Job Application Form

Job Application Form

Your Location
Are you currently living / working in England, UK?*

YesNo
Thank you for your interest in the position, though we are not currently accepting applicants from outside of the UK. We wish you all the best in your search for employment.

Your Details
Applying for Position*
Full Name*

TitleFirst NameMiddle Name (if applicable)Last Name
Current Address*
Address Line 1
Address Line 2
*
Town / City
*
Post Code
Date Moved in to Current Address

DayMonthYear
Date
Details of last 5 years of addresses
Phone Number
Home
*
Mobile
National Insurance Number*
Email Address*
Date of Birth*

DayMonthYear
Date
Place of Birth*
Nationality*

Health
Do you have any disabilities which may be relevant to this Job Application?*

YesNo
If 'Yes' please describe them

How many days absence have you had from work in the last three years?

Data Protection Notice: The company requires certain information prior to you commencing employment, to ensure you will be able to perform the requirements of the job and give reliable service and to ensure compliance with relevant Health and Safety regulations. The information is also required in order to establish whether any reasonable adjustments may need to be made to assist you in performing your duties, in accordance with the Equality Act 2010. The information you provide will be treated in the strictest confidence and used only for the purpose detailed above in compliance with the Data Protection Act 2018 (DPA 2018).
Have your had your Covid-19 vaccinations?*

YesNo

Covid Vaccination Proof

Browse Files

Cancelof
Name of GP
Surgery Name*
Telephone Number*
Do you hold a current Driving Licence?*

YesNo

	Date
Vaccination 1
Vaccination 2
Vaccination 3
Vaccination 4
Vaccination 5

Education & Professional Training
EDUCATION & PROFESSIONAL TRAINING

(from year 11)
*
Please state any other training you have attended relevant to the position you have applied for (Please provide certificates)
Membership of Professional Organisation / Trade Union
Supporting / Additional Information
REHABILITATION OF OFFENDERS ACT 1974
Through the 1975 Exemptions Order of the Rehabilitation of Offenders Act, 1974, and by virtue of the nature of the post for which you are applying, we are obliged, as your prospective employers, to ask the following question. Any information supplied by yourself will be remain confidential and considered only in relation to this Job Application. With the exception of minor motoring offences, have you ever been convicted of any criminal offence? Please include all convictions, cautions, reprimands or warning.*

YesNo
If YES please provide brief details of other offence(s) and relevant dates
Do you have a current & transferable DBS check?*

YesNo
If YES please provide the certificate number (starts with 00)
12 digit number

Employment
EMPLOYMENT HISTORY

Most Recent First
Please start with the current / most recent employer and go back to the point of leaving education. Any gaps in employment must be explained in the box below. *
Provide details of any gaps in your employment history (of two weeks or more) in a covering letter. This should include the length of the period of unemployment, the reason you were unemployed and what you did to occupy your time.
EMPLOYMENT INFORMATION
Type of employment desired*

Full-TimePart-TimeBank

Available to take up employment from

DayMonthYear
Date

References
REFERENCES
Right to Contact Former Employers, Referees and Training Organisations.

We have a right to contact referees / training organisations to verify the information you have provided because:- Data protection laws give us a right to process data for our legitimate interests. This includes contacting former employers and training organisations you have attended to verify the information you have provided in this form, without needing your consent.- We have a legitimate interest to ensure we employ staff that are honest and act with integrity when working for and representing our business, to minimise our risk or exposure to criminal or civil claims, to comply with the law or to comply with the rules of any regulators.- We confirm that we have done a ‘legitimate interests assessment’ to ensure your rights and interests are fully considered and protected. As you are applying to work for us, there appears to be no good reason why your data protection privacy rights would override ours. Further, this is necessary for exercising rights which are conferred on us by law, in connection with employment, namely making pre-employment checks before making a decision of employment.- As a result, we need to contact former employers, referees noted below and training organisations you have attended to be sure that you have truthful with the information you have provided - we will not ask them to verify more than the information that you have provided. Please provide details of 3 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.

Employment Reference
Employment Reference (Most Recent Employer)*

First NameLast Name
Name of Company*
Position of Referee*
Position in the Company
Length of Time Known*
Address of the Company*
Email Address*
example@example.com
Telephone Number*
Your Relationship to The Referee*
i.e. Employer, Manager etc.

Character Reference 1
Character Reference 1*

First NameLast Name
Name of Company
(if applicable)
Position of Referee
Position in the Company (if applicable)
Length of Time Known*
Address*
Email Address*
example@example.com
Telephone Number*
Your Relationship to The Referee*
i.e. Colleague, known professional etc.

Character Reference 2
Character Reference 2*

First NameLast Name
Name of Company
(if applicable)
Position of Referee
Position in the Company (if applicable)
Length of Time Known*
Address of the Referee*
Email Address*
example@example.com
Telephone Number*
Your Relationship to The Referee*
i.e. Colleague, known professional etc.

JOB APPLICANT PRIVACY NOTICE

As part of any recruitment process, Yarborough House collects and processes personal data relating to job applicants. The organisation is committed to being transparent about how it collects and uses that data and to meeting its data protection obligations.

What information do we collect?

Yarborough House collects a range of information about you.

This includes:

·       Your name, address and contact details, including email address and telephone number;

·       Details of your qualifications, skills, experience and employment history;

·       Information about your current level of remuneration, including benefit entitlements;

·       Whether or not you have a disability for which the organisation needs to make reasonable adjustments during The recruitment process; and

·       Information about your entitlement to work in the UK.

Yarborough House may collect this information in a variety of ways. For example, data might be contained in application forms, CVs or resumes, obtained from your passport or other identity documents or collected through interviews or other forms of assessment.

We may also collect personal data about you from third parties, such as references supplied by former employers. We will seek information from third parties only once a job offer to you has been made and will inform you that we are doing so. Data will be stored in a range of different places, including on your application record, in employee management systems and on other IT systems (including email).

Why does Yarborough House process personal data?

We need to process data to take steps at your request prior to entering into a contract with you. We may also need to process your data to enter into a contract with you.

In some cases, we need to process data to ensure that we are complying with its legal obligations. For example, it is mandatory to check a successful applicant's eligibility to work in the UK before employment starts.

Yarborough House has a legitimate interest in processing personal data during the recruitment process and for keeping records of the process. Processing data from job applicants allows us to manage the recruitment process, assess and confirm a candidate's suitability for employment and decide to whom to offer a job. We may also need to process data from job applicants to respond to and defend against legal claims.

Yarborough House may process special categories of data, such as information about ethnic origin, sexual orientation or religion or belief, to monitor recruitment statistics. We may also collect information about whether or not applicants are disabled to make reasonable adjustments for candidates who have a disability. We process such information to carry out its obligations and exercise specific rights in relation to employment.

If your application is unsuccessful, Yarborough House may keep your personal data on file in case there are future employment opportunities for which you may be suited. We will ask for your consent before it keeps your data for this purpose and you are free to withdraw your consent at any time.

Who has access to data?

Your information may be shared internally for the purposes of the recruitment exercise. This includes members of senior management and interviewers involved in the recruitment process.

We will not share your data with third parties unless your application for employment is successful and we make you an offer of employment. We will then share your data with former employers to obtain references for you, employment background check providers to obtain necessary background checks.

How does Yarborough House protect data?

We take the security of your data seriously. We have internal policies and controls in place to ensure that your data is not lost, accidentally destroyed, misused or disclosed, and is not accessed except by our employees in the proper performance of their duties.

For how long does Yarborough House keep data?

If your application for employment is unsuccessful, the organisation will hold your data on file for 6 (six) months after the end of the relevant recruitment process. If you agree to allow us to keep your personal data on file, we will hold your data on file for a further 6 (six) months for consideration for future employment opportunities. At the end of that period, or once you withdraw your consent, your data is deleted or destroyed. You will be asked when you submit your application form whether you give us consent to hold your details for the full 12 months in order to be considered for other positions or not.

If your application for employment is successful, personal data gathered during the recruitment process will be transferred to your employee file (electronic and paper based) and retained during your employment. The periods for which your data will be held will be provided to you in a new privacy notice.

Your rights

As a data subject, you have a number of rights. You can:

·       Access and obtain a copy of your data on request;

·       Require the organisation to change incorrect or incomplete data;

·       Require the organisation to delete or stop processing your data, for example where the data is no longer necessary for the purposes of processing; and

·       Object to the processing of your data where Yarborough House is relying on its legitimate interests as the legal ground for processing.

If you would like to exercise any of these rights, please contact Marion Bourn at home@grimsbycare.com.

If you believe that the organisation has not complied with your data protection rights, you can complain to the Information Commissioner.

What if you do not provide personal data?

You are under no statutory or contractual obligation to provide data to Yarborough House during the recruitment process. However, if you do not provide the information, we may not be able to process your application properly or at all.

REFERENCE AUTHORISATION
Reference Authorisation

I, First Name* Last Name* , authorise Yarborough House Residential Care Home to contact my references to investigate my past employment and professional activities. I also agree to release from liability all persons and companies providing this information.

I understand and acknowledge that any offer of employment is conditional upon the organisation being completely satisfied with the information provided as a result of this reference check.
Signature*

Clear
Date

DayMonthYear
Date

Application Instructions
Upload your CV / Supporting Documentation Here

Browse Files

Cancelof
DECLARATION

It is understood and agreed that any misrepresentation by me on this application form will be sufficient cause for cancellation of this application and/or termination from the employer’s service, if I am employed. I give the employer the right to investigate all of the references, contact them and to secure additional information about me, if job related. I hereby release from liability the employer and its representatives for seeking such information and all other persons, corporations or organisations for furnishing such information.
Signature*

Clear
Date

DayMonthYear
Date
Should be Empty:

	Excellent	Good	Poor	Comments
Overall State of Health
Hearing
Eyesight

	Yes	No	Further Details
Are you currently on medication (excluding contraceptives)?
Have you spent time in hospital in the last three years?
Do you suffer from any injury, illness, medical condition or allergy that might affect your ability to perform your duties?
Have you had treatment for any condition relating to the abuse or mis-use of drugs or alcohol within the last 5 years?
Have you had the flu vaccination?
If required are you prepared to undergo a medical examination?

	Yes	No	Further Details
If you are offered this position, is there any other work that you will continue elsewhere?
Are you related to any employee of this organisation?
Have you ever had a verbal or written warning from any employer?
Have you ever been dismissed from any employer?

	No	Yes	Further Details
Typhoid Fever / Paratyphoid Fever? Enteric Fever?
Salmonella Infection?
Diarrhoea / Vomiting for more than 2 days?
Frequent Infections of the Upper Respiratory Tract e.g., Colds, Sinusitis, Sore Throat, etc?
Severe Chest conditions, such as chronic Bronchitis with Phlegm, Pleurisy, TB (Tuberculosis?)
Discharge from the Ear / Eyes / Nose?
Problems with the Heart and / or Circulatory System, such as Angina, Abnormal Blood Pressure, Anaemia?
Problems with Sight or Hearing, such as Colour Blindness, Hard of Hearing?
Skin Rash / Eczema / Dermatitis / other Skin Disease?
Recurrent Boils / Styes / Septic Fingers?
Fits or Blackouts?
Migraines and other Severe Headaches?
Mental Health problems, such as Stress, Hypertension, Addictions, Depression or Anxiety Attacks?
Have you been an in-patient or out-patient at a hospital within the last 5 years?
Have you had treatment for any condition relating to the abuse or misuse of alcohol or drugs within the last 5 years?
Do you regularly take any type of prescription medication?
Have you ever suffered from a back strain, slipped disc, or other conditions of the back, joints or ligaments?
Are you registered disabled?
Have you ever been refused a Drivers’ Licence through health reasons?
Have you ever had medical insurance refused, or offered subject to special conditions?
Have you ever been refused employment, or had your employment terminated for health reasons?

Job Application Form

EDUCATION & PROFESSIONAL TRAINING

REHABILITATION OF OFFENDERS ACT 1974

EMPLOYMENT HISTORY

EMPLOYMENT INFORMATION

REFERENCES

CONFIDENTIAL MEDICAL QUESTIONNAIRE

REFERENCE AUTHORISATION

Application Instructions