Application Form Careers

Application for Employment. Please type or complete this form in black ink

Position Applied For Date of Application

PERSONAL DETAILS

Surname: First names:
Mobile No. Home Telephone No.
Immigration Details: E-mail:
Please notify us of any dates you are available for interview: National Insurance No.
Are you a citizen of the EU? Do you need a work permit?
Current driving licence? Do you have a car for work use?

NEXT OF KIN

Surname: First name:
Other name: Relationship:
Address: Telephone:

PREVIOUS EMPLOYMENT

A full employment history must be detailed beginning with your current employment and covering all reasons for gaps in any given year.

Date Employer’s name (most recent first) Position held Salary & Benefits Reason for leaving

PREVIOUS EDUCATION

(Original documents as proof of qualification will be required at interview)

Secondary School / College / University Examinations taken Result

MANDATORY TRAINING

Please tick if you have completed the following training within the last 12 months Please enclose copies of your training certificates

Moving and Handling

Basic Life Support

Health and Safety

Safeguarding Adult

Complaints Handling

Medication Awareness

Fire Safety

COSHH

First Aid

Dementia Awareness

Data Protection

Infection Control

Lone Worker Training

Equality & diversity

Food Hygiene (where required to handle food)

Mental capacity Act

Safeguarding Children

Sexual harassment

Practical

REHABILITATION OF OFFENDERS ACT 1974 – NOTICE TO OFFENDERS

Because of the nature of the work involved, the post for which you are applying is exempt from Section 4(2) of the Rehabilitation of Offenders Act 1974 by virtue of the Rehabilitation Offenders Act (Exemption Order 1975). This means that you are not entitled to withhold information relating to any convictions you may have had.

Do you have any convictions to disclose?

Any information should be given on a separate sheet and sent with this application form. This information will be treated as confidential and will not necessarily preclude you from employment.

Signature: Date:

Your DBS status

Please send a copy of your most recent DBS Disclosure (formally known as CRB)

Current DBS Disclosure (formally known as CRB) Issue Date:
Is this certificate registered with the update service Disclosure Number

All applicants who cannot provide a registered DBS or full immunisation record may be required to complete at their own cost.

ADDITIONAL PERSONAL DETAILS

Outside interests, leisure time activities and other personal information which you think may assist us in evaluating your application.

REFERENCES:

Please give the name and address of at least two referees, one of whom must be your present employer or your most recent employer.

S/n Name Status Address and Telephone No
1
2
3

This organization seeks to work in a flexible and family-friendly manner with its staff, however, unsocial hours are part and parcel of a quality care service. Weekend working is a requirement for all staff, the frequency of which will be determined at interview.

Please indicate holiday dates if already booked

Period of notice required in the present post

Earliest start date

Thank you for completing this application form.

I declare that to the best of my knowledge, all of the information contained and documented herein is complete and truthful.

Signature: Date:

Equal Opportunities Monitoring

This section of the application will be detached and used for monitoring purposes only. Our organization recognize and actively promote the benefits of a diverse workforce and are committed to treating all employees with dignity and respect regardless of race, gender, disability, age, sexual orientation religion or belief. We welcome applications from all sections of the community.

Date of Birth:
Gender Male Female I do not wish to disclose this

Race Relations (Amendment) 2000

I would describe my ethnic origin as (please indicate with a tick)

Asian or Asian British
Bangladeshi
Indian
Pakistani
Any other Asian background
Mixed Raced
White & Asian
White & Black African
White & Black Caribbean
Any other White background
Other Ethnic Group
Chinese
Any other ethnic group
I do not want to disclose this
Black or Black British
African
Caribbean
Any other White background
White
British
Irish
Any other White background

Please select the option which best Please indicate your religion or belief describes your sexuality.

Lesbian
Gay
Bisexual
Heterosexual
I do not wish to disclose this
Atheism
Buddhism
Christianity
Islam
I do not wish to disclose this
Sikhism
Judaism
Hinduism
Other
I do not wish to disclose this

I declare that to the best of my knowledge, all of the information contained and documented herein is complete and truthful.

Signature: Date:

FOR OFFICE USE ONLY

Applicant shortlisted
Interview Date:
References requested:
Verbal reference check
Date:

Additional Notes from application

Applicant shortlisted
Full employment history?

Your Registration Checklist

To complete your registration, you will be required to provide the following documentation

Completed Registration Form – signed in all requested areas

CV – Emailed in pdf/word format – Your CV must cover full work history from education

Right to Work in the UK (Share Code)

Proof of ID (Birth Certificate, Passport or Driving License) We require to see the originals of these documents. (Posted originals will be returned the same day received by recorded delivery).

HPC or NMC Entry Certificate and up to date renewal card

Copy of your most recent DBS – less than 1-year-old/ on update service

Training Qualifications – Diploma/Degree/NVQ – Any other training Certificates

Proof of Address e.g. Utility bill, council tax e.t.c

Proof of National Insurance Number

2x Reference Forms

Please ask two senior members of staff to complete the reference forms and return them to us. This is to speed up your application. If we apply for them ourselves, we often struggle to get them returned and it delays the process. We are happy to apply for them if it is not possible for you to get them. Please ensure that they include verification. We will contact the referee to verify once they have been received. All references will be verified by a member of the compliance team via email or phone call.

Term Time letter (for Students) or Sponsorship Certificates (for sponsored candidates)

I declare that the information given is correct to the best of my knowledge. I understand that omissions or false statements may disqualify me from employment or lead to dismissal. I give the employer the right to investigate all references.

Signature: Date:
Verification: Answer: