURNAME : DATE: *MALE / FEMALE FIRST NAMES : STATUS : MARRIED MAIDEN NAME (if applicable) Home Tel: DATE OF BIRTH: PLACE OF BIRTH: NATIONALITY: NUMBER OF DEPENDENT CHILDREN (if any): Work Tel: Mobile Tel : E Mail : Do you have the permission of the UK Government to live and work in the UK? : Do you have a National Insurance number? If YES What is the number? Are you on the Electoral Register at this address? Do you own, rent or mortgage your present address? How long have you lived at your present address? If less than two years, give previous address: 1

2 PERSONAL SECTION continued Are you prepared to move to another area? If yes, how far? Do you have a valid Driving Licence? If no, how far prepared to travel? Do you own a car? Is your health generally good? If NO, give brief details: ACADEMIC SECTION Have you experience of working in petrol station: If Yes, how long? : Do you hold a Petroleum Industry Competent Persons Certificate? Are you familiar with COSHH Regulations? State your academic qualifications and any professional qualifications you hold: 2

3 What other training courses have you attended? State briefly the primary reasons for your application to run a Park site. EMPLOYMENT OR BUSINESS RECORD SECTION Are you in paid work at the moment? If NO, for how long? Have you held a Retailer s Agreement with another company before or been employed on a petrol fillingstation site before? If YES, give details: Are you acquainted with anyone involved in the running of a forecourt site? : If YES, give details: 3

4 Give FULL details of all employment or business enterprises you have undertaken. START WITH YOUR PRESENT OR LAST OCCUPATION AND THEN WORK BACK. Any gaps should be shown and explained, eg Sickness, unemployment etc DATES: From/To BUSINESS OR EMPLOYER S NAME, ADDRESS AND TYPE OF ACTIVITY CARRIED OUT LAST POSITION HELD SALARY ON LEAVING REASON FOR LEAVING SECURITY SECTION Have you a Police Record? Have you been on Probation? Have you become Bankrupt? Have you been subject to any Civil Court Action or County Court Judgements? If YES to any of the above, please give details: 4

5 TESTIMONIALS (for reference check purposes) Please supply below full details of three persons/companies with whom you have regularly traded (in the case of self employment), or your last three employers: 1) *TRADE REFERENCE or NAME OF EMPLOYER : POST CODE: Tel: CONTACT: 2) *TRADE REFERENCE or NAME OF EMPLOYER : Tel: CONTACT: POST CODE: 3) *TRADE REFERENCE or NAME OF EMPLOYER : POST CODE: Tel: CONTACT: What amount of capital do you have to invest? Are you or would you be trading as either (please give details as appropriate): *Sole Trader: *Partnership: *Limited Company: Trading as... Trading as Company Name VAT Registration number. 5

6 DECLARATION I have read and understood all the notes and questions in this application form and hereby certify that to the best of my knowledge and belief the information given in this application is true and complete. I understand that if any details declared herein change or should be added to during the term of any Agreement I may enjoy with you, I must report them to the Company and I further understand that if any of the details declared herein are found subsequently to be untrue, any Agreement offered to me may be terminated. I further authorize Park Garage Group to request references and carry out a CRB check on my Status. SIGNED DATE : FOR OFFICE USE ONLY AREA MANAGER: SITE APPLIED FOR: COMMENCING DATE:. COMMENTS:.. 6