Employment Application Form

Thank you for your interest in applying to join the Rutland House Counselling & Psychotherapy (RHCP) team. To be considered for the role, please complete the application form in full.

Data Protection. In order to process your application we must collect some personal data from you, including personal contact details and professional work history. If you are successful we will hold your details on file for the duration of your employment and seven years post termination in line with our legal obligations. If you are unsuccessful, we shall hold your application for three months. If you wish to withdraw your applciation, please let us know and we will remove your personal data from our shortlisting.
Please state the Job Title of the role you wish to apply for.
Full Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Email
example@example.com
Education & Training
please provide details of all relevant education and training you have undertaken including year and training institute.
Qualifications
Please list all formal qualifications you hold.
Employment History
Name of your current employer
Address
Job title
Pay
How long have you been employed with this employer?
Reason for leaving?
Main duties
Previous Employers. Please provide details of previous employment including skills and duties undertaken.
Please list your previous employers, including start and end dates. Where there are any gaps in employment history please let us know why.
Please tell us why you wish to apply for this role?
We want to understand your motivation to work for our company and/ or this particular role.
Supporting Statement. Please tell us how you think you can bring a positive contribution to the organisation and this role. Please refer to the person specification to support your statement.
Interview Arrangements and Availability. If you have a disability, please tell us if there are any reasonable adjustments we can make to help you in your application or with our recruitment process.
Have you checked the advertised interview date, and can you be available for interview on this date?
If you were successful, when could you be available to start the position?
Right to Work
Do you need a work permit to work in the UK?

YesNo
Criminal Record Declaration
If you are unsure about how to answer the questions on this form, please contact Nacro's Criminal Record Support Service on 0300 123 1999 or helpline@nacro.org.uk. All enquiries to this service are confidential. You will not be asked for any personal details, unless you want information or advice sent to you.
Do you have any unspent convictions or conditional cautions?

YesNo
Do you have any spent adult cautions (simple or conditional) or convictions that are not 'protected' as defined by the Rehabilitation of Offenders Act 1974 (Exemptions) Order 1975 (as amended)?

YesNo
If you have answered yes to either question, you now have two options for disclosing your criminal record. Option 1. You can disclose your criminal record on a separate sheet provided that you state below that this has been provided separately. You may then email the practice with the attachment using a password protected document. Option2: Please provide details in the space below.
Declaration: I declare that the information provided on this form is correct. I understand that the declaration of a criminal record will not necessarily prevent me from being offered this role at RHCP.

Clear
References

Please give the names and contact details of 2 people who we can ask to give you a reference. We may ask them before an employment offer is made. We will not ask your current employer until we get your permission.
Referee 1
Referee 2
Thank you for taking the time to complete this application form. We endeavour to let you know as soon as possible if you are short-listed for interview. We are keen to inform all applicats where we can if they are unsuccessful for short-listing, however where we receive a large amount of applications this may not always be possible. If you do not hear from us within 3 weeks of the closing date then unfortunatley you have not been successful on this occassion.
Should be Empty:

Employment History

Right to Work

Criminal Record Declaration

References