Application Form

Payment Details

(Information required to process salary payments upon commencement of employment.)

End of payment details

Do you hold a current full driving licence?

Yes No

Do you have a clean driving licence?

Yes No

Do you have access to a car during work hours?

Yes No

Do you have business insurance?

Yes No

Are you entitled to work in the UK?

Yes No

Are you registered with the DBS online update service?

Yes No

Education and Qualifications

School

Please enter your secondary school?

Please enter the date you started secondary school?

Please enter the date you finished secondary school?

Here is your field description

College

Please enter your College?

Please enter the date you started college?

Please enter the date you finished college?

Here is your field description

University

Please enter your University?

Please enter the date you started University?

Please enter the date you finished University?

Please list your subjects, qualifications gained and the grades from University

Vocational Training Courses

Have you completed the Care Certificate?

Yes No

Do you have English and Maths Qualifications level 2 and/or above?

Yes No

Do you have any of the following NVQ or diploma equivalent in health and social care?

Level 2 Level 3 Level 4 Level 5

Are you a member of any relevant professional associations? If yes please provide details.

Yes No

Employment History

You are required to provide a full employment history.

Previous Employment

All gaps in employment must be accounted for. Please include the following:

1. Name & Address of Previous Employer(s)
2. Date from / to
3. Job title
4. Main Responsibilities
5. Reason for Leaving

Have you ever been dismissed or requested to resign from any previous employment? If yes please provide details below.

Yes No

Please provide the following details:

Name & Address of Previous Employer(s)
Date
Type of Employment
Details of Formal Disciplinary Action

References

Please provide three references, one of which must be your current/last employer.

If you have previously worked in health and social care please provide reference details for these employers.

When stating an employer for a reference please provide their business address, not their private address.

Relatives and friends may not be used as a referee.

References will only be contacted after an offer of employment has been made.

Reference 1 (Current/Most Recent Employer)

Reference 2 (Current/Most Recent Employer)

Reference 3 (Current/Most Recent Employer)

Disclosure of Criminal Background

Due to the nature of the service we provide, all offers of employment will be subject to a satisfactory enhanced disclosure via the Disclosure and Barring Service (DBS).

The post for which you are applying does not entitle you to rely on the Provisions of the Rehabilitation of Offenders Act 1974. All previous convictions must be disclosed.

If you disclose that you have a criminal conviction, and your application is successful, this will be discussed in confidence at interview.

If you do not disclose any convictions you have then this may result in your application being rejected, or any conditional job offer you have received being withdrawn. If you are appointed, this non-disclosure may later lead to your dismissal.

Any applicants who disclose convictions will be treated fairly, and will be provided with the opportunity to evidence their suitability for the post for which they are applying.

Have you ever been convicted of a criminal offence? If yes, you will be asked to provide details if selected for interview.

Yes No

Do you have any unspent conditional cautions or convictions under the Rehabilitation of Offenders Act 1974?

Yes No

Do you have any adult cautions (simple or conditional) or spent convictions that are not protected as defined by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (Amendment) (England and Wales) Order 2020?

Yes No

The amendments to the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (2013 and 2020) provides that when applying for certain jobs and activities, certain convictions and cautions are considered protected.

This means that they do not need to be disclosed to employers, and if they are disclosed, employers cannot take them into account.

Guidance about whether a conviction or caution should be disclosed can be found on the Ministry of Justice website.

Conflict of Interest/Relationships

Do you have a pre-existing relationship with anyone associated with the organisation or any of the people we support? This may be a family relationship, friendship, or other. If yes, please provide the information requested below:

Yes No

Please provide the following details:

1. Name
2. Relationship With You
3. Relationship With The Organisation e.g. staff member, person we support

Here is your field description

Are you aware of any other conflicts of interest you may have with the organisation? If yes please provide detailed information.

Yes No

If yes please provide detailed information.

Where did you hear about this position?

Declaration

Please enter your name and todays date below to confirm the below.

I declare that to the best of my knowledge and belief all the information I have provided in this application form is true and correct.

I understand that providing incorrect information or deliberately concealing any relevant information, may result in disqualification from the selection process, or any conditional job offer you receive being withdrawn. If you are appointed, this may later lead to your dismissal.

Please input your full name as your signature

Please enter todays date