Job Application

Position Applied For *

PERSONAL DETAILS

Title *

Name *

First

Last

Address *

Postcode *

Telephone/Mobile *

Email *

This Address is: *

Personal
Work

Do you need a permit to work in the UK *

Yes
No

DRIVING RECORD

Do you have a regular use of a car? *

Yes
No

Make/ Model/ Year: *

Current Driving Licence *

PROVSIONAL
FULL
PSV
NONE

Driving Licence valid from/to *

First

Last

Details of current endorsements: *

Do you have any driving related prosecutions/ fixed penalties/ endorsements or similar currently pending? *

Yes
No

If "YES"please provide brief details: *

Have you ever been disqualified from driving? *

Yes
No

If "YES"please provide brief details: *

Have you ever had insurance refused? *

Yes
No

If "YES"please provide brief details: *

Education & Professional Training ( from year 11)

Secondary Education (Secondary School)

Date: From/To

Qualifications gained

Higher Education (university/college/polytechnic)

Date: From/To

Qualifications gained

Further Education (Professional training)

Date: From/To

Qualifications gained

Membership of Professional Organisations

LANGUAGES

Date: From/To

Qualifications gained

Languages (other than english)

Select...

Languages

Select...

Languages

Select...

If the position you are applying for (whether paid or voluntary) is listed in Schedule 1, Part II of the Rehabilitation of Offenders Act (Exceptions) Order 1975, we are entitled to ask Exempted Questions as defined by Section 113(5) of the Police Act 1997 about you. We are required to check a DBS Certificate in relation to any person who is a Care Manager or Care Worker. If your application is successful and before your appointment is confirmed, you will be required to submit a personal current and valid DBS Certificate for our inspection. Having a criminal record will not necessarily bar you from working with us. This will depend upon the nature of the position and the circumstances and background of your offences. We observe the “Code of Practice for Registered Persons and Other Recipients of Disclosure Information” published through the Disclosure & Barring Service on behalf of the Home Office, and we will provide you with a copy of it upon request. *

First

Last

EMPLOYMENT HISTORY

Please provide details of all employment, beginning with your present or most recent job first

Date:From/To

VOLUNTARY & COMMUNITY WORK EXPERIENCE

Employers/ Positions held

Salary

Reason For Leaving

Date: From/To

JOB FLEXIBILITY

Organisation

Position(s) Held

Duties

Prepared to work

FULL TIME
PART TIME
SHIFTS

If PART-TIME please indicate perferred hours:

Details of any other work which you will continue to undertake if you are offered this Job Position:

Please provide details of any outstanding holidays to be taken:

AVAILABLE TO TAKE UP EMPLOYMENT FROM:

REFERENCES

Please provide details of 2 referees who we may approach with regards to this Job Application. These referees must not be members of your family, and one must be your present or most recent employer:

Name

Address

Telephone number

Occupation

Name

Address

Telephone number

Occupation

May we contact your referees prior to making a job offer?

YES
NO

DECLARATION BY JOB APPLICANT

ANY PERSON, UPON SUBSEQUENT EMPLOYMENT, THAT IS FOUND TO HAVE KNOWINGLY SUPPLIED FALSE OR MISLEADING INFORMATION, OR HAS DELIBERATELY WITHHELD RELEVANT INFORMATION, MAY BE SUBJECT TO DISCIPLINARY PROCEEDINGS WHICH MAY RESULT IN DISMISSAL. I have read and understood the information supplied to me in relation to this Job Position, and the information requested in this Job Application Form. I confirm that all information supplied by me is true and correct to the best of my beliefs. I give the prospective employer the right to follow up all references and to make any other job-related enquiries as may be deemed necessary. *

First

Last

Name *

IS AN EQUAL OPPORTUNITIES EMPLOYER. The sole criterion for selection of applicants will be suitability for the Job Position, regardless of gender, background, culture, ethnic denomination, religious affiliation, marital status or disability. Data Protection Act 1998: Your signature on this document gives us the right, under the Data Protection Act 1998 to process the information you have given, including data of a sensitive nature, relating to your application for employment. Any processing of the data by us will be in accordance with our Policy and the processing principles set out in the Act. Application forms of unsuccessful candidates will be destroyed after 6 months in accordance with our Record-keeping Policy.

Job Application

PERSONAL DETAILS

DRIVING RECORD

Education & Professional Training ( from year 11)

LANGUAGES

EMPLOYMENT HISTORY

VOLUNTARY & COMMUNITY WORK EXPERIENCE

JOB FLEXIBILITY

REFERENCES

DECLARATION BY JOB APPLICANT

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