Registration Form 2023
Registration Form 2023
SURNAME:
TITLE: MR. FORENAME(S): keval
Sidhdhapara
HAVE YOU PREVIOUSLY BEEN KNOWN BY ANY OTHER NAME?: no
DATE OF BIRTH: 19/12/1994 NATIONALITY: indian
WORK PERMIT REQUIRED: Yes ✘ No
NATIONAL INSURANCE NO: TL633111D TAX REF. NO.:
DRIVING LICENCE: Yes No Provisional
✘
CAR OWNER: Yes No ✘
POSTCODE: HA27sj
Healthcare Car Parking ✘ Pension (Non Con) Pension (Con) Bonus (Disc) ✘
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Douglas ✘ Castletown ✘ Ramsey ✘ Peel ✘ Other ✘
EMPLOYMENT
If you answer ‘Yes’ to any of the following questions, please provide further
details on the
Additional Information page.
Have you ever failed to complete a probationary period? Yes No ✘
Have you ever been the subject of a disciplinary investigation or Yes No ✘
disciplinary action by a previous employer?
Have you ever been dismissed by a previous employer? Yes No ✘
Have you ever been barred from entry to, or disciplined by, any Yes No ✘
professional body or occupation?
Have you held a “Key Persons” role within an organisation and been Yes No ✘
approved by the Isle of Man Financial Services Authority?
GENERAL HEALTH
If you answer ‘Yes’ to any of the following questions, please provide further
details on the
Additional Information page.
Are you a registered disabled person? Yes No ✘
Do you currently suffer from any medical conditions or illnesses Yes No ✘
which may impact on your ability to undertake employment?
DECLARATION
I certify that the above statements are true and that I hereby authorise McKenzie Fox
Limited to retain my personal details and to act on my behalf for the purposes of securing
employment.
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HOW DID YOU HEAR ABOUT MCKENZIE FOX RECRUITMENT?
Recommended Radio ✘ Internet Newspaper Job
Centre
Contacted Directly Referred By A Friend Facebook Other
JOB ALERTS
Would you like to receive automatic email job alerts specific Yes ✘ No
to your current job search?
This information constitutes sensitive personal data as defined by the Data Protection
Act. By submitting this data you consent to the holding of this data by McKenzie Fox
Limited for the purposes of finding employment and also being used by us for the
purposes of diversity statistical data which may occasionally be shared with clients.
I confirm that all the information provided to McKenzie Fox Limited on this form is true
and correct. I understand that McKenzie Fox Limited will be unable to act on my behalf
for the purpose of seeking employment should I provide false information.
DATE: 2-11-2023
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If you are seeking temporary or contract employment or are not currently
employed then you must provide reference contact details to cover the last
five years of employment and / or education. You should provide reference
details from former employers but not your current employer (if applicable),
unless you are happy for us to contact them. In all cases we require a minimum
of two references.
REFERENCE ONE
PLEASE INDICATE AS APPROPRIATE: Employment Education Professional
✘ Other
I hereby give McKenzie Fox permission to contact the above referees for the
purpose of obtaining references.
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DATE: 02-11-2023
ADDITIONAL INFORMATION:
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