----------------------- Page 1----------------------- APPLICATION FOR EMPLOYMENT Thank you for applying for a position at Matalan. Your details will be treated in the strictest confidence. In order for your application to be processed, please complete all sections using BLOCK CAPITALS. All candidates invited for an interview will be asked to produce proof of eligibility to work in the UK, failure to do so will lead to your application being declined. POSITION APPLIED FOR: (Please tick appropriate box) Retail: Head Office: Distribution Centre: General Sales Assistant Buying Central Merchandising Stockroom Assistant Central Operations Merchandising Team Member Cash Administrator Corporate Purchasing Business Risk Clerk Full-Time Design Travel Department Team Trainer Part-Time Finance Supervisor Management Human Resources Other Store Manager Marketing Deputy Manager Payroll Department Manager Quality Control Administration Manager Retail Operations LOCATION: Sourcing Skelmersdale LOCATION/STORE: Store Development Knowsley Supply Chain Corby Technical Services Where did you hear about the vacancy? (Please tick appropriate box) Job Centre Friend / Family Matalan Website Recruitment Website Newspaper In Store Poster/Banner Other Please Specify If other please specify Personal Details FIRST NAMES: SURNAME: TELEPHONE NUMBER: E-MAIL ADDRESS: MOBILE NUMBER: FULL POSTAL ADDRESS: POSTCODE: Age Will you be aged 16 or over as of 1st July on the year of this application? YES: NO: (Please tick as appropriate) Expected salary/rate of pay: National Insurance Number: Are there any restrictions to your residence in the UK that might affect your right to take up employment in the UK? e.g student visa YES/NO If yes, please provide details. If you were successful in your application, would you require a work permit prior to taking up employment? YES/NO ----------------------- Page 2----------------------- Employment History – Please detail your current and previous job history and give an explanantion for any gaps in employment. NAME & ADDRESS OF EMPLOYER J OB TITLE / REASON FOR LEAVING / (most recent employer first) MAIN RESPONSIBILITIES WANTING TO LEAVE Education / Training (or further experience) Achievement Results Your Skills & Experience In support of your application, please detail any relevant skills, qualifications, personal qualities which you believe are relevant to the position you are applying for within Matalan. ----------------------- Page 3----------------------- Availability (Retail & Distribution Centre only) Matalan operates between 6am and midnight (24 hours a day in the Distribution Centre) 7 days a week. In order to match your availability to any existing vacancies, please indicate your maximum overall availability throughout the whole of the week. Please note, if offered employment, this information will form part of your contract. Monday Earliest Start Time Latest Finish Time Tuesday Earliest Start Time Latest Finish Time Wednesday Earliest Start Time Latest Finish Time Thursday Earliest Start Time Latest Finish Time Friday Earliest Start Time Latest Finish Time Saturday Earliest Start Time Latest Finish Time Sunday Earliest Start Time Latest Finish Time If offered an interview, would we need to make any adjustments in order to enable you to attend an interview? YES/ NO If Yes, please give details: If offered employment, would we need to make any adjustments to enable you to undertake your role? YES/ NO If Yes, please give details: ----------------------- Page 4----------------------- References will only be requested upon offer of employment. If you are in employment, one reference must be of that organisation. Other references should include either previous employers or educational institutions. NAME: NAME: ADDRESS: ADDRESS: POSTCODE: POSTCODE: TELEPHONE NUMBER: TELEPHONE NUMBER: RELATIONSHIP TO YOU: RELATIONSHIP TO YOU: Emergency Contact: Please give details of the person who can be contacted in the event of an emergency Name: Relationship: Address: Telephone number: (Daytime) Telephone number: (Evening) (MOBILE) REHABILITATION OF OFFENDERS ACT 1974 You are not required to disclose convictions that are “spent”. Please note that “unspent” cautions or convictions will not necessarily disqualify you from the post. Do you have any cautions or convictions? YES / NO Please list below details of any unspent cautions or convictions against you giving date, type of offence, sentence/fine imposed etc Please note: At the expense of the Company, you may be required to apply for a ‘Police Subject Access report‘, undergo a medical examination or agree to the provision of a General Medical Practitioner’s report. Declaration I declare that the information I have given in this application is accurate and true. I understand that providing misleading or false information or failure to disclose medical or any other relevant information will disqualify me from appointment or, if appointed, may result in my dismissal. I understand that any appointment or offer of appointment is conditional upon the receipt of satisfactory references. I also understand that in some circumstances any appointment or offer of appointment may be conditional upon receipt of a satisfactory medical and / or police report. SIGNED DATE Please Return to:- For all General Sales Assistant Positions: Please return to your nearest store For Head Office Positions: For Distribution Centre positions: For Retail Management Positions: LIMITED LIMITED LIMITED HEAD OFFICE HR DEPARTMENT DC HR DEPARTMENT RETAIL RESOURCING TEAM GILLIBRANDS RD GILLIBRANDS RD GILLIBRANDS ROAD SKELMERSDALE SKELMERSDALE SKELMERSDALE LANCASHIRE LANCASHIRE LANCASHIRE WN8 9TB WN8 9TB WN8 9TB ----------------------- Page 5----------------------- Data Protection. The Data Protection Act 1998 (“The Act”) sets out certain requirements for the protection of your personal information against unauthorized use of disclosure. The Act gives you certain rights. Except to the extent we are required or permitted by law, the information which you provide in this application form, and any other information obtained or provided during the course of your application (“the information”) will be used solely for the purpose of assessing your application. If your application is unsuccessful or you choose not to accept any offer of employment we make, the information will not be held for longer than necessary, after which time it will be destroyed, although relevant information will be retained in the longer term to facilitate our Equal Opportunities Monitoring. If your application is successful, the information will form part of your Personnel file and we will be entitled to process it for all purposes in connection with your employment. So that we may use the information for the above purposes and on the above terms, we are required under the Act to obtain your explicit consent. I consent to the use of my personal information for the purpose and on terms set out above. Signed Date ----------------------- Page 6----------------------- ----------------------- Page 7----------------------- OUR COMMITMENT TO EQUAL OPPORTUNITIES This section of the application form will be detached from your application and will be used solely for monitoring purposes Matalan is committed to its Equal Opportunity Policy and assesses all job applicants without regard to disability, race, gender, age, sexual orientation, religion or belief. To enable the Company to adhere to this policy this application form includes questions relating to these topics and are non- obligatory. This information shall be kept separate to your application. Age Date Of Birth: Gender - Please specify Ethnic Origin Please tick the box which best describes your ethnic origin: White Black/Caribbean Black/African Black/Other Other (please specify) Indian Pakistani Bangladeshi Chinese If you wish, you may disclose information about yourself in this section about the following: Religion Sexual Orientation