Application Form Blacker Hall Farm Shop Ltd. Position Date of Application Office Use Only: Date Processed: Initial:

Place of advert: Mr Miss Mrs Other :

Title: Surname: Forename(s): Address: Post Code:

Email: Telephone: Mobile:

Current or most recent Employment details: Role and duties: Duration : Reason for leaving:

Job Title Employer Start & End Date 1

Responsibilities and reason for leaving: 2

Responsibilities and reason for leaving: 3

Attach CV if available: Or Details of last three positions held

Responsibilities and reason for leaving:

School/College/

University Qualifications Grades

Education:

Award Achieved

Level Date Grade Additional Relevant

Qualifications/Awards (Food Hygiene, Health & Safety, Customer Service etc.) If you would like to add anything further, eg. Copies of certificates, qualifications please attach or continue on the reverse of the form.

Hours Please note that Blacker Hall Farm Shop / Coffee Shop is a seven day operation. In some departments weekend shifts may be required, depending on your position. This will be on a rota basis and shifts will be arranged in advanced on rotas prepared by line managers.

We want to know more about you. What are your hobbies, interests, sports etc: What is your ambition?

In what ways would you most benefit the team at Blacker Hall Farm Shop?

Gender: Male/Female Date of birth: Age: Are you a known certified carrier of a food-borne disease or related illness that may be passed to others? Eg. Salmonella, thyphoid etc. Y / N Have you suffered from food poisoning, or food-borne illness, confirmed by a medical examination in the last 24 months? Y / N Do you consider yourself to have a disability? If yes, what is the nature of your disability?

Data Protection Statement

The information collected by this application form allows us to make an informed decision as to whether to proceed with your application. Where the information provided is sensitive (such as your state of health) you expressly

consent to our use of the information to assess your application. The information will only be used by Blacker Hall Farm Shop Ltd and will not

be forwarded to any other third parties. Please supply details of two suitable references that you consent to us contacting should we wish to take your application further.

Return by email to: Return by post to: Recruitment Blacker Hall Farm Shop Ltd. info@blackerhall.com Branch Rd, Calder Grove, subject: Job Application Wakefield WF4 3DN

Name: Relationship to you Date known Referee Contact Details:

Name: Relationship to you Date known Referee Contact Details:

Official Use Only:

Position: Part Time Customer Service AssistantDate of Application: Place of advert: In StoreOther: MrEmail: jack.wright1337@gmail.comCurrent or most recent Employment details Role and duties Duration Reason for leaving: Holiday-Temporary Sales Assistant at Next fashion outlet, Wakefield.

Maintain levels of stock on the shelves and appearance of the store, direct and converse with customers concerning issues and queries.December 2014

TemporaryResponsibilities and reason for leaving: Maintain levels of stock on the shelves and appearance of the store, direct and converse with customers concerning issues and queries. Only a temporary role for a busy period, dismissed afterwards.Responsibilities and reason for leaving_2: Responsibilities and reason for leaving_3: SchoolCollege UniversityAward Achieved: QEGS WakefieldQualificationsAward Achieved: Maths GCSEGradesAward Achieved: CSchoolCollege UniversityAward Achieved_2: QEGS WakefieldQualificationsAward Achieved_2: Geography GCSEGradesAward Achieved_2: ASchoolCollege UniversityAward Achieved_3: QEGS WakefieldQualificationsAward Achieved_3: English Lang GCSEGradesAward Achieved_3: BSchoolCollege UniversityAward Achieved_4: QEGS WakefieldQualificationsAward Achieved_4: English Lit GCSEGradesAward Achieved_4: ASchoolCollege UniversityAward Achieved_5: QEGS WakefieldQualificationsAward Achieved_5: Biology GCSEGradesAward Achieved_5: BSchoolCollege UniversityAward Achieved_6: QEGS WakefieldQualificationsAward Achieved_6: Chemistry GCSEGradesAward Achieved_6: BSchoolCollege UniversityAward Achieved_7: QEGS WakefieldQualificationsAward Achieved_7: Physics GCSEGradesAward Achieved_7: BSchoolCollege UniversityAward Achieved_8: QEGS WakefieldQualificationsAward Achieved_8: French GCSEGradesAward Achieved_8: CSchoolCollege UniversityAward Achieved_9: QEGS WakefieldQualificationsAward Achieved_9: Art and Design GCSEGradesAward Achieved_9: A*SchoolCollege UniversityAward Achieved_10: QualificationsAward Achieved_10: GradesAward Achieved_10: SchoolCollege UniversityAward Achieved_11: QualificationsAward Achieved_11: GradesAward Achieved_11: LevelAdditional Relevant QualificationsAwards Food Hygiene Health Safety Customer Service etc If you would like to add anything further eg Copies of certificates qualifications please attach or continue on the reverse of the form: DateAdditional Relevant QualificationsAwards Food Hygiene Health Safety Customer Service etc If you would like to add anything further eg Copies of certificates qualifications please attach or continue on the reverse of the form: GradeAdditional Relevant QualificationsAwards Food Hygiene Health Safety Customer Service etc If you would like to add anything further eg Copies of certificates qualifications please attach or continue on the reverse of the form: We want to know more about you What are your hobbies interests sports etc What is your ambition: Socializing with my friends, often cycling with them.Reading a wide variety of novels, mostly fiction with some non-fiction.Cook often for the family, as well as my family.Oainting and drawing ocasionally, mostly portraits nowadays.Watching cult movies and certain TV shows.

Strive to achieve and constantly find ways to improve my skills, however I would like to sucessfully climb a mountain within my lifetime.

In what ways would you most benefit the team at Blacker Hall Farm Shop: Through having a genuine interest with high quality food and produce, my desire to help the business succeed would be emphasize greatly. I would become dedicated to seeing that things run smoothly, good food is a good motivator, and I would certainly strive to polish the already shining reputation of this authentic business.Name: Damian DrylandName_2: Nicholas LambertSurname: WrightForename: JackAddress and Post Code: 1 Woodyard CottagesWalton Wakefield

WF1 5RZTelephone / Mobile Number: 07733276079Job Title: Sales AssistantStart & End Date: -Employer: NextJob Title 2: Employer 2: Start & End Date 2: Job Title 3: Employer 3: Start & End Date 3: Age: 17Do you consider yourself to have a disability?: NIf yes, what is the nature of your disability?: Contact Details: 01924 397343Relationship to you: TeacherDate known: 2011+Contact Details2: 01924 397343Relationship to you_2: TeacherDate known 2: 2013+Please state Y / N: NPlease state Y / N 2: NDate of birth: 14/9/1997Male / Female: Male