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    | Oaklands Industrial Estate, Essex Road, Hoddesdon, Herts. EN11 0BX | 
   
    | Tel:01992 470404, Fax: 01992 479009  E-mail:mail@eirscot.co.uk | 
   
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    | Pre-Employment Questionaire - All Information Confidential | 
   
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    | Personal Information - Please complete 
      in block capitals | Date of Birth |  |  |  | 
   
    | Present Address: |  |  | Age |  | 
   
    |  |  |  | Nationality |  | 
   
    | Phone No: |  | Mobile: |  | Marital status |  | 
   
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    | Employment Desired |  | 
   
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    | Position applied for: |  | Date you can start: |  |  |  | 
   
    | Ever applied to this company before? |  | Yes |  | No |  | When? |  |  |  | 
   
    | CIS 4 | Yes |  | No |  |  | Confined Spaces | Yes |  | No |  | 
   
    | CIS 6 | Yes |  | No |  |  | 360 Degrees CITB/CTA | Yes |  | No |  | 
   
    | Vat Registered? | Yes |  | No |  |  | CSCS Card | Yes |  | No |  | 
   
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    | NRSWA | Yes |  | No |  |  | Abrasive wheels | Yes |  | No |  | 
   
    | Driving Licence | Yes |  | No |  |  | Any other certificates |  | 
   
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    | Are you registered disabled | Yes |  | No |  | Registered Disabled No |  | Expiration Date |  | 
   
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    | Name & location of School and 
      Further Education & Training | Yrs Attended | Exams passed & Grades | 
   
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    | Professional membership/ Qualifications | Yrs Attended | Exams passed & Grades | 
   
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    | Employment History-(List below last 
      four employers, starting with most recent employer) | 
   
    | Date/month/year | Name & Address of Employer | Rate | Position | Reason for leaving | 
   
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    | References-Give below the names of three persons not related to you, whom you have known at least 
      one year | 
   
    | Name | Address | Business | Years Known | 
   
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    | Information to support your application: | 
   
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