Employment Application Form

Private & Confidential

POSITION

Ref. No (if applicable) Blockbuster Store Location Position Applied For: Store Management Temporary Customer Service Representative Full-Time Part-Time

Other (specify)

Please specify availability:Mon From To How many hours would you wish to work per week? If you are offered this position, will you continue to work in any other capacity? Yes/No* If Yes please state: Date available to start: Have you worked for Blockbuster before? Yes/No* If Yes which store(s)? Date(s): From To Reason(s) for leaving? Tue Wed Thur Fri Sat Sun

How did you hear about the job?(reference number if applicable) What has attracted you to work for Blockbuster?

PERSONAL DETAILS Surname Address Forename(s) Mr/Mrs/Miss/Ms

Postcode: Telephone Number Home: NI Number: Are you eligible to work in the UK? Yes/No* If No, please attach a copies of a valid work permit Have you ever been convicted of a criminal offence? Yes/No* If Yes, please give details (under the Rehabilitation of Offenders Act 1974, spent convictions need not be declared) Work: Mobile:

EDUCATION & TRAINING

School/University/College (Address & Tel Number) From To School/University/College (Address & Tel Number) From To

Examinations taken and results

Examinations taken and results

Please explain your Computer Skills/Experience:

DETAILS OF PREVIOUS EMPLOYMENT (Most recent job first)

Company name & Address 1

Dates (From & To)

Job Title

Main Responsibilities

Reason For Leaving

Salary 2

Salary References Please give names and addresses of two referees, one of whom must be your present or most recent employer or your school, university or college. Where possible, we require references from two previous employers. If you have no present or previous employer, please give details of whom we can contact for a personal or educational reference. Name Job Title/Relationship Company/Institution Address Telephone No May we contact the above referee prior to making the job offer: Yes/No Name Job Title/Relationship Company/Institution Address Telephone No Postcode
(Delete as applicable)

Postcode

May we contact the above referee prior to making the job offer: Yes/No PRODUCT KNOWLEDGE

(Delete as applicable)

Whats your favourite movie? In one sentence, how would you recommend the above movie to a customer?

How many movies do you watch on average per month?

EQUAL OPPORTUNITIES

We are committed to equality of opportunity in employment and our aim is to ensure that all applicants are considered solely on their merits. Information on ethnic/racial origin is strictly confidential and is used for statistical purposes only. If you decide not to give this information, your application will not be affected in any way, as this section will not be used for short-listing purposes.

Personal Details: Last Name Date of Birth Ethnic Monitoring Gender: Male

First Name Female

The Commission for Racial Equality recommends that employers should use the 2001 Census categories in order to monitor the ethnicity of their staff. (a) White: British: Irish:

Any other white background please specify. (b) Mixed: White and Black Caribbean: White and Black African: White and Asian:

Any other mixed background please specify. (c) Asian or Asian British: Indian: Pakistani: Bangladeshi:

Any other Asian background please specify. (d) Black or Black British: Caribbean: African:

Any other Black background please specify. (e) Chinese or Other ethnic group: Chinese:

Any other ethnic group please specify. Disability We are committed to assisting people with disabilities to obtain and remain in employment. We will therefore endeavour to provide reasonable adjustments to equipment and premises when required. Do you have a disability? Yes/No* Please give details of the effects of any disability or any long-term medical condition (over the last 12 months) and any assistance you need.

Declaration Blockbuster Entertainment Limited (Blockbuster) will collect personal information about you in order to deal with your application. We will use and retain the personal information you provide in this form, for as long as necessary, to allow us to consider your application and assess your suitability for the role, and for personnel administration and statistical analysis including equal opportunities monitoring. If you become an employee of Blockbuster, certain information you have given on this form will be transferred to your employment records. The information on this form, your employment records and other related information may be transferred to Blockbuster Inc. and its subsidiaries from time to time. Your data may also be transferred to third parties engaged to process and collate information on our behalf. Blockbuster Inc. is situated in the USA, and its subsidiaries and the third parties acting on Blockbusters behalf may also be located outside of the European Economic Area. The privacy laws in such countries may not provide protection to the same level as in the UK. I consent to Blockbuster processing my personal information as set out above and confirm that the information that I have provided in this application form is true and complete. I understand that misrepresentation, falsification or omission of factual information requested on this application form may constitute Gross Misconduct, which may result in dismissal. Prior to any offer of employment being made I understand that I shall have to provide evidence of my eligibility to work in the UK. I agree to the company contacting my present and/or previous employer for a reference. Signature Print name Date

FOR STORE PERSONNEL ONLY please send this page only to:
Blockbuster Entertainment Limited, Harefield Place, The Drive Middlesex, UB10 8AQ