PLEASE RETURN THE COMPLETED FORM TO:

~NYONE ELSE ISSECOND BEST!

Vigilant Security Services UK LimitedAMC Business House12 Cumberland AvenueLondonNW107QL

Tel: 0207 1834247Fax: 0208 961 3905

APPLICA nON FORMCONFIDENTIAL (WHEN COMPLETE)

FOR DATA PROTECTION PURPOSES, THIS APPLICATION FORM WILL BE SHREDDED AFTER ONEYEAR, IF YOUR APPLICATION WAS UNSUSSESSFUL

NOTES:CONFIDENTIAL (WHEN COMPLETE)

1. PLEASE USE BLACK INK AND CAPITAL LETTERS2. PLEASE ANSWER ALL QUESTIONS(USE N/A, NO OR NONE IF A QUESTION DOES NOT APPLY)3. PLEASE READ ALL SECTIONS CAREFULLY AND SIGN WHERE APPLICABLE

(Now Please Turn Over)

FOR OFFICE USE ONLY-- - ---- ---- - _. -- --INAME I lID

I

ISTART DATE IISCREENING DATE I I PROBATION DATE

I PHOTO

ISIA LICENCE NO. IISIA EXPIRY DATE

I

ILICENCE TYPE IITRAINING NOTES

I

DOCUMENTS SEEN

PASSPORT 0 PASSPORT/VISA TYPE EXP. I 1 SIA LICENCE 0PROOF OF ADDRESS 0 DRIVING LICENCE 0 UK BIRTH CERTIFICATE 0ADDITIONAL SCREENING REQUIREMENTS

LETTER ISSUED D

I

TUPEINFO IDATE OF TRANSFER 1I PREVIOUS COMPANY

ICONTINUOUS SERVICE IISITE NAME IPAPERWORK FORWARDED TO ACCOUNTS D

IINVITE SIGNATURE ISCREENING DCONTROL D DATE

LEAVERS INFO UNIFORM REASON FOR LEAVING DEPARTMENTS INFORMED OPERATIONS URETURNED

0 0Y/N ACCOUNTS PERSONNEL

LEAVING DATE RE EMPLOYYIN SIGNED

VSS-FRM-301 Issue:1 12104/2011

ISURNAMEIFAMILY NAME IITITLEHAVE YOU WORKED FOR YES 0VSS BEFORE NO 0IF YES FROM TO

IFORENAM ECS) IIMATE/FEMALE HAVE YOU APPLIED TO YES 0VSS BEFORE NO 0IF YES, WHEN:

!PREVIOUS SURNAME I IDATE OF BIRTH I ARE YOU SEEKING FT OPT 0SECURITY 0 RECEPTION 0

OTHER 0ADDRESS

HOW DID YOU HEAR ABOUT THIS POSITION?

IF THIS WAS A VSS EMPLOYEEPLEASEPROVIDE COMPLETE NAME

POST CODE NEAREST TRAIN STATION DATE ANY HOLIDAYS BOOKED

HOME TELEPHONE NAME AND ADDRESS OF NEXT OF KIN (IN CASE OF EMERGENCY)

MOBILE

EMAIL

INATIONAL

IHOW RELATED:

HOME TEL: WORK TEL:INSURANCE No.

INATIONALITY !!VISA TYPE. EXPIRY

IPLACEOFffi~H~OWNANDOOU~~)II;D;A;T;E~O;F~E;N;T;R;Y;I;N;U;K;==========~!;!P;A;S;S;P;O;R;T;N;O=.===========~

DO YOU HAVE A DRIVING LICENCE: 0 FULL 0 PROVISIONAL D NO 0 IF YES, WHICH CLASS: CARMOTORCYCLE

ooDRIVING LICENCE No: DETAILS OF CURRENT ENDORSEMENTS:

WE REQUIRE A CONTINUOUS RECORD OF YOUR PREVIOUS ADDRESS FOR THE LAST 5 YEARS

PREVIOUS ADDRESS 1: PREVIOUS ADDRESS 2:

FROM TO FROM TO

DETAILS OF SIA LICENCE:

SIA LICENCE No.SIA LICENCE TYPE SIA LICENCE EXPIRY DATE

PLEASE READ THIS SECTION CAREFULLY AND SIGN

HAS A COUNTY COURT JUDGEMENT EVEOEEN IF YD GIVE DETAILS:AWARDED AGAINST YOU? YES NO DATE:

HAVE YOU EVER APPEARED BEFORE A COURT, CHARGEDWITH A CRIMINAL, CIVIL OR MILITARY OFFENCE AND BEENCONVICTED, OR CAUTIONED BY THE POLICE, FOR ANY YES 0 SIGNATURE:

OFFENCE WHICH IS CONSIDERED AN UPSPENT CONVICT NO 0 SIGNATURE:IF YES GIVE DETAILS AND DATES:

HAVE YOU ANY ALLEGED OFFENCES OUTSTANDING? YES 0 SIGNATURE:

NO 0 SIGNATURE:IF YES GIVE DETAILS AND DATES:

VSS-FRM-301 2 Issue:1 12/04/2011

SERVICE RECORD

N/A D ARMYD NAVYD AIRFORCED POLICESERVICED FIRESERVICED TERRITORIALARMY D

ARE YOU LIABLE FOR RECALL YES D NO D ARE YOU A MEMBER OF ANY RESERVE INVOLVING TRAINING YES D NO DCHARACTER REFERENCESPLEASE GIVE DETAILS OF 2 PEOPLE (OTHER THAN FAMILY AND NOT A FORMER EMPLOYER), WHO HAVE KNOWN YOU FOR AMINIMUM OF 3 YEARS. WE WILL APPROACH FOR REFERENCES AND IF NEED BE, TO ASSIST IN VERIFYING CERTAIN PERIODS OFYOUR EMPLOYMENT HISTORY.

NAME: NAME:

ADDRESS: ADDRESS:

TELEPHONE No. TELEPHONE NO.

OCCUPATION: OCCUPATION:

PERIOD KNOWN: PERIOD KNOWN:

EDUCATION AND QUALIFICATIONS (STATE NAME AND ADDRESS OF ALL SCHOOLS/COLLEGES ATTENDED WIHIN LAST 5 YEARS)

DATES SECONDARY SCHOOUCOLLEGE/UNIVERSITY EXAMS TAKEN OFFICE USEFROMITO INCLUDING FULL ADDRESS AND TELEPHONE No. QUALIFICATION GAINED

EMPLOYMENT - FIVE YEARS HISTORY STARTING WITH TODAY'S DATE AND WORKING BACKWARDS

EMPLOYMENT DATES DETAILS OF EMPLOYMENT, SELF EMPLOYMENT, REGISTERED/UNREGITERED/ OFFICE USEMONTHIYEAR UNREGISTERED UNEMPLOYMENT, MILlLARY SERVICE, PART TIME WORK

FROM: COMPANY NAME: POSITION HELD

TO: ADDRESS: WORKS No.

TEL: REPORTING TO:

LAST SALARYIWAGE:

FAX: REASON FOR LEAVING:

POSTCODE:

FROM: COMPANY NAME:

TO: ADDRESS: POSITION HELD

TEL: WORKS No.

REPORTING TO:

FAX: LAST SALARYIWAGE:

POSTCODE: REASON FOR LEAVING:

FROM: COMPANY NAME:

TO: ADDRESS: POSITION HELD

TEL: WORKS No.

REPORTING TO:

FAX: LAST SALARYIWAGE:

POSTCODE: REASON FOR LEAVING:

FROM: COMPANY NAME:

TO: ADDRESS: POSITION HELD

TEL: WORKS No.

REPORTING TO:

FAX: LAST SALARYIWAGE:

POSTCODE: REASON FOR LEAVING:

VSS-FRM-301 3 Issue:1 12/04/2011

EMPLOYMENT - FIVE YEAR HISTORY (CONTINUED)

EMPLOYMENT DATES DETAILS OF EMPLOYMENT, SELF EMPLOYMENT, REGISTERED/UNREGISTERED/ UNREGISTERED OFFICE USEMONTHIYEAR UNEMPLOYMENT, MILITARY SERVICE, PART TIME WORK, ETC.FROM:

TO: ADDRESS: WORKS No.

TEL: REPORTING TO:

LAST SALARY/ WAGE:

FAX: REASON FOR LEAVING:

POSTCODE:

FROM: COMPANY NAME:

TO: ADDRESS: POSITION HELD

TEL: WORKS No.

REPORTING TO:

FAX: LAST SALARYIWAGE:

POSTCODE: REASON FOR LEAVING:

FROM: COMPANY NAME:

TO: ADDRESS: POSITION HELD

TEL: WORKS No.

REPORTING TO:

FAX: LAST SALARYIWAGE:

POSTCODE: REASON FOR LEAVING:

PLEASE READ THIS SECTION CAREFULLY BEFORE YOU SIGN THE STATEMENTS

STATE:

REFERENCE DECLARATION SIGNED DDATA PROTECTION STATEMENT SIGNED D

YES D SIGNATuRE: ~EQUAL OPPORTUNITIES FORM SIGNED DNO D SIGNATURE: BANK DETAILS FORM FILLED D

OFFICE USE ONLY

ARE YOU ABLE AND FIT TO WORK NIGHT SHIFTS

APPLICANTS SIGNATURE.:....: _ DATE -----

STATEMENT TO BE SIGNED BY APPLICANT1 IF OFFERED EMPLOYMENT, IT WILL INITIALLY BE FOR A PROBATIONARY PERIOD OF 12 WEEKS2 DURING THE PROPATIONARY PERIOD, YOUR CONTRACT OF EMPLOYMENT MAY BE TERMINATED BY YOU (EXCEPT IN CASE

OF GROSS MISCONDUCT), BY NOT LESS THAN 2 WEEKS NOTICE.3 CONTINUED EMPLOYMENT IS CONDITIONAL UPON SATISFACTIORY SCREENING, TRAINING AND A MEDICAL EXAMINATION

(IF REQUIRED) AND ADHERENCE TO THE TERMS AND CONDITIONS OF EMPLOYMENT.4 I HAVE READ AND UNDERSTOOD THE COMPANY'S EQUAL OPPORTUNITY POLICY5 CUSTOMER TELEPHONES ARE FOR BUSINESS USE ONLY. CRIMINAL PROCEEDINGS WILL BE INSTIGATED AGAINST ANY

MEMBER OF STAFF WHO IS REASONABLY SUSPECTED OF THIS OFFENCE AND YOU WILL BE LIABLE FOR ANY COST INCURREDBY YOU.PLEASE SIGN BELOW TO INDICATE THAT YOU HAVE READ UNDERSTOOD THE ABOVE 5 POINTS IN THIS STATEMENT.

APPLICANTS SIGNATURE.:....: _ DATE _

STATEMENT TO BE SIGNED BY APPLICANT

1, -----------(FULL NAME IN CAPITALS)CERTIFY THAT TO THE BEST OF MY KNOWLEDGE, THE INFORMATION PROVIDED IS COMPLETE AND CORRECT AND I UNDERSTAND THATPRESENTATION OF ANY FALSE INFORMATION OR DOCUMENTS IS GROUNDS FOR IMMEDIATE DISMISSAL AND RENDERS ME LIABLE TOPROSECUTION.

IN ORDER TO COMPLETE THE EMPLOYEE SCREENING TO THE BS7858 STANDARD I AUTHORISE THAT ORGANISATION TO APPROACH THECREDIT REFERENCE BUREAU, ANY AGENCIES, FORMER EMPLOYERS AND PERSONAL REFERENCES TO VERIFY THE INFORMATION GIVENAND WILL SUPPLY A STATUTORY DECLARATION IF REQUIRED.

VSS-FRM-301 4 Issue:1 12/04/2011