APPLICATION FOR EMPLOYMENT

Please fully complete this form and return to jobs@monbs.com, you may also include a CV if you wish.

Role
Applying
For:

Department /
Branch:

PERSONAL DETAILS
Title:

Mr / Mrs / Miss / Ms / Other

Last name:
Middle
names:
Main
Telephone
Number:
Alternative
Telephone
Number:

First Name:

Address:

Email
Address:

ELIGIBILITY TO WORK
Are you eligible
to work in the
UK?

Yes / No

If you hold a visa or work

permit please give details:

EDUCATION
Name of School /
College / University

Type of
Qualification (A
Level, GCSE etc)

Results/
Grades

Subjects/Course

PROFESSIONAL QUALIFICATIONS / MEMBERSHIPS

Name of Organisation
/ Establishment

Type of Qualification /Membership

Level/
Grades

Please give of any other relevant training or development you have received:

July 2015

E MPLOYMENT H ISTORY
Please start with the most recent position and account for all gaps in employment; education, career breaks,
maternity etc. We will need to obtain references for at least five years of employment so please ensure you
provide full contact details. If you have had any employment gaps (4 weeks and over) we will also ask you to
provide evidence in the form of your benefits office address or a contact name who can provide evidence. Your
referees will not be contacted until a conditional offer of employment is made.

Present or most
recent
Job Title:

Type of Business:
Leave Date:
(if applicable)
Details of
benefits:
Period of Notice:

Start Date:
Current Salary:

Reason for
leaving:
Please give brief details of your key duties and responsibilities including any achievements

Company Details

Job Title

Dates Employed

Name:
Address:

Reason
for
Leaving

Telephone Number:
Name:
Address:
Telephone Number:
Name:
Address:

Telephone Number:
Name:
Address:

Telephone Number:
Please attach a CV with further employer details if applicable.
Please also provide details of two personal referees:

Referee Name:

Referee Address:

July 2015

July 2015

ADDITIONAL I NFORMATION
How do you feel your skills and experience relate to the job which you are applying for?

Please include any details in support of your application and include any other skills or
qualifications not mentioned earlier e.g. typing skills, etc:

What are your main spare time/leisure interests?:

Do you have any other employment which you intend to carry on if you are
successful in gaining employment with the MBS Group?

Yes / No

If Yes please provide details

of the employer and hours
worked:
Do you know or are you related to any current member of staff at the
Monmouthshire?

Yes / No

Where did you hear about this vacancy?

If a Monmouthshire member of staff
referred you please state their name
here:
Do you hold a current driving licence?

Yes / No

If yes are there any penalty points?

Yes / No

Have you ever been banned from driving?

Are you subject to any restrictive covenants regarding your current / past
employment?
If Yes please provide
details:

Yes / No
Yes / No

Do you have any holidays booked?

If yes please list dates:
Dates you are not available for
interview:

July 2015

REASONABLE ADJUSTMENTS
If you require any assistance during the application stage or any selection process should you be
shortlisted please contact the MBS HR team at jobs@monbs.com

July 2015

DISCLOSURE AND BARRING SERVICE (DBS) CHECKS AND CREDIT CHECKS

As a Financial Services organisation Monmouthshire Building Society uses credit checking and the Disclosure
and Barring Service to assess applicants suitability for positions of trust. The Society complies fully with the Code
of Practice and undertakes to treat all applicants for positions fairly. It undertakes not to discriminate unfairly
against any subject of a disclosure on the basis of a conviction or other information revealed. We also comply fully
with our obligations under the Data Protection Act 1998 and has a policy regarding the safe handling, use,
storage, retention and disposal of Disclosure information. If you wish to see a copy of our DBS Retention and
Disposal policy please contact the MBS HR team at jobs@monbs.com
By completing this application form you are giving your permission for us to conduct a credit check and to
undertake a DBS check. A DBS check will not be completed until we propose an offer of employment with the
Society. You will also be required to provide three forms of identification (i.e. a driving licence, passport, utility bill,
bank statement) one of which must be photo identification.
In order for us to process the DBS application and credit check we require the following information:

Surname at birth
(if different from
current)

Forename at birth
(if different from
current)

Please state the dates you

used this name.

Please state the dates you

used this name.

Any other previous

surnames

Any other previous

forenames

Please state the dates you

used this name.

Please state the dates you

used this name.

Date of Birth

Gender

Town of Birth

County of Birth

Mothers family
name

Nationality

National Insurance
Number

What date did you

move into your
current address?

If you have lived at your current address for less than five years, please provide your residential addresses over
the last 5 years:

Previous Address & postcode (if less than 5

years)
Resident from date:
Previous address & postcode (if applicable)
Resident from date:
I confirm that the information I have provided in support of this application is complete and true and understand
that knowingly to make a false statement for this purpose is a criminal offence.
I consent to the Disclosure and Barring Service (DBS) checking the details I have provided in support of this
application against the data sources specified in the notes for guidance, in order to verify my identity and process
this application.
I consent to this information being used to undertake a Basic Criminal Disclosure and a Credit Report by
Complete Background Screening Ltd and understand that the contents of which will be provided to the
Monmouthshire Building Society. I acknowledge that my involvement with Monmouthshire Building Society is
subject to information held in this report.

July 2015

July 2015

DECLARATION
Have you ever been refused or had revoked or withdrawn any membership of or
authorisation of registration by the FCA, its predecessor bodies (including) SIB, any
recognised SRO or RPB) Mortgage Code, Compliance Board or professional bodies, have
you ever resigned from, or discontinued membership of or authorisation by such body? Are
you currently or have you ever been the subject of public censure, disciplinary
proceedings, suspension, expulsion by any of the bodies listed above?
Have you ever been refused or had revoked or withdrawn, any authorisation to carry on
insurance, investment, mortgage intermediary or banking business?
Have you ever been convicted by a court (including civil or military) for offences (including
motoring offences) which are not spent convictions under the Rehabilitation of Offenders
Act 1974, (including any criminal offence for dishonesty, Fraud, financial crime, violence or
other offences under the legislation relating to Banking and financial services, companies,
insurance or consumer protection) or have Been subject to penalties for tax evasion?

Yes/No

Yes/No

Yes/No

(Please be assured that disclosing a Conviction will not necessarily be a bar to obtaining a position,
however if you do not disclose a conviction which is later revealed in a CRB check, we may withdraw an

Have you ever been a defendant in any civil proceedings, or a party to any arbitration, in
relation to any investment business, mortgage intermediary business or other financial
business?
Have you ever had a petition for bankruptcy presented against you, or been declared

Yes/No

Yes/No
bankrupt, or had your estate sequestrated, or are you currently the subject of such
proceedings, sequestration of your estate?
Have you ever defaulted on a loan, had any judgement debt entered against you, made a
Yes/No
compromise or arrangement with one or more of your creditors, or made proposals for
such, ceased trading in circumstances in which one or more of your creditors did not
Have you been involved as a director, secretary or partner in any financial services or
Yes/No
mortgage intermediary business that has ceased trading, or gone into insolvency,
liquidation or administration within the last three years?
Are you or have you ever been in arrears with any credit agreement, including your
Yes/No
mortgage or rent, or voluntarily / involuntarily given up possession of your home, or had
your home repossessed by a lender?
Are you currently repaying any monies due to a previous employer in respect of an
Yes/No
industry debt / are you in dispute with any previous employer regarding monies allegedly
owed
you?
If youby
have
answered yes to any of the above questions please provide full details on a
separate sheet.
It is the Groups duty to ensure that its staff are fit and proper to conduct business whilst in their employment. Part of
this confirmation of fit and proper will be obtained by undertaking a credit search. Your signature below will be
considered due authorisation for this.
The 1998 Data Protection Act controls the obtaining and use of data about individuals. The information provided by you
as part of your application, together with any other personal information you provide or, the Group obtains e.g.
references from former employers, referees and sensitive information such as medical details, will be retained by the
Group for 3 months following the conclusion of the recruitment period. If you are successful with your application and
subsequently take up employment with the Group this information will be retained for the duration of your employment
and at least 6 years after you leave. We may check the information collected, with third parties or with other information
held by us. We may also use or pass to certain third parties information to prevent or detect crime, to protect public
funds, or in other ways as permitted by law. Your personal details will not be passed to any third party (except in
response to an employment reference request or as mentioned above), without your consent. Your details will be used
to assess your suitability and competence to work for the Group and, statistical analysis purposes. By signing this
application you are giving your consent to the Group to obtain and hold personal data as described above.
We will check your details with/against fraud prevention databases. Should our investigation identify fraud or the
commission of any other criminal offence by you (on your part) when applying for, or during the course of your
employment with us, we will record details of this on fraud prevention databases. This information may be accessed
from the UK and other countries and used by law enforcement agencies and by us and other employers (and potential
employers) to prevent fraud.

I certify that the details given in this application are accurate to the best of my knowledge.
Signature:

Date:

July 2015

E QUAL O PPORTUNITIES M ONITORING

Monmouthshire building Society Group wishes to promote equality of opportunity and we seek your cooperation in achieving this aim by completing this monitoring form. The data will only be used to
produce anonymous statistical analysis, and will only be retained for a period of six months after the
completion of the selection process.
No-one directly involved with the selection process will have access to this data.
We thank you for your co-operation.

Role
Applying
For:

Gender:

Department /
Branch:
Sexual Orientation
(please place an X next to)
Bisexual

Male / Female

Age:

Gay man

Nationality:

Gay woman/lesbian
Heterosexual/straight

I consider myself
to be disabled:

Yes / No

Other
Prefer not to say

Ethnicity (please place an X next to which best describes your ethnic group or background):
White:
Welsh/English/Scottish/Northern
Irish/British
Irish

Mixed/multiple ethnic groups:

Gypsy or Irish Traveller

White and Asian

Any other white background

Any other mixed/multiple ethnic

background

Asian/Asian British:

Black/African/Caribbean/Black British:

Indian

African

Pakistani

Caribbean

Bangladeshi

Any other Black/African/Caribbean/Black

British background:

Chinese

Other ethnic group:

Any other Asian background

Arab:

White and black Caribbean

White and black African

Any other ethnic group:

By completing this form I give my consent to Monmouthshire Building Society Group recording
and processing information about me in the above categories.

July 2015