8pp Application Form:Layout 1

18/01/2008

16:34

Page 1

EMPLOYMENT HISTORY CONTINUED

CONDITIONS

(List the most recent employment first) 3) Previous Employer – Company Name, Address & Telephone Number

Nature of Business

If you are successful in your application and are offered a position with Servier (Irl) Industries Ltd./ Servier Laboratories (Irl) Ltd the offer may be conditional upon you:1) 2)

Producing evidence to show that you are entitled to live and work in Ireland Successfully completing medical examination to be carried out by a medical practitioner

Job Title: Key responsibilities:

DECLARATION

Dates Employed: From:

Length of Service: To:

……..years……….months

Reason for Leaving:

“I have reviewed the above information supplied to me and hereby certify that, to the best of my knowledge, information and belief, such information is true and complete and is not misleading in any material respect. I understand that any falsification, omission or misrepresentation on my part will be treated as serious misconduct and may result in the termination of my employment with the company in the event that I am successful in my application for employment with Servier (Irl) Industries Ltd./ Servier Laboratories (Irl) Ltd”.

Application Form

“I understand that certain information hereby provided by me is personal data within the meaning of that term as defined in the Data Protection Acts 1988 and 2003 (the “Acts”) and I confirm that the provision of this information by me so that it may be processed for the purposes of consideration of my application constitutes a consent for the purposes of the Acts.

Salary & Benefits (Pension, VHI, BUPA, Bonus…)

Shift Premium

Date: ………………………..

Signature: ………………………………………………….

RECRUITMENT SOURCE

CHECKLIST (Tick once enclosed)

Additional Information regarding previous periods of Employment (Company, Job Title, Duties, Dates Employed…)

Website (please specify) ..............…….....……………………………… Newspaper Advert (please specify)

- Completed Application Form - Your Curriculum Vitae - Photocopy of Academic Transcripts

..............…….....………………………………

Additional Information regarding your Application (Why you are applying to Servier?)

College Career Service (please specify) ..............…….....………………………………

Once complete, please return this Form at your earliest convenience

Servier (Ireland) Industries Ltd. Gorey Road Arklow Co. Wicklow Tel: (0402) 20800 Fax: (0402) 20889

a) By post in the envelope provided or

www.servier.ie

HOW TO RETURN YOUR APPLICATION FORM

Employee Referral (please specify) ..............…….....……………………………… Other (please specify) ..............…….....………………………………

b) Scan & e-mail it to [email protected] or c) By Confidential Fax to (0402) 20889

Life through Discovery

‘Where people are respected you will find a love of work’ Hippocrates

8pp Application Form:Layout 1

18/01/2008

16:34

Page 2

PERSONAL DETAILS Surname:

First Name(s):

Have you ever applied to Servier before? If yes, please give details

Current Occupation:

Location:

Position Applied For:

Home Address (if different):

(List the most recent employment first)

Driving Licence (If Relevant) Yes

No Do you have a current driving licence?

Approx. Date:

Yes

No

Yes

No

Are you willing to work shift if required?

Yes

No Are you willing to work nights if required?

Are you willing to work overtime if required?

Yes

No

Have you ever been convicted of a crime other than a minor traffic offence or is a criminal charge threatened or pending against you? If yes or in doubt please provide full details: Mobile Phone Number:

Nature of Business

Number and dates of endorsements:

How soon could you commence employment with us?

Home/Land Line Telephone Number:

1) Previous Employer – Company Name, Address & Telephone Number

Categories of vehicle covered:

Position: Address for Correspondence:

EMPLOYMENT HISTORY

GENERAL INFORMATION

Job Title: Key responsibilities:

Dates Employed: From:

Work Telephone Number:

Length of Service: To:

……..years……….months

Reason for Leaving: Are you currently employed? (Please tick as appropriate) Yes

If yes, how much notice must you give?

EDUCATION

Date of Application:

No

VISA & JOB PERMITS

Name and addresses of schools, colleges or universities attended

Dates Attended

Qualifications obtained (with levels and grades)

Date(s) Awarded Salary & Benefits (Pension, VHI, BUPA, Bonus…)

Shift Premium

For the purposes of work permits & visa applications, please answer the following:Are you a member of an EU Member State? Yes

No

2) Previous Employer – Company Name, Address & Telephone Number

If your answer is No, please outline whether you will require:a work permit an Entry Visa

FOREIGN LANGUAGES

Job Title:

State Languages spoken and circle the number corresponding to your level of fluency 1) Fluent

2) Good

3) Reasonable

4) Some knowledge

Nature of Business

ADDITIONAL TRAINING & DEVELOPMENT

Key responsibilities:

5) Poor

………………………………….. 1 2 3 4 5

………………………………….. 1 2 3 4 5

………………………………….. 1 2 3 4 5

………………………………….. 1 2 3 4 5

Course

Duration

Training Body

How did course benefit you

Dates Employed: From:

Length of Service: To:

……..years……….months

Reason for Leaving:

LEISURE ACTIVITIES Outline your interests/hobbies and membership of clubs/societies.

AWARDS & SCHOLARSHIPS

Salary & Benefits (Pension, VHI, BUPA, Bonus…)

Shift Premium

Outline any other achievements, awards, scholarships (professional or private) which could be of benefit to your application, e.g. membership of a professional society etc.

Employment record must be continuous and at all times should be accounted for, including periods of unemployment. (Please use additional sheets if necessary)

8pp Application Form:Layout 1

18/01/2008

16:34

Page 2

PERSONAL DETAILS Surname:

First Name(s):

Have you ever applied to Servier before? If yes, please give details

Current Occupation:

Location:

Position Applied For:

Home Address (if different):

(List the most recent employment first)

Driving Licence (If Relevant) Yes

No Do you have a current driving licence?

Approx. Date:

Yes

No

Yes

No

Are you willing to work shift if required?

Yes

No Are you willing to work nights if required?

Are you willing to work overtime if required?

Yes

No

Have you ever been convicted of a crime other than a minor traffic offence or is a criminal charge threatened or pending against you? If yes or in doubt please provide full details: Mobile Phone Number:

Nature of Business

Number and dates of endorsements:

How soon could you commence employment with us?

Home/Land Line Telephone Number:

1) Previous Employer – Company Name, Address & Telephone Number

Categories of vehicle covered:

Position: Address for Correspondence:

EMPLOYMENT HISTORY

GENERAL INFORMATION

Job Title: Key responsibilities:

Dates Employed: From:

Work Telephone Number:

Length of Service: To:

……..years……….months

Reason for Leaving: Are you currently employed? (Please tick as appropriate) Yes

If yes, how much notice must you give?

EDUCATION

Date of Application:

No

VISA & JOB PERMITS

Name and addresses of schools, colleges or universities attended

Dates Attended

Qualifications obtained (with levels and grades)

Date(s) Awarded Salary & Benefits (Pension, VHI, BUPA, Bonus…)

Shift Premium

For the purposes of work permits & visa applications, please answer the following:Are you a member of an EU Member State? Yes

No

2) Previous Employer – Company Name, Address & Telephone Number

If your answer is No, please outline whether you will require:a work permit an Entry Visa

FOREIGN LANGUAGES

Job Title:

State Languages spoken and circle the number corresponding to your level of fluency 1) Fluent

2) Good

3) Reasonable

4) Some knowledge

Nature of Business

ADDITIONAL TRAINING & DEVELOPMENT

Key responsibilities:

5) Poor

………………………………….. 1 2 3 4 5

………………………………….. 1 2 3 4 5

………………………………….. 1 2 3 4 5

………………………………….. 1 2 3 4 5

Course

Duration

Training Body

How did course benefit you

Dates Employed: From:

Length of Service: To:

……..years……….months

Reason for Leaving:

LEISURE ACTIVITIES Outline your interests/hobbies and membership of clubs/societies.

AWARDS & SCHOLARSHIPS

Salary & Benefits (Pension, VHI, BUPA, Bonus…)

Shift Premium

Outline any other achievements, awards, scholarships (professional or private) which could be of benefit to your application, e.g. membership of a professional society etc.

Employment record must be continuous and at all times should be accounted for, including periods of unemployment. (Please use additional sheets if necessary)

8pp Application Form:Layout 1

18/01/2008

16:34

Page 2

PERSONAL DETAILS Surname:

First Name(s):

Have you ever applied to Servier before? If yes, please give details

Current Occupation:

Location:

Position Applied For:

Home Address (if different):

(List the most recent employment first)

Driving Licence (If Relevant) Yes

No Do you have a current driving licence?

Approx. Date:

Yes

No

Yes

No

Are you willing to work shift if required?

Yes

No Are you willing to work nights if required?

Are you willing to work overtime if required?

Yes

No

Have you ever been convicted of a crime other than a minor traffic offence or is a criminal charge threatened or pending against you? If yes or in doubt please provide full details: Mobile Phone Number:

Nature of Business

Number and dates of endorsements:

How soon could you commence employment with us?

Home/Land Line Telephone Number:

1) Previous Employer – Company Name, Address & Telephone Number

Categories of vehicle covered:

Position: Address for Correspondence:

EMPLOYMENT HISTORY

GENERAL INFORMATION

Job Title: Key responsibilities:

Dates Employed: From:

Work Telephone Number:

Length of Service: To:

……..years……….months

Reason for Leaving: Are you currently employed? (Please tick as appropriate) Yes

If yes, how much notice must you give?

EDUCATION

Date of Application:

No

VISA & JOB PERMITS

Name and addresses of schools, colleges or universities attended

Dates Attended

Qualifications obtained (with levels and grades)

Date(s) Awarded Salary & Benefits (Pension, VHI, BUPA, Bonus…)

Shift Premium

For the purposes of work permits & visa applications, please answer the following:Are you a member of an EU Member State? Yes

No

2) Previous Employer – Company Name, Address & Telephone Number

If your answer is No, please outline whether you will require:a work permit an Entry Visa

FOREIGN LANGUAGES

Job Title:

State Languages spoken and circle the number corresponding to your level of fluency 1) Fluent

2) Good

3) Reasonable

4) Some knowledge

Nature of Business

ADDITIONAL TRAINING & DEVELOPMENT

Key responsibilities:

5) Poor

………………………………….. 1 2 3 4 5

………………………………….. 1 2 3 4 5

………………………………….. 1 2 3 4 5

………………………………….. 1 2 3 4 5

Course

Duration

Training Body

How did course benefit you

Dates Employed: From:

Length of Service: To:

……..years……….months

Reason for Leaving:

LEISURE ACTIVITIES Outline your interests/hobbies and membership of clubs/societies.

AWARDS & SCHOLARSHIPS

Salary & Benefits (Pension, VHI, BUPA, Bonus…)

Shift Premium

Outline any other achievements, awards, scholarships (professional or private) which could be of benefit to your application, e.g. membership of a professional society etc.

Employment record must be continuous and at all times should be accounted for, including periods of unemployment. (Please use additional sheets if necessary)

8pp Application Form:Layout 1

18/01/2008

16:34

Page 1

EMPLOYMENT HISTORY CONTINUED

CONDITIONS

(List the most recent employment first) 3) Previous Employer – Company Name, Address & Telephone Number

Nature of Business

If you are successful in your application and are offered a position with Servier (Irl) Industries Ltd./ Servier Laboratories (Irl) Ltd the offer may be conditional upon you:1) 2)

Producing evidence to show that you are entitled to live and work in Ireland Successfully completing medical examination to be carried out by a medical practitioner

Job Title: Key responsibilities:

DECLARATION

Dates Employed: From:

Length of Service: To:

……..years……….months

Reason for Leaving:

“I have reviewed the above information supplied to me and hereby certify that, to the best of my knowledge, information and belief, such information is true and complete and is not misleading in any material respect. I understand that any falsification, omission or misrepresentation on my part will be treated as serious misconduct and may result in the termination of my employment with the company in the event that I am successful in my application for employment with Servier (Irl) Industries Ltd./ Servier Laboratories (Irl) Ltd”.

Application Form

“I understand that certain information hereby provided by me is personal data within the meaning of that term as defined in the Data Protection Acts 1988 and 2003 (the “Acts”) and I confirm that the provision of this information by me so that it may be processed for the purposes of consideration of my application constitutes a consent for the purposes of the Acts.

Salary & Benefits (Pension, VHI, BUPA, Bonus…)

Shift Premium

Date: ………………………..

Signature: ………………………………………………….

RECRUITMENT SOURCE

CHECKLIST (Tick once enclosed)

Additional Information regarding previous periods of Employment (Company, Job Title, Duties, Dates Employed…)

Website (please specify) ..............…….....……………………………… Newspaper Advert (please specify)

- Completed Application Form - Your Curriculum Vitae - Photocopy of Academic Transcripts

..............…….....………………………………

Additional Information regarding your Application (Why you are applying to Servier?)

College Career Service (please specify) ..............…….....………………………………

Once complete, please return this Form at your earliest convenience

Servier (Ireland) Industries Ltd. Gorey Road Arklow Co. Wicklow Tel: (0402) 20800 Fax: (0402) 20889

a) By post in the envelope provided or

www.servier.ie

HOW TO RETURN YOUR APPLICATION FORM

Employee Referral (please specify) ..............…….....……………………………… Other (please specify) ..............…….....………………………………

b) Scan & e-mail it to [email protected] or c) By Confidential Fax to (0402) 20889

Life through Discovery

‘Where people are respected you will find a love of work’ Hippocrates

8pp Application Form:Layout 1

18/01/2008

16:34

Page 1

EMPLOYMENT HISTORY CONTINUED

CONDITIONS

(List the most recent employment first) 3) Previous Employer – Company Name, Address & Telephone Number

Nature of Business

If you are successful in your application and are offered a position with Servier (Irl) Industries Ltd./ Servier Laboratories (Irl) Ltd the offer may be conditional upon you:1) 2)

Producing evidence to show that you are entitled to live and work in Ireland Successfully completing medical examination to be carried out by a medical practitioner

Job Title: Key responsibilities:

DECLARATION

Dates Employed: From:

Length of Service: To:

……..years……….months

Reason for Leaving:

“I have reviewed the above information supplied to me and hereby certify that, to the best of my knowledge, information and belief, such information is true and complete and is not misleading in any material respect. I understand that any falsification, omission or misrepresentation on my part will be treated as serious misconduct and may result in the termination of my employment with the company in the event that I am successful in my application for employment with Servier (Irl) Industries Ltd./ Servier Laboratories (Irl) Ltd”.

Application Form

“I understand that certain information hereby provided by me is personal data within the meaning of that term as defined in the Data Protection Acts 1988 and 2003 (the “Acts”) and I confirm that the provision of this information by me so that it may be processed for the purposes of consideration of my application constitutes a consent for the purposes of the Acts.

Salary & Benefits (Pension, VHI, BUPA, Bonus…)

Shift Premium

Date: ………………………..

Signature: ………………………………………………….

RECRUITMENT SOURCE

CHECKLIST (Tick once enclosed)

Additional Information regarding previous periods of Employment (Company, Job Title, Duties, Dates Employed…)

Website (please specify) ..............…….....……………………………… Newspaper Advert (please specify)

- Completed Application Form - Your Curriculum Vitae - Photocopy of Academic Transcripts

..............…….....………………………………

Additional Information regarding your Application (Why you are applying to Servier?)

College Career Service (please specify) ..............…….....………………………………

Once complete, please return this Form at your earliest convenience

Servier (Ireland) Industries Ltd. Gorey Road Arklow Co. Wicklow Tel: (0402) 20800 Fax: (0402) 20889

a) By post in the envelope provided or

www.servier.ie

HOW TO RETURN YOUR APPLICATION FORM

Employee Referral (please specify) ..............…….....……………………………… Other (please specify) ..............…….....………………………………

b) Scan & e-mail it to [email protected] or c) By Confidential Fax to (0402) 20889

Life through Discovery

‘Where people are respected you will find a love of work’ Hippocrates