Date of Birth:
Address Line 1:
Address Line 2:
Preferred Contact Method: PhoneEmailPost
In order that the Company can monitor its Equal Opportunities Policy, applicants are requested to complete this monitoring section. The information will remain confidential to the HR Department. It will not be made available to the interview panel.
Country of Residence:
Date of Entry to Country of Residence:
How would you describe your ethnic origin? ---ArabAsian - BangladeshiAsian - ChineseAsian - IndianAsian - OtherAsian - PakistaniBlack - AfricanBlack - CaribbeanBlack - OtherMixed - OtherMixed - White & AsianMixed - White & Black AfricanMixed - White & Black CaribbeanWhite - BritishWhite - GypsyWhite - IrishWhite - Irish TravellerWhite - OtherAny other ethnic groupPrefer not to say
Please complete 1 of the following:
Military Service Number:
Veteran Service Number:
Parents Service Number:
Military force you or your parents were in: ---ArmyNavyRAFMarinesSpecial ForcesOther - please fill out below
Please pick your prefered course datefor the three day residential course: ---18th & 19th June 2019
Present Occupation: (if applicable)
Your Support Needs
We wish to make our courses accessible to all verterans and veteran family members that wish to apply, the following information will help us to give you all the support you need. You will have the opportunity to discuss your needs during the interview.
Do you consider yourself to have a:Combat PTSDModerate Learning DifficultySevere Learning DifficultyDyslexiaDyscalculiaOther Learning DifficultyAutism Spectrum DisorderMultiple Learning DifficultiesVisual ImpairmentHearing ImpairmentDisability Affecting MobilityOther Physical DisabilityOther Medical ConditionEmotional/Behavioural DifficultiesMental Health ConditionTemporary Disability After Illness or AccidentProfound/Complex DisabilitiesAspergers SyndromeMultiple disabilitiesNo Learning DifficultyNo DIsabilityAny Other
If Under 19 years of age
Present or Last School/College:
Date of Leaving:
(Declaration subject to the Rehabilitation of Offenders Act 1974)
Please give details:
I confirm that this application is, to the best of my knowledge, true and complete.
I understand and accept that any false statement may be sufficient for rejection or, if employed, dismissal.
Application forms are held on file for 9 months, please tick the boxes to let us know if you do or do not wish us to keep your details on file for 9 months YesNo
If you do not want to receive information from Tilbury on the Thames Trust this isn't related to this application, please tick here No Info
By using this form you agree with the storage and handling of your data by Tilbury on the Thames.