Gen2 Application Form, E&D
Monitoring & Guaranteed Interview Scheme
Part One – Application Form
If you require this application form in an alternative format please contact the
Gen2 HR Department on 01900 701300
Position Applied for:
Where did you see this Vacancy Advertised?
Personal Details
Mr 
Title:
Mrs 
Surname:
Miss 
Ms 
Other (Please Specify):
Forename/s:
Address:
Postcode:
Telephone (Home):
Mobile:
Work: (Include STD)
N.I. Number:
Email Address:
Do you hold a current Driving Licence?
Yes
Do you have access to a car?
Yes
Please state any dates when you are NOT available for interview:


If offered the position, will you continue to work in any other capacity?
No
No
Yes



No

If Yes? Please give details:
Education Record
Please give details of your Education, Qualifications and Training to Date:
Dates
Establishment Attended
Qualification & Grade Attained
From:
To:
Membership of Relevant Professional Bodies/Associations
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Gen2 is committed to equality of opportunity and values diversity in our workforce – Gen2 welcomes enquiries from everyone
Gen2 Application Form, E&D
Monitoring & Guaranteed Interview Scheme
Employment Details (Present/Most Recent)
Job Title:
Name & Address of Employer:
Postcode:
Notice Period:
Current Salary:
Dates From/To:
Reason for Leaving:
Outline of Main Duties:
Previous Employment History (Most Recent First)
Job Title:
Name & Address of Employer:
Postcode:
Starting Salary:
Leaving Salary:
Dates From/To:
Reason for Leaving:
Outline of Main Duties:
Previous Employment History
Job Title:
Name & Address of Employer:
Postcode:
Starting Salary:
Leaving Salary:
Dates From/To:
Reason for Leaving:
Outline of Main Duties:
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Gen2 is committed to equality of opportunity and values diversity in our workforce – Gen2 welcomes enquiries from everyone
Gen2 Application Form, E&D
Monitoring & Guaranteed Interview Scheme
Previous Employment History
Job Title:
Name & Address of Employer:
Postcode:
Starting Salary:
Leaving Salary:
Dates From/To:
Reason for Leaving:
Outline of Main Duties:
Interests/Hobbies: (Please give details of any Interests and Hobbies pursued)
References
Please give the names of two people who are able to provide references relating to your work
experience and your suitability for the post applied for. One referee should be your current or most
recent employer. Gen2 may request and will pay for CRB checks on appointment, if this is relevant.
1.
Current*/ Most Recent* Employer
2.
Other
(*please delete as appropriate)
Name:
Name:
Position:
Position:
Address:
Address:
Postcode:
Telephone Number:
May we approach this person prior to interview:
Yes 
No 
Postcode:
Telephone Number:
May we approach this person prior to interview:
Yes 
No 
Declaration
I certify that to the best of my knowledge the information I have given is correct.
Providing false information or withholding any relevant information will result in dismissal or the
withdrawal of any offer of employment.
Signature:
Date:
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Gen2 is committed to equality of opportunity and values diversity in our workforce – Gen2 welcomes enquiries from everyone
Gen2 Application Form, E&D
Monitoring & Guaranteed Interview Scheme
Additional Information
(Please use this section to give brief details of other skills, experience, qualifications, leisure activities
and any other interests which you feel are relevant and will support your application, i.e.
unpaid/voluntary work (please continue on a separate sheet if necessary).
The above information will only be used by Gen2 for recruitment purposes. It will not be
disclosed to any third party, and only members of the HR Department and Interview Panel will
have access to the information. The Data Protection Act 1998 gives you the right to withhold
this information should you wish to do so.
Please return Part One when completed to the Gen2 Head Office at:
HR Department, Gen2, Unit 1, Joseph Noble Road, Lillyhall Industrial Estate,
Workington, Cumbria, CA14 4JX
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Gen2 is committed to equality of opportunity and values diversity in our workforce – Gen2 welcomes enquiries from everyone
Gen2 Application Form, E&D
Monitoring & Guaranteed Interview Scheme
Part Two – Equality & Diversity Data Collection form
Strictly Confidential – for Personnel use only
This information is not for use in the selection process
Position Applied for:
Surname:
Forenames:
Equality and Diversity Data Collection Form
Gen2 is committed to supporting equality of opportunity and works towards ensuring that
everyone has access to all our products and services. The information you provide in this
section can be very helpful in ensuring we have a diverse workforce.
We constantly monitor and review our recruitment process to ensure that it adheres to this
commitment, and to ensure that no-one is disadvantaged at any stage of a recruitment
competition. One way of monitoring is through the collection and analysis of statistical
information. To do this we need to gather details of ethnic background, age, gender,
transsexual, disability, sexual orientation and religion or belief of people who apply to join Gen2
and for those people who are employed by Gen2..
Please help us to monitor the effectiveness of our equality and diversity work by answering the
questions below.
The information you provide will be treated confidentially and will play no part in the recruitment
process, and will continue to be used for monitoring purposes throughout your employment with
Gen2. Such use will be subject to the provision of the Data Protection Act 1998.
Criminal Convictions
Have you ever been convicted of a criminal offence, other than a ‘spent’ conviction under the
rehabilitation of Offenders Act 1974?
Yes

No

If Yes? Please give brief details:
Employment
Are you currently:
Employed 
Unemployed 
If ‘Unemployed’ please state how long for: Less than 6 months
Self-Employed 
 More than 6 months
Please tick the appropriate boxes below
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Gen2 is committed to equality of opportunity and values diversity in our workforce – Gen2 welcomes enquiries from everyone

Gen2 Application Form, E&D
Monitoring & Guaranteed Interview Scheme
What is your gender?
Female

What is your age?
Male

16 – 18

Prefer not to say

19 - 24

25 – 29

30 - 34

35 - 39

40 - 44

45 - 49

50 - 54

55 and over

Prefer not to say

Gay man

Gay woman/lesbian

What is your sexual orientation?
Bisexual

Heterosexual/straight

Prefer not to say

Other sexual orientation - please specify:
What is your marital status?
Divorced or separated
Single


Married/civil partnership/cohabiting

Widowed

Prefer not to say

No

Prefer not to say

Prefer not to say

Do you have dependants?
Yes

Do you consider yourself to be a disabled person?
Yes

No

If the answer is yes please give details:
Do you have a learning difficulty (i.e. dyslexia, dyspraxia, etc.)
Yes

No

Prefer not to say


Pakistani

If the answer is yes please give details:
What is your ethnic group?
Asian
Bangladeshi

Indian
Any other Asian background - please specify
Black
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Gen2 is committed to equality of opportunity and values diversity in our workforce – Gen2 welcomes enquiries from everyone
Gen2 Application Form, E&D
Monitoring & Guaranteed Interview Scheme
African

Caribbean

Any other Black background - please specify:
Mixed
White & Asian

White & Black Caribbean

White & Black African

Any other Mixed background - please specify:
White

British (white)

Irish
Other British (white) - please specify:
Any other White background - please specify:
Other ethnic background

Chinese
Middle Eastern/North African
Any other background - please specify:
Prefer not to say:


Do you have a religion or similar belief?

No
Yes

Prefer not to say


Christian - Protestant

Jewish

If the answer is yes please indicate which:
Baha’i

Christian - Roman Catholic
Buddhist

Christian - Other - please specify:
Hindu

Jain

Muslim

Sikh

Other religion or similar belief - please specify:
What is your country of permanent residence?
UK

Other European Union/European Economic Area
Other

Prefer not to say


Have you a legal right to work in the UK (for security clearance purposes)?
No

Yes

Please return Part Two when completed to the Gen2 Head Office at:
HR Department, Gen2, Unit 1, Joseph Noble Road, Lillyhall Industrial Estate,
Workington, Cumbria, CA14 4JX
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Gen2 is committed to equality of opportunity and values diversity in our workforce – Gen2 welcomes enquiries from everyone
Gen2 Application Form, E&D
Monitoring & Guaranteed Interview Scheme
Part Three - Guaranteed Interview Scheme
We guarantee to interview anyone with a disability whose application meets the minimum
criteria for the post. By “minimum criteria”, we mean that you must provide us with evidence in
your application form which demonstrates that you generally meet the level of competence for
each of the criteria, as well as meeting any of the qualifications, skills or experience defined as
essential. Gen2 is committed to the employment and career development of disabled people
(the minimum criteria means the essential competences as set out in the advertisement/job
description for the post). To show this, we use the Disability Symbol awarded by the
Employment Service.
What do we mean by Disability?
The Disability Discrimination Act (DDA), 1995 defines a disable person as someone who has a
physical or mental impairment which has a substantial and adverse long-term effect on
his or her ability to carry out normal day-to-day activities.
How do I Apply?
Simply complete the declaration below and send it in with the main application form.
Please let us know if there are any special arrangements you need for the interview.
We will try to provide access, equipment or other practical support to ensure that if you have a
disability you can compete on equal terms with non-disabled people.
Declaration
I consider myself to have a disability as defined above and I would like to apply under the
Guaranteed Interview Scheme.
Name:
Date:
Signature:
Please return the completed form with your application, using a sealed envelope if you prefer,
marking “GIS” on it and firmly attaching it to your application.
Please Note:
Any false declaration of disability to obtain an interview will subsequently invalidate any
offer of a post.
If applicable please return Part Three when completed (in confidence) to the
Gen2 Head Office at:
HR Department, Gen2, Unit 1, Joseph Noble Road, Lillyhall Industrial Estate,
Workington, Cumbria, CA14 4JX
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Gen2 is committed to equality of opportunity and values diversity in our workforce – Gen2 welcomes enquiries from everyone