Fidelity Questionnaire

Fidelity Questionnaire
The questions are of a personal nature and we do understand that you may feel uncomfortable; however, the questions are directly relevant to the position of trust that you are applying for, where working unsupervised in the homes and work places of our clients requires the utmost fidelity and trustworthiness from each and every employee.
Name:*
Prefix First Last
Have you ever been convicted of an offence?*
If yes, please provide details of the nature of the offence and the date which you were convicted of the offence.*
Have you ever been cautioned but not convicted of an offence?*
If yes please provide details of the nature of the caution and the date you were cautioned.*
Have you ever been dismissed by an employer for Gross misconduct?*
If yes please provide details of the nature of the dismissal, the employer in question and the date of dismissal.*
Have you ever been dismissed from a workplace for any reason other than Gross Misconduct?*
if yes, please provide details of the dismissal, the employer and the date of dismissal.*
Have you ever been dismissed from a work place specifically for an allegation of theft?*
if yes please provide details of the dismissal, the employer and the date.*
Have you ever resigned from a position of employment in order to prevent being dismissed for an allegation of theft?*
If yes please provide details of the resignation, the employer and the date of the resignation.*
Have you ever been addicted to alcohol or suffered with Alcoholism?*
If yes please provide details and dates of your illness and your recovery.*
Have you ever been addicted to drugs (of any kind) and suffered with drug addiction?*
If yes please provide details and dates of your addiction/illness and your recovery.*
Please disclose any details/dates that are not listed above but may show up during our extensive background checks.
Honesty*
- Please note that honesty is most integral function of this questionnaire and that being open and honest regarding your past is what is most important to us as an employer and in many instances this is very much more important than what actually may have occurred in your past. If you have any concerns please do speak to your manager prior to completing this form, any instances of disclosure after this form has been completed will be noted as dishonest.
Privacy Policy*
- I give consent to Rosa Clean LTD to use my personal information for the purposes of my contract of Employment. I also understand information I have given will be used to carry out reference checks.
Data Withdrawal*
- I understand that if in future I would like to withdraw my details from the system I must return to this website and access the - Data Withdrawal Form.

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