Telephone Numbers

Home:
Work:
Mobile:
Home:

Driving Licence

Current driving licence?:SelectYesNo
Groups:
Expiry date:
Details of any endorsements:
NI number:
Are there any restrictions on you taking up work in the UK? If yes please provide details:
Schools attended and qualifications gained:
College / University attended and qualifications gained:
Other training:

Other Employment

Please note any other employment you would continue with if you were to be successful in obtaining this position:

Leisure

Please note here your leisure interests, sports and hobbies, or other pastimes, etc::

EMPLOYMENT HISTORY - please start with your most recent employment and give reasons for any gaps in employment

Name & Address of employer:
Job title & Duties:
Salary on leaving:
Reason for leaving:
Name & Address of employer:
Job title & Duties:
Salary on leaving:
Reason for leaving:
Name & Address of employer:
Job title & Duties:
Salary on leaving:
Reason for leaving:

REFERENCES - Please provide details of two referees who can provide information relating to your competency in a caring role, one of whom must be your present or most recent employer (referees for qualified Nurses must be professionals). If you are a student, please give an academic referee. If you are applying for a post which requires unsupervised access to children/vulnerable adults, we reserve the right to approach any past employer for a reference.

Reference 1

Name:
Position:
Organisation:
Address:
Postcode:
Telephone No:
May we approach the above prior to interview?:SelectYesNo

Reference 2

Name:
Position:
Organisation:
Address:
Postcode:
Telephone No:
May we approach the above prior to interview?:SelectYesNo

GENERAL COMMENTS

Please detail here your reasons for this application, your main achievements to date and the strengths you would bring to this post. Specifically, please detail how your knowledge, skills and experiences meet the requirements of this role (as summarised in the person specification):

CAUTIONS, REHABILITATION AND CRIMINAL RECORDS

Because of the nature of the work for which you are applying, this post is exempt from the provisions of Section 4(2) of the Rehabilitation of Offenders Act 1974, by virtue of the Exceptions Order 1975 as amended by the Exceptions (Amendment) Order 1986, which means that convictions that are spent under the terms of the Rehabilitation of Offenders Act 1974 must be disclosed, and will be taken into account in deciding whether to make an appointment. Any information will be completely confidential and will be considered only in relation to this application.
In addition you are required to submit to a Criminal Records Bureau check. Any standard or enhanced disclosure made by the CRB/SCRO will remain strictly confidential.

Have you ever been convicted in a Court of Law and/or cautioned in respect of any offence?:SelectYesNo
If YES, please give details:

SPECIAL REQUIREMENTS (CARE SECTOR)

Because this position involves the care of children and/or vulnerable adults employment is dependent on the following:

1) Your written consent to obtaining a standard/enhanced disclosure certificate from the Criminal Records Bureau or an approved umbrella body.

2) Such disclosure being acceptable to us.

3) Proof of identity – birth or marriage certificate (where appropriate) and passport (if available).

4) Two satisfactory written references.

5) That you will supply a photograph of yourself for retention in your records.

6) Evidence of physical or mental suitability for your work.

DECLARATION (Please read carefully before signing this application)

1. I confirm that the above information is complete and correct and that any untrue or misleading information will give my employer the right to terminate any employment contract offered.

2. Should we require further information and wish to contact your doctor with a view to obtaining a medical report, the law requires us to inform you of our intention and obtain your permission prior to contacting your doctor. I agree that the organisation reserves right the right to require me to undergo a medical examination. In addition, I agree that this information will be retained in my personnel file during employment and for up to six years thereafter and understand that information will be processed in accordance with the Data Protection Act.

3. I agree that my previous employers may be approached for references. I also agree that should I be successful in this application, I will, if required, apply to the Criminal Records Bureau/Scottish Criminal Records Office for a standard or enhanced (as appropriate) disclosure. I understand that should I fail to do so, or should the disclosure or reference not be satisfactory, any offer of employment may be withdrawn or my employment terminated.

Signed (electronic):
Date: