WORLD LEADERS IN PERISTALTIC PUMPING
	TELEPHONE +44 (0) 1326 370 370 . FAX +44 (0) 1326 370 360 . HR@WMB.BIZ
	Application for employment
Position applied for
If you want to send an attachment to us, please email it to:		hr@wmb.biz
Applicant details
Surname		Forenames
Address		Telephone - private
		Telephone - evening
		Telephone - mobile
		Telephone - work
Postcode		Email address
National insurance number		Where did you
Are you legally eligible		see this vacancy
for employment in the UK?	Please select Yes No	advertised?	Please select Advertisement Internet Job Centre Recommendation by a friend Recruitment agency Other
Education and qualifications
Secondary education
School
Dates
Examination subjects
and grades achieved
(Keep within
borders of box)
Further and/or higher education
College/University
Course
Dates
Grades achieved
College/University
Course
Dates
Grades achieved
Vocational and specialist courses eg company courses and training
Subject
Dates
Details
(Keep within
borders of box)
Professional qualifications and memberships of professional bodies
Professional
qualifications
and dates achieved
Professional
body
memberships
Languages
Languages - please
indicate level of fluency
and if oral or written
Please outline any skills and experience you have which are relevant to your application
Skills and experience
(Keep within
borders of box)
Medical history
Have you had any serious or recurring illness or injury in the past ten years?			Please select Yes No
If yes,
please give
brief details
Are you colour blind?	Please select Yes No
Do you have any physical or mental impairment which
could have a substantial effect on your ability to perform normal daily activities?			Please select Yes No
If yes,
please give
brief details
Employment
Pay level anticipated £		Please do not leave blank
Are you
currently employed	Please select Yes No	Date you could start
If Watson-Marlow employs you, will you continue to work in any other capacity?			Please select Yes No
If yes,
please give
brief details
Have you previously worked for Watson-Marlow or a Spirax-Sarco group company?			Please select Yes No
If yes, please
state when and
in what capacity
Employment historymost recent first
Company
Job title
Dates		Final salary £
Brief job
description
(Keep within
borders of box)
Reason for leaving
Company
Job title
Dates		Final salary £
Brief job
description
(Keep within
borders of box)
Reason for leaving
Company
Job title
Dates		Final salary £
Brief job
description
(Keep within
borders of box)
Reason for leaving
Company
Job title
Dates		Final salary £
Brief job
description
(Keep within
borders of box)
Reason for leaving
Present pay and benefits
Current salary £		per	Please select Week Month Year
Additional benefits -
car, BUPA,
pension etc
Personal references
Please list two people who have known you for at least two years (not relatives or former employers)
Name		Name
Occupation		Occupation
Address		Address
Postcode		Postcode
Telephone		Telephone
Personal information
Do you hold a current UK driving licence?			Please select Yes No
Please give details of
any current endorsements
Are you related to anyone now
or formerly employed by Watson-Marlow or any Spirax-Sarco group company?			Please select Yes No
If yes, please give brief
details
Have you made any
previous application to Watson-Marlow or any Spirax-Sarco group company?			Please select Yes No
If yes, please
give brief details
Please detail
personal interests,
hobbies etc
Is there anything else
you would like to add to
support your application?
(Keep within
borders of box)
Declaration
I declare that to the best of my knowledge and belief, all the particulars given above are complete and true. I
understand that any false or misleading statement or any significant omission may disqualify me from employment or
render me liable to dismissal.
I understand that the Company will take up the personal references once an offer of employment has been made and
accepted and that such an offer is conditional upon receipt of these references.  I also agree to co-operate fully with
the Company's medical screening programme and if required undergo a medical examination and/or supply other
medical evidence either before or after joining the Company.
I also understand that the information provided by me will be treated as personal information, as defined by the Data
Protection Act, and used solely for the purpose of determining my suitability for employment with the Company.
Should my application for employment be successful, this information will be retained by the Company as part of my
confidential personnel records and may be used as part of my employment contract with the Company.
Signed		Date
Contact information
Personnel Advisor . Watson-Marlow Bredel Pumps . Falmouth . Cornwall . TR11 4RU . England
Telephone +44 (0) 1326 370 370 . Fax +44 (0) 1326 370 360 . hr@wmb.biz