JPR Engineering Services Limited
North Street
Stoke on Trent
Staffordshire
ST4 7SA

Tel: 01782 744675
Fax: 01782 411780

Recruitment


  • Post Applied For   

    Equal Opportunities

    We are an equal opportunity employer all data collected will be treated in the strictest confidence. In order to assist us in ensuring that our equal opportunity policy is being carried out please provide us with the following information. This data is used for statistical purposed only and is not used in the selection process. Electronic replies preferred in the first instance please make sure that your email is included
  • Your Personal Details
    Surname
    First Name
    Day Time Telephone
    Evening Telephone
    Fax
    Email
    Address
    Driving Licence No
    Penalty Points
    NI Number
    Date of birth
    Ethnic Origin   Other  
    Marital Status
  • Employment Record

    Employer Contact Position Held From To
  • References (Please Give 2)

    Your present employer will not be contacted until you have signed your willingness to except an offer of employment

    Referee 1 Referee 2
    Name
    Address
    Telephone
    Name
    Address
    Telephone
  • Occupational History

    Has your employment ever been terminated on the grounds of ill health Yes No

    Approximately how many days or weeks sickness or absence in the last 12 months:

    Days Weeks

  • Education And Training

    From To Name Of College School Qualifications Date Taken Grade
  • Disability

    Do you consider yourself to have a disability: Yes No

    If disabled registration No

    Describe disability

  • Medical History
    Heart Trouble High blood pressure
    Lung Disease Asthma
    Stomach/bowel trouble Hernia or rupture
    Jaundice/hepatitis Kidney/bladder disorder
    Joint problem Back/neck problem
    Diabetes Fits/blackouts/epilepsy
    Allergies Depression/anxiety
    Headaches/migraines Hearing/sight problem
    Severe stress reaction Skin problems
    Serious accident Surgical operations
    Colour blindness Dyslexia


    What is your height  

    Do you smoke   No Yes

    Are you under the doctors care   No Yes

    Are you currently taking medicine   No Yes

    If the answer to any question in medical history is YES then give details below,

  • Criminal Convictions

    Have you any criminal convections inc pending    No Yes

    If the above is yes please give details,

  • Declaration


    • I agree that if offered an appointment references supplied will be taken up

    I also agree if requested to do so i will undergo a medical examination

    I confirm that the form submitted on this electronic Employment Application is accurate to the best of my knowledge and