Form
Personal Details Please completed all fields.
Title
Mr
Mrs
Miss
Ms
Surname
First Name(s)
Maiden Name or Previous Name
Current Address:
Postcode
Telephone Number
Mobile Number
E-mail Address
Do you have a vehicle you can use for work?
Yes
No
If yes, what vehicle do you have?
Type of Licence:
Do you have any current endorsements?
Yes
No
If yes, please give details:
Date(s) of endorsement(s) if any:
Next of Kin - details Next of Kin - Name
Next of Kin - Address:
Next of Kin - Postcode
Next of Kin - Telephone Number
Next of Kin - Mobile Number
Present / Most Recent Employment (or place of study)
Name of Employer / Place of Study
Address:
Job Title (if applicable)
Date employment / study commenced:
Leaving date / or notice required:
Briefly describe your present or last job (or course); its main purpose and your responsibilities (where appropriate):
Full Work History (paid or unpaid) - Starting with most recent employment:
Please explain any gaps in employment
Education and Qualifications
Professional membership details (if any). Please state whether gained by examination:
Knowledge and experience relevant to the job (gained through paid, unpaid or voluntary work):
We operate a shift system (7am - 2pm and 2pm - 10pm).
**All applicants are expected to offer some evening/ weekend availability**
Area / distance you are willing to travel to / from:
Are there any adjustments you consider we need to make to our recruitment process as a result of a disability?
Please note that it is our usual practice to carry out pre-employment medical checks at offer stage and any offer made to you will be subject to the results of those checks being satisfactory to us.
References
Please provide here the name, job titles and work addresses of two persons from whom we may obtain both character and work experience references. One should be from your current or most recent manager / supervisor.
Convictons and 'Spent' Convictions of a Criminal Nature
You will appreciate that this organisation, being responsible for the provision of services to many vulnerable groups in society – the young, the elderly, the physically and the mentally impaired – must be particularly careful to enquire about the character and background of all applicants for appointments to posts involving work with these vulnerable groups. It is therefore essential that, in making your application, you disclose whether you have been convicted of a criminal offence and, if so, for what offence(s). You must also provide full details of all cautions, reprimands and warnings that you have been issued with. Because of the nature of the work for which you are applying, this post is exempt from the provisions of Section 4(2) and 4(3) of the Rehabilitation of Offenders Act 1974 by virtue of the Rehabilitation of Offenders Act 1974 (Exemptions) Order 1975. Applicants are, therefore, not entitled to withhold information about convictions which for other purposes are ‘spent' under the provision of the Act and, in the event of employment, any failure to disclose such convictions could result in dismissal or disciplinary action by this organisation. For the avoidance of doubt, you must disclose full details of all convictions, cautions, reprimands and warnings that you have been issued with, regardless of when these were received. The fact that conviction(s) have been recorded against you will not necessarily debar you from consideration for this appointment.
You must answer the questions below: If you answer 'Yes' to any question you may write the details below in the box provided. Any information given will be completely confidential and will be considered only in relation to an application for positions to which the order applies. The object of this notice is not, in any way, to reflect upon the applicants integrity, but is necessary to protect the public and the organisation.
Have you ever been convicted of a criminal offence?
Please Choose...
Yes
No
Have you ever received a caution, reprimand or warning from the police or other statutory body?
Please Choose...
Yes
No
Are there any criminal or civil court hearings or proceedings against you, either pending or scheduled?
Please Choose...
Yes
No
If you answered 'Yes' to any of the above questions regarding your convictions, please give brief details here
Data Protection Act 1998
The information you have supplied on this application form will be processed by computer. This data is required for operational, managerial and associated purposes relevant to the payment of remuneration and the maintenance of the personnel system.
Asylum and Immigration Act 1996
Nationality:
Place of Birth. Town:
Country:
National Insurance Number:
Please note that you will be required at interview stage to provide evidence of your entitlement to live and work in the UK. This will require you to provide us with original supporting documentation, and not copies of such documents.
Declaration (please read carefully before submitting this application)
1. I understand and accept that the provision of false or misleading information, or the omission of a material fact at any stage during the application process may be legitimate cause for the immediate withdrawal of any offer of engagement or, if I am already engaged, for disciplinary action up to and including dismissal.
2. I hereby authorise the Company or its appointed Agents without any further recourse to me to procure, process and store, in whatever manner they see fit, information from any individual, company, institution or other body which the Company or its Agents consider appropriate for the assessment of my suitability for engagement. This specifically includes access to medical information. I understand that this may involve the transfer of my personal data outside of the European Economic Area.
3. I accept that the Company reserves the right to require me to undergo a medical examination, and that such examination may be a pre-requisite of engagement with the Company.
Date:
Please click this box if you agree to, and agree to be bound by, the above statements.
You will be required to sign a paper copy of this application form at interview, confirming the content and accuracy of the application.
How did you hear about us?
Local Press (which paper/magazine?)
Radio (which station?)
Word of Mouth (who referred you?)
Leaflet (where seen?)
Internet (which site?)
Working Links
G4S
A4e
Job Centre Plus
Avanta
Other (please state)
