| PERSONAL DETAILS |
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| Accredited Instructor Registered Number |
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| Date of Original Registration |
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| Please give the number of days spent training operators over the last 12 months and types of equipment trained on |
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PRESENT EMPLOYMENT |
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| Brief Description of Duties |
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| Reasons for Wanting to Leave |
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PREVIOUS EMPLOYMENT DETAILS (In ascending order) |
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| Do you have a criminal record? |
Yes
No
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| If Yes, please give details |
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Please give details of materials handling equipment for which you hold an operator certificate, eg Electric Reach, Counterbalance, Mobile Crane etc.
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| NB. We will need to have sight of certificates before work can be offered. |
| Please give brief details of relevant experience and any other information in support of your application |
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REFEREES (one of whom should preferably be your current employer) |
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| Please state where you learned of this vacancy |
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SIGNATURE
Typing your name in this box will be treated as a signature and your confirmation of the information submitted in this form. |
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| DATE |
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