Title

Mr

Mrs

Miss

Ms

Name *

First Name

Last Name

Have you previously been employed by Butters Group Ltd? *

No

Yes

Preferred hours of work

Full time

Part time

Have you been convicted of any criminal offence? *

Yes

No

To your knowledge and belief, is there any possible outstanding or prosecution pending against you?

Yes

No

Would this be your main job?

Yes

No

Should you be offered the position you have applied for, when would you be able to commence employment?

MM

DD

YYYY

Do you have any experience in the following areas?

Please tick appropriate boxes.

Health & Safety

Poep Truck

First Aid

Quality Control

Stock Control

Paperwork / Admin

Supervisory Experience

Pallet Truck

System / Computer

Team Leader Experience

Fork Truck

Stacking / Packing

Machinery Cleaning

Other, please state below

Do you hold a forklift license?

Yes

No

If yes, what type of license

Counterbalance

Reach