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If no, please give further information: For health and safety reasons, and to ensure your wellbeing, we would like ascertain the following information.

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Have yoy ever suffered, or do you currently suffer from any illness, slimming iv push, injury or disability that would be aggravated or prevented you from,or cause you difficulty in carrying out any of the job duties? I declare that I do not possess, nor have ever possessed a criminal conviction, whether in the UK or anywhere else in the world, nor have I been subject to any Conditional Discharges, Bindovers or Cautions.

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I understand my potential employment is subject to a Criminal Records Bureau Disclosure Check and that in the event that this Declaration slimming iv push found to be false that my employment may be terminated immediately. I understand that any false information or deliberate omissions will disqualify me from employment or may render me liable for dismissal. I consent to my CV and references being forwarded to employers.

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I understand that the information provided will be used to make a decision regarding my suitability for employment and, if successful, the information will be used to form my personnel record and will be retained for the duration slimming iv push my employment and as long as is deemed necessary thereafter.

If am not successful, I understand that the Organisation will retain the formfor as long as is deemed necessary for the purpose of recruitment and that the Organisation may use it to contact ne in the event of there being any other for which I may be suitable.