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EMPLOYMENT QUESTIONNAIRE
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EMPLOYMENT QUESTIONNAIRE
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Name
*
First
Last
Gender
*
Male
Female
Address
E-mail address (where we may communicate freely with you)
*
Telephone / Mobile (*optional)
Date of Birth
*
Day
Month
Year
Age
About your job
Job Title
Employment Commencement Date:
Day
Month
Year
Notice Period
Date of Dismissal or Resignation (if applicable)
Day
Month
Year
Last working day (this can be a future date)
Reason for dismissal or resignation (if applicable)
Has any redundancy or settlement sum already been offered? If so, how much?
Employer’s Name
*optional at this stage
Nature of your employer's business
Contact Name of HR Person/Line Manager (or both)
*optional at this stage
Email address of the above contact
*optional at this stage
Your employer's address
Your place of work (if different from above field)
Employer's work address
Employer’s Telephone
*optional at this stage
Please state gross basic wage or salary per annum (before deduction of tax)
Please state basic take home pay per month (after deduction of tax)
Please specify any other benefits such as car allowance, medical cover etc.
Please give the number of normal basic hours worked each week
Bonus
Yes/No
Discretionary/fixed
% of salary
Shares or deferred stock. Please give details where appropriate.
Holiday outstanding (how many days)
Full history of events. Please try to be as brief a possible: (the box will automatically expand if you need more space)
How did you hear about us? If Internet-which site?
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Accepted file types: pdf, docx, jpg, Max. file size: 128 MB, Max. files: 3.
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