Application for employment CONFIDENTIAL

■ PLEASE COMPLETE ALL SECTIONS OF THIS FORM IN BLACK INK (IN CAPITAL LETTERS) OR TYPE AND RETURN TO THE STORE YOU ARE
APPLYING TO ■ PLEASE MARK YOUR ENVELOPE “PRIVATE & CONFIDENTIAL” ■ THIS FORM IS USED FOR THE EMPLOYMENT PROCESS, WHICH
INCLUDES SELECTION AND RECRUITMENT, AND FOR MONITORING PURPOSES UNDER THE TERMS OF THE HOMEBASE RECRUITMENT AND
SELECTION POLICY ■ HOMEBASE IS AN EQUAL OPPORTUNITIES EMPLOYER.

Store name Return address

(to be completed by store)
Position applied for

IMMIGRATION AND ASYLUM ACT 1996 (SECTION 8)

Under Section 8 of the Asylum and Immigration Act 1996, we are obliged to make certain document checks on ALL individuals asked to attend an
interview to ensure that work is only offered to those who have a right to live and work in the United Kingdom (England, Northern Ireland,
Scotland and Wales). You will be advised of the documentation you need to bring with you if you are invited to interview.
PERSONAL DETAILS Please complete in BLOCK capitals
Surname Title Current salary

Forenames

Address National Insurance Number

Work permit required? Yes No

(Please tick)
Postcode
Home / mobile number Daytime / mobile number

Date available for employment Full driving licence: Yes No Clean Endorsements
(Please tick)
Have you ever been convicted of an offence or do you have any charges outstanding? Yes No
If ‘Yes’ please give details below. (Convictions defined as spent under the Rehabilitation of Offenders Act should not be mentioned)

HOURS AND DAYS YOU CAN WORK For each day of the week, please write the start and finish times you are available to work.

Sun Mon Tue Wed Thur Fri Sat

Start
Finish

This will allow us to match you to our vacancy. Number of hours per week you can work
YOUNG PEOPLE & SCHOOL CHILDREN
Please tick the box if you have left school and you are aged between 16 and 17*
Please tick this box if you are below the minimum school leaving age*
*Note: If you are aged 16 or 17 or you are below the minimum school leaving age, there are legal restrictions on the amount of night work and the daily/weekly hours you can work.
Your answer to this question allows us to consider you for vacancies with working hours which are suitable for your age group.

REFERENCES Please complete in BLOCK capitals. Continue on a separate sheet if necessary.

Please give names and addresses of referees covering employment/study in the last three years, including present employment if applicable. Please
also indicate in the box provided whether you agree to us approaching your named referee before an offer of employment is made. If you select
the “no” box, we will only contact your referee after we have received your written acceptance of our offer of employment.
May we make contact before an offer of employment is made? Yes No May we make contact before an offer of employment is made? Yes No
Name Name
Position Position
Address Address

Telephone Telephone
number number

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EDUCATION Include all examinations from the age of 15, irrespective of results.

Dates from – to School / college name Subject Level Result Date

HIGHER / FURTHER EDUCATION / PROFESSIONAL QUALIFICATIONS

University / Polytechnic /
Dates from – to Course title and subjects Final qualification attained
College name

EMPLOYMENT Start with current / most recent. Include any part-time or voluntary work, etc.

Name and full address Description of position

Dates from – to Nature of business
of employer and responsibilities

ACTIVITIES / SPECIALIST INFORMATION

Please tell us about your hobbies, interests and any specialist training / experience you may have had to the position you are applying for
ie. First Aid, Fork Lift, Customer Services. Please continue on a separate sheet of paper if necessary.

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SKILLS
Please answer the following questions. Continue on a separate sheet if necessary.

a. Why are you applying for this position?

b. How can you make a difference, if you are successful in your application?

c. How would you ensure that we put our customers first?

d. How well do you work as part of a team? (Please give examples.)

e. What are your salary expectations?

Homebase will interview all applicants with a disability who meet the minimum criteria for a job vacancy and consider them on their ability.

If you consider you have a disability and would like us to make reasonable adjustments at interview, for example the use of a portable Mini Loop,
or if you would like us to contact you to discuss your particular needs, please indicate below:

Yes, I would like a reasonable adjustment to be made at interview, namely:

I would prefer you to call me to discuss my specific needs.

Dates not available for interview

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DECLARATION

I confirm that the information given on this form is, to the best of my knowledge, complete and accurate and I understand that if any statement, or
document provided, is subsequently found to be false or misleading, my employment may be terminated.
I agree to the processing of personal data, including sensitive data as defined under the Data Protection Act 1998, that I may have identified or
volunteered in the completion of this application form. I understand that in particular the Company will process information relating to criminal
convictions for the purposes of determining suitability for a particular job, and that the information obtained will be recorded on file.
I authorise the Company to take up reference and acknowledge that any offer of employment is subject to the receipt of satisfactory references. I
understand that no contact will be made with my present employer (unless indicated otherwise) until an offer of employment is made. I hereby
give Homebase Ltd authority to obtain references on my employment history and to verify any of the information I have given in the completion of
this application form.

Signature of applicant Date

FOR OFFICIAL USE ONLY

Acknowledged Date Interview arranged Date

Screened Date Hold Date

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DATA PROTECTION ACT 1998

Information in the next section is used solely for the purposes of monitoring. Once the recruitment process is completed, the data will be stored
for a maximum of 36 months and then destroyed. If you are a successful candidate, relevant information will be taken from the entire form and
used as part of your personnel record.

THIS PAGE MUST BE REMOVED FROM THE MAIN APPLICATION BEFORE THE APPLICATION IS ASSESSED.

EQUALITY OF OPPORTUNITY MONITORING QUESTIONNAIRE

Homebase operates an equal opportunity policy and welcomes applications from people of all backgrounds. In order to help us monitor the
effectiveness of our Equal Opportunity policy, please tick the appropriate boxes below.

Are you: Female Male Date of birth

Would you describe yourself as having a disability? Yes No

Please tick the box from the list below that best describes the ethnic group to which you belong.

WHITE BLACK OR BLACK BRITISH CHINESE OR OTHER ETHNIC GROUP

British Caribbean Chinese
Irish African Other ethnic group
Other white background Other black background
Please specify
Please specify Please specify

ASIAN OR ASIAN BRITISH MIXED

Indian White & black Caribbean
Pakistani White & black African
Bangladeshi White & Asian
Other Asian background Other mixed background

Please specify Please specify

SOURCE OF INTRODUCTION To help us monitor our advertising policy, please say where you saw this post advertised.

Friends / family Job centre Local press Instore advertisement Other

Application for employment