Employment Application Form

Employment Application Regulated Activity
All information will be treated as strictly confidential and no approach will be made to any person without your permission
Position Applied For
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Birth Date

MonthDayYear
Gender
Nationality
E-mail Address:*
How were you referred to us?*

Walk-InEmployeeGoogleOther (please specify)Social Media
Other:
Upload Resume:

Upload a File

Cancelof
Do you have a UK drivers licence and have access to a car?*

YesNoProvisionalawaiting driving test
Are you driving with an international licence?
Do you have any driving endorsements
Do you have any motoring prosecutions pending?
Business Insurance is required for all drivers - do you have business insurance or willing to get it?
Please note full time, part time hours includes evening and weekend work.
Question asked under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

Do you have any physical or mental health conditions which are relevant to your capability, after reasonable adjustments are made, to properly perform the tasks which are intrinsic to this employment?
Yes/No If yes provide details
Available to work*

Full timePart time
Job Skills & Training
Relevant Education

Care CertificateNVQ level 1 or 2NVQ level 3 or 4DiplomaDegreeMastersNo CertificationsOther
Please include more information about your education
Relevant Skills (any courses or specific skills gained)
Years of Experience

No Experience, wish to learn a new carer/skillsunder 1 year1 to 5 years5 to 10 years10 years +
Please include more information about your experience in care
Reason for application:
Notice Period:
Employment History, please include name of employer, start date, end date and reason for leaving *
Gaps in Employment (please specify)*
References

Please list two (2) references that are familiar with your work life. One must be form most recent employer
Please specify*

Employment ReferenceCharacter Reference
Reference 1
Name:*

First NameLast Name
Name of Company *
Phone Number*

Area CodePhone Number
Years Known:*
Email*
example@example.com
Reference 2
Please specify

Employment ReferenceCharacter Reference
Name:*

First NameLast Name
Name of Company
Phone Number*

Area CodePhone Number
Years Known:*
Email*
example@example.com
Declaration under the Protection of Freedoms Act 2012

The post for which you are applying is a ‘regulated activity’ within the meaning of Part 5 Chapter 1 of the Protection of Freedoms Act 2012 and it is a criminal offence for a ‘barred person’ to apply to work in a regulated activity. If you are a barred person you must not proceed with this job application.

If your application is successful you will be required to co-operate with us in obtaining a disclosure of criminal convictions and in checking your barred status with the Disclosure and Barring Service.
Are you a Barred Person?*
Do you have any outstanding safeguarding or investigations or suspensions, criminal prosecutions or convictions that might lead to you being barred from working with children or vulnerable adults?*
Do you have any convictions, cautions, reprimands or final warnings that would not be filtered in line with current guidelines?*
Signature*

Clear
Privacy notice

We process personal data relating to those who apply for job vacancies with us or who send speculative job applications to us. We do this for employment purposes, to assist us in the selection of candidates for employment, and to assist in the running of the business. The personal data may include identifiers such as name, date of birth, personal characteristics such as gender, qualifications and previous employment history.

We will not share any identifiable information about you with third parties without your consent unless the law allows or requires us to do so. The personal data provided during an application process will be retained for a period of at least six months or, if required by law, for as long as is required.

This privacy notice does not form part of an employment offer or contract between us. If we make an employment offer to you, we will provide further information about our handling of your personal information in an employment context separately.

If you would like to find out more about our data retention policy and how we use your personal data, you want to see a copy of the information about you that we hold or have any questions or issues regarding data protection, please email us with the Subject “Data Protection Request”.
Statement on the recruitment of ex-offenders

Introduction

As an organisation using the Disclosure and Barring Service’s (DBS) checking service to assess applicants’ suitability for positions of trust, we comply fully with the Code of Practice and undertake to treat all applicants for positions fairly. We undertake not to discriminate unfairly against any subject of a DBS check on the basis of a conviction or other information revealed.

We are committed to the fair treatment of our employees, potential employees and users of our services, regardless of their offending background.

Policy

We actively promote equality of opportunity for all with the right mix of talent, skills and potential and welcome applications from a wide range of candidates, including those with criminal records. We select all candidates for interview based on their skills, qualifications and experience.

A DBS check is only requested after a thorough risk assessment has indicated that one is both proportionate and relevant to the position concerned. For those positions where a DBS check is required, all application forms, job adverts and recruitment briefs will contain a statement that a DBS check will be requested in the event of the individual being offered the position.

Where a DBS check is to form part of the recruitment process, we encourage all applicants called for interview to provide details of their criminal record at an early stage in the application process. We request that this information is sent under separate, confidential cover, to a designated person within the organisation and we guarantee that this information will only be seen by those who need to see it as part of the recruitment process.

Unless the nature of the position allows us to ask questions about your entire criminal record, we only ask about ‘unspent’ convictions as defined in the Rehabilitation of Offenders Act 1974.

We ensure that all those who are involved in the recruitment process have been suitably trained to identify and assess the relevance and circumstances of offences. We also ensure that they have received appropriate guidance and training in the relevant legislation relating to the employment of ex-offenders, e.g. the Rehabilitation of Offenders Act 1974, and in the secure handling of “sensitive personal data”, e.g. DBS checks.

At interview, or in a separate discussion, we ensure that an open and measured discussion takes place on the subject of any offences or other matter that might be relevant to the position. Failure to reveal information that is directly relevant to the position sought could lead to withdrawal of an offer of employment.

This policy document is made available to all DBS applicants at the outset of the recruitment process and we make every subject of a DBS check aware of the existence of the Code of Practice and make a copy available on request.

We undertake to discuss any matter revealed in a DBS check with the person seeking the position before withdrawing a conditional offer of employment.
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Employment Application Regulated Activity