Please fill out the application form below to apply:

Position Applied For:*

Where did you see this job advertised?:*
---Job CentreIndeedCompany WebsiteJobs BoardsReedNewspaperFriendOther

1. Personal Details and Information

Surname:*

Forenames:*

NI Number:*

Address: (including postcode)*

Email:*

Home Tel (including code):*

Mobile Tel:*

2. Additional Information:

Do you possess a valid clean driving licence for the UK?:*
---YesNo

Do you have use of a car for work?:*
---YesNo

Do you have the legal right to work in the UK?:*
---YesNo

If ‘Yes’ to the above, but there are conditions attached, please specify:

If ‘No’, please note we are unable to recruit anyone who does not have the legal right to work in the UK.

Are you related to or do you know anyone who works for this company?:*
---YesNo

If ‘Yes’ to the above, please give the name of the employee and the relationship to them:

Do you have any other work commitments, either paid or unpaid, which you would wish to continue with if offered employment?:*
---YesNo

3. Criminal Record Declaration
The nature of the work you are applying for is exempt from the provisions of the Rehabilitation of Offenders Act 1974. If you are applying for a post involving access to persons in receipt of care services, your offer of employment will be subject to a satisfactory enhanced Disclosure and Barring check. It is therefore a requirement that all previous convictions are declared, even those which would otherwise be regarded as ‘spent’. (Any such information will be treated confidentially).

The amendments to the Exceptions Order 1975 (2013) provide that certain spent convictions and cautions are 'protected' and are not subject to disclosure to employers, and cannot be taken into account.

Guidance and criteria on the filtering of these cautions and convictions can be found on the Disclosure and Barring Service website.

Please read the above carefully and then answer the following questions:

Have you ever been convicted of a criminal offence?:*
---YesNo

Have you ever received any official cautions, reprimands or warning?:*
---YesNo

To your knowledge, are you currently the subject of any criminal proceedings or any police investigation?:*
---YesNo

If you have answered yes to any of the last 3 questions please provide details below:

4. Education, training, qualifications and current learning
(Please ensure you include all dates and do not leave any gaps in history)

Secondary education:*

Dates to and from:*

Qualifications/grades/date obtained:*

Further education:*

Dates to and from:*

Qualifications/grades/date obtained:*

Other relevant training, professional qualifications or work related skills (including dates)*

Any details of membership to professional bodies (please provide details including any offices held)

5. Employment History
Current/most recent employment

Employer's Name:*

Start Date:*

End Date:*

Address:*

Postcode:*

Telephone Number:*

Reason for Leaving (if applicable):

Brief description of duties and responsibilities:*

Full Employment History (most recent first with any gaps explained)

Details:

6. Relevant Experience

Please use this section to state how your skills, experience and training would enable you to meet the requirements of the role for which you are applying. Please make reference to the person specification:

7a . AVAILABILITY - PLEASE NOTE THIS WILL BE DISCUSSED AT INTERVIEW

Weekdays:*
Morning ShiftAfternoon ShiftEvening ShiftSleep NightsWaking Nights

Saturdays:*
Morning ShiftAfternoon ShiftEvening ShiftSleep NightsWaking Nights

Sundays:*
Morning ShiftAfternoon ShiftEvening ShiftSleep NightsWaking Nights

8. References

Please provide the names and contact details of referees: the first two must be your present or most recent employer and most recent previous employer, if there is less than two years between both of these then please provide a further reference. We will not contact any referee without your permission or until an offer of employment has been accepted. If you do not have three employment references, one may be from a professional body, a lecturer or teacher or similar. Also, if you have previously been employed in a position which involved working with vulnerable adults or children then one of the references you provide must be from this agency/employer (in accordance with the Health and Social Care Act 2008).
Personal referees such as relatives, friends, neighbours etc ARE NOT acceptable as referees.

1. CURRENT OR LAST EMPLOYER

Company Name:*

Referee’s name and position:*

Referee’s address and postcode:*

Referee’s telephone number:*

Email address (not a personal email address):*

Relationship to you:*

Reason for leaving:*

Can referee be contacted prior to interview?:*
YesNo  

1. PREVIOUS EMPLOYER

Company Name:*

Referee’s name and position:*

Referee’s address and postcode:*

Referee’s telephone number:*

Email address (not a personal email address):*

Relationship to you:*

Reason for leaving:*

Can referee be contacted prior to interview?:*
YesNo  

1. PREVIOUS EMPLOYER 2

Company Name:*

Referee’s name and position:*

Referee’s address and postcode:*

Referee’s telephone number:*

Email address (not a personal email address):*

Relationship to you:*

Reason for leaving:*

Can referee be contacted prior to interview?:*
YesNo  

9. Applicant Declaration (Please read carefully before approving the application)

1) The information in this form is true and complete. I agree that any deliberate omissions, falsification or misrepresentation on this form will be grounds for rejecting this application or subsequent dismissal if employed by the organisation. This equally applies to any medical questionnaires or falsified documents I may provide.

2) I confirm that I have not been subject to any cautions or convictions (other than those given above), investigation, disciplinary action, or enquiry into adult/child protection matters or inappropriate behaviour, and that the information I have given in the Criminal Record declaration section is to the best of my knowledge correct.

3) The Company is required to tell you about the personal data that we collect about you and what we do with that information, including how we use, store, transfer and secure your personal data. Your application will be kept on file for a period of 12 months should you be unsuccessful, should you be successful then this will remain on your staff file for duration of employment. Your file will be retained as per Company guidelines which are found within the Confidentiality, Data Protection and disclosure Policy.

4) You confirm that you shall at all times comply with all relevant data protection legislation and all obligations imposed on you under the Company's data protection policy and privacy notice

The information provided by you on this form may be processed for purposes permitted by the UK General Data Protection Regulation. You have, on written request, the right of access to personal data held about you. The company treats personal data collected during the recruitment process in accordance with our Data Protection Policy.

Thank you for your application

I have read and understood the applicant declaration above*
Please leave this field empty.