Application – Fitness At Work

Previous Employment (Where applicable please give details of your last 3 jobs:)
Have you ever been the subject of complaint, dismissal or disciplinary action?
- Yes
- No
Employment 1
Job Title
Date From (DD/MM/YYYY)
DD slash MM slash YYYY
Date To (DD/MM/YYYY)
DD slash MM slash YYYY
Company Name
Contact Name
Telephone Number
Address
Main Duties
Reason for leaving
Employment 2
Job Title
Date From (DD/MM/YYYY)
DD slash MM slash YYYY
Date To (DD/MM/YYYY)
DD slash MM slash YYYY
Company Name
Contact Name
Telephone Number
Address
Main Duties
Reason for leaving
Employment 3
Job Title
Date From (DD/MM/YYYY)
DD slash MM slash YYYY
Date To (DD/MM/YYYY)
DD slash MM slash YYYY
Company Name
Contact Name
Telephone Number
Address
Main Duties
Reason for leaving
Employment 4
Job Title
Date From (DD/MM/YYYY)
DD slash MM slash YYYY
Date To (DD/MM/YYYY)
DD slash MM slash YYYY
Company Name
Contact Name
Telephone Number
Address
Main Duties
Reason for leaving
Employment 5
Job Title
Date From (DD/MM/YYYY)
DD slash MM slash YYYY
Date To (DD/MM/YYYY)
DD slash MM slash YYYY
Company Name
Contact Name
Telephone Number
Address
Main Duties
Reason for leaving
Employment 6
Job Title
Date From (DD/MM/YYYY)
DD slash MM slash YYYY
Date To (DD/MM/YYYY)
DD slash MM slash YYYY
Company Name
Contact Name
Telephone Number
Address
Main Duties
Reason for leaving

References
Fitness At Work will be taking up references covering a minimum of 3 years. One reference will normally be from your previous/current employer. College/university leavers should give the name of their lecturers/tutors/professors. Please note, friends and relatives do not qualify as suitable referees. Please provide referees below, including your most recent employer, covering a 3 year period
Reference 1
Date From (DD/MM/YYYY)
DD slash MM slash YYYY
Date To (DD/MM/YYYY)
DD slash MM slash YYYY
Company Name
Contact Name
Telephone Number
Email
In what capacity is this person known to you? (e.g. previous employer, college tutor)
Reference 2
Date From (DD/MM/YYYY)
DD slash MM slash YYYY
Date To (DD/MM/YYYY)
DD slash MM slash YYYY
Company Name
Contact Name
Telephone Number
Email
In what capacity is this person known to you? (e.g. previous employer, college tutor)
Reference 3
Date From (DD/MM/YYYY)
DD slash MM slash YYYY
Date To (DD/MM/YYYY)
DD slash MM slash YYYY
Company Name
Contact Name
Telephone Number
Email
In what capacity is this person known to you? (e.g. previous employer, college tutor)
More info
Where did you hear about Fitness At Work?
Supporting Documents
Max. file size: 256 MB.
Supporting Documents
Max. file size: 256 MB.
Supporting Documents
Max. file size: 256 MB.
Supporting Documents
Max. file size: 256 MB.

Application Form