APPLICATION FOR EMPLOYMENT

PRIVATE & CONFIDENTIAL - POSITION APPLIED FOR/REFERENCE
Title
Name Name First Last
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email
Phone
Current Driving Licence

Current Driving Licence Yes No
Details of any Endorsements
Schools and Qualifications Gained
College/University and Qualifications Gained
National Insurance Number
Are there any restrictions on you taking up work in the UK?

Are there any restrictions on you taking up work in the UK? Yes No
If so, please provide details
Any other training? If so, please provide details
OTHER EMPLOYMENT
Please note any other employment you would continue with if you were to be successful in obtaining this position
What availability do you have for work? When, on a weekly basis, would you be available to pick up shifts?
(Please detail the days and times)
LEISURE
Please note here your leisure interests, sports and hobbies or other pastimes
EMPLOYMENT HISTORY
Please complete in full starting with your most recent employment and give reasons for any gaps in employment

Please include the following:-

Name and address of employer
Job title and duties
Dates employed - from/to
Salary on leaving
Reason for leaving
Name of employer
Address of employer Address of employer
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Job title and duties
Dates employed - from/to Dates employed - from/to / MM / DD YYYY
/ MM / DD YYYY
Salary when leaving £ Pounds . Pence
Reason for leaving
Name of employer
Address of employer Address of employer
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Job title and duties
Dates employed - from/to Dates employed - from/to / MM / DD YYYY
/ MM / DD YYYY
Salary when leaving £ Pounds . Pence
Reason for leaving
Name of employer
Address of employer Address of employer
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Job title and duties
Dates employed - from/to Dates employed - from/to / MM / DD YYYY
/ MM / DD YYYY
Salary when leaving £ Pounds . Pence
Reason for leaving
If you have any further employment history information to detail, please do so in the following box -
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
Name Name First Last
Position
Organisation
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone
Email
May we approach the above prior to interview?

May we approach the above prior to interview? Yes No
Capacity in which you know them

Capacity in which you know them Personal Professional
Name Name First Last
Position
Organisation
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone
Email
May we approach the above prior to interview?

May we approach the above prior to interview? Yes No
Capacity in which you know them

Capacity in which you know them Personal Professional
Please provide below details of a third reference. This reference will only be contacted in the event that we are unable to contact either of your above named contacts
Name Name First Last
Position
Organisation
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone
Email
May we approach the above prior to interview?

May we approach the above prior to interview? Yes No
Capacity in which you know them

Capacity in which you know them Personal Professional
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 experience 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 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?

YES/NO (delete as required)

Have you ever been convicted in a Court of Law and/or cautioned in respect of any offence? YES/NO (delete as required) Yes No
If yes, please provide details
SPECIAL REQUIREMENTS (CARE SECTOR)
Because this position involves the care of children and/or vulnerable adults, employment is dependent on the following:-

SPECIAL REQUIREMENTS (CARE SECTOR) Because this position involves the care of children and/or vulnerable adults, employment is dependent on the following:- Your written consent to obtaining a standard/enhanced disclosure certificate from the Criminal Records Bureau or an approved umberella body Such disclosure being acceptable to us Proof of identity - birth or marriage certificate (where appropriate) and passport (if available) Two satisfactory written references That you will supply a photograph of yourself for retention in your records Evidence of physical or mental suitability for your work
DECLARATION
Please read this carefully before signing this application

DECLARATION Please read this carefully before signing this application 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. 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 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. I 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 basic disclosure. I understand that should I fail to do so, or should the disclosure not be to the satisfaction of the company any offer of employment may be withdrawn or my employment terminated.
Draw your signature into the box below.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Date Date / MM / DD YYYY

APPLICATION FOR EMPLOYMENT

APPLICATION FOR EMPLOYMENT

EMPLOYMENT HISTORY Please complete in full starting with your most recent employment and give reasons for any gaps in employment Please include the following:- Name and address of employer Job title and duties Dates employed - from/to Salary on leaving Reason for leaving

Please provide below details of a third reference. This reference will only be contacted in the event that we are unable to contact either of your above named contacts

EMPLOYMENT HISTORY
Please complete in full starting with your most recent employment and give reasons for any gaps in employment

Please include the following:-

Name and address of employer
Job title and duties
Dates employed - from/to
Salary on leaving
Reason for leaving