Direct Agent

Welcome to Canis Majoris Direct Agent application form. The purpose of this document is to assist us in processing your application efficiently. We follow a 3-stage process.

Stage 1: Complete Application form
Stage 2: Application Approval
Stage 3: Your Journey Begins

If you require any assistance with the application form, you can email customer services where a member of the time will be happy to assist you – [email protected].

We are now offering worldwide coverage of diagnostic testing and we’re excited to have you registered with us at this time. We look forward to working with you and sharing your ideas to achieve success together.

Agent Application

Before you get started please have the following ready.

Proof of identify
- Current Passport
- Driving License
- Birth Certificate
Proof of Address (dated within 3 months)
- Utility bill
- Bank statement
- Driving license

Questions to expect

Personal Details
Employment History
Educational Record
Offences, Cautions & Convictions (If Any)
Character References

Title

First Name

Surname

Date of Birth

Contact Number

Address

Post Code

Character Referees Please give the details of two character referees who have known you for at least 5 years. We may approach your character referees to assist us in verifying your career history.

Character Reference 1:

Title

First Name

Surname

Nature of relationship

Number of years known

Contact Number

Address

Post Code

Character Reference 2:

Title

First Name

Surname

Nature of relationship

Number of years known

Contact Number

Address

Post Code

OFFENCES, CAUTIONS AND CONVICTIONS

Have you ever been fined or convicted of a criminal offence or received a police caution or been made the subject of any order, civil or criminal, made by a Court of Law?
Are you aware of any Police investigation in which you may be involved?

If the answer to any of the above questions is YES, please give indication of type and date of offence below:

Education Record (only complete if applicable within the last 5 years)

School Name

School Address

Telephone Number

Fax Number

E-Mail

Student Ref Number

Course Details

Any other education or qualification details

EMPLOYMENT RECORD

Please give the details from the last three years of employment.

Most recent or current employment:

Name

Address

Telephone Number

E-Mail Address

Staff Number

Position Held

Reporting To

Reason for Leaving

Start Date

End Date if applicable

Previous employment details:

Name

Address

Telephone Number

E-Mail Address

Staff Number

Position Held

Reporting To

Reason for Leaving

Start Date

End Date

Any other relevant employment details

Signature

By ticking this box you agree to the terms above as well as our Policy Documents.

Please read this carefully before completing this application.

I hereby certify that to the best of my knowledge, the details I have given in this application are complete and correct. I understand that to make a false statement to Canis Majoris or its representatives may result in my application being rejected.

I understand that my employment on behalf of Canis Majoris is subject to satisfactory vetting and I agree to co-operate in providing any additional information required to meet this criteria. I authorise Canis Majoris or its representatives to approach previous employers, schools/colleges, character referees or Government Agencies to verify the information I have provided.

I understand that some of the information I have provided in this application will be held on a computer and some or all will be held in manual records.

Please upload your CV and any other supporting documents. Permitted file types pdf, doc, docx,jpg, jpeg, png. Maximum upload file size 8MB.

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