Application Form

Application for Employment

1. PERSONAL DETAILS

2. EDUCATION

Schools/FE/HE attended | Examination Grade | Year Obtained *
Please list all relevant schools, specializations, courses, with examination grades and years obtained.

3. PREVIOUS EMPLOYMENT

Date (From/To) | Employer’s name (most recent first) | Position held | Salary & Benefits | Reason for leaving *
A full employment history must be detailed beginning with your current employment and covering all reasons for gaps in any given year.

4. 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? YesNo

Details of convictions

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.

Failure to declare or the falsification of any of the above details will result in the withdrawal of any job offer.

5. ADDITIONAL DETAILS ON WHY YOU HAVE APPLIED FOR THIS JOB

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

6. REFERENCES

Please give the name and address of two referees, one of whom must be your present employer, or your previous employer.
Employer 1 - Name | Status | Address and Telephone No
Employer 2 - Name | Status | Address and Telephone No
Employer 3 (optional) - Name | Status | Address and Telephone No

This organisation seeks to work in a flexible and family friendly manner with its staff. However, for certain roles 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 present post
Earliest start date *
* I declare that to the best of my knowledge, all of the information contained and documented herein is complete and truthful.