FTS CARE LTD.
APPLICATION FORM
Position Applied For
Please Select
Residential Child Care Worker
Senior Residential Child Care Worker
Assistant Manager
Residential Manager
Name
Date of Application
/
Day
/
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
PART 1 - PERSONAL DETAILS
Name
First Name(s)
Surname
Are you now, have you ever been, or were you at birth known by a different name? Please give details.
Address
Street Address
Town / Address Line 2
Town / City
County / Region
Post Code
Daytime Phone Number
Format: 00000 000 000.
Mobile Phone Number
Format: 00000 000 000.
Evening Phone Number
Format: 00000 000 000.
Email Address
example@example.com
PART 2 PRESENT OR MOST RECENT EMPLOYER
Present or Previous Employer
Most recent details
Present or Previous Employer Address
Street Address
Town / Address Line 2
Town / City
County / Region
Post Code
Present or Previous Employer Daytime Phone Number
Format: 00000 000 000.
Salary
Position Held
Full / Part Time
Please Select
Full Time
Part Time
Date Started
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Notice Period or Leave Date
Key responsibilities of post and main achievements
Reason for leaving/Wishing to Leave
PART 2 - Continued 2nd MOST RECENT EMPLOYER
Previous Employer
Most recent details
Present or Previous Employer Address
Street Address
Town / Address Line 2
Town / City
County / Region
Post Code
Previous Employer Daytime Phone Number
Format: 00000 000 000.
Salary
Position Held
Full / Part Time
Please Select
Full Time
Part Time
Date Started
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Notice Period or Leave Date
Key responsibilities of post and main achievements
Reason for leaving/Wishing to Leave
PART 2 - Continued 3rd MOST RECENT EMPLOYER
Previous Employer
Most recent details
Present or Previous Employer Address
Street Address
Town / Address Line 2
Town / City
County / Region
Post Code
Previous Employer Daytime Phone Number
Format: 00000 000 000.
Salary
Position Held
Full / Part Time
Please Select
Full Time
Part Time
Date Started
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Notice Period or Leave Date
Key responsibilities of post and main achievements
Reason for leaving/Wishing to Leave
PART 3 - FULL EMPLOYMENT HISTORY
(including any voluntary work, periods of training/education and accounting for any gaps in employment history - please provide explanations for any employment gaps)
Most Recent Employer
Name and Address of Employer
Start Date
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
End Date
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Job Title and Main Duties
Reason for leaving
2nd Most Recent Employer
Name and Address of Employer
Start Date
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
End Date
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Job Title and Main Duties
Reason for leaving
3rd Most Recent Employer
Name and Address of Employer
Start Date
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
End Date
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Job Title and Main Duties
Reason for leaving
4th Most Recent Employer
Name and Address of Employer
Start Date
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
End Date
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Job Title and Main Duties
Reason for leaving
5th Most Recent Employer
Name and Address of Employer
Start Date
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
End Date
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Job Title and Main Duties
Reason for leaving
6th Most Recent Employer
Name and Address of Employer
Start Date
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
End Date
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Job Title and Main Duties
Reason for leaving
7th Most Recent Employer
Name and Address of Employer
Start Date
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
End Date
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Job Title and Main Duties
Reason for leaving
8th Most Recent Employer
Name and Address of Employer
Start Date
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
End Date
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Job Title and Main Duties
Reason for leaving
PART 4 - SCHOOL EDUCATION
School Education Summary #1
Qualification / Level
Subject
Grade
Year
School Education Summary #2
Qualification / Level
Subject
Grade
Year
School Education Summary #3
Qualification / Level
Subject
Grade
Year
School Education Summary #4
Qualification / Level
Subject
Grade
Year
School Education Summary #5
Qualification / Level
Subject
Grade
Year
School Education Summary #6
Qualification / Level
Subject
Grade
Year
School Education Summary #7
Qualification / Level
Subject
Grade
Year
School Education Summary #8
Qualification / Level
Subject
Grade
Year
School Education Summary #9
Qualification / Level
Subject
Grade
Year
School Education Summary #10
Qualification / Level
Subject
Grade
Year
PART 5 - FURTHER EDUCATION
Further Education Summary #1
University or College
Degree or Qualification
Course Start Date
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Course End Date
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Further Education Summary #2
University or College
Degree or Qualification
Course Start Date
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Course End Date
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Further Education Summary #3
University or College
Degree or Qualification
Course Start Date
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Course End Date
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Further Education Summary #4
University or College
Degree or Qualification
Course Start Date
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Course End Date
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Further Education Summary #5
University or College
Degree or Qualification
Course Start Date
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Course End Date
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
PART 6 - MEMBERSHIP/REGISTRATION OF PROFESSIONAL BODIES
MEMBERSHIP/REGISTRATION OF PROFESSIONAL BODIES # 1
Professional Body
Registration Number
Conditions Affecting Registration
Date Gained
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Expiry Date
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
MEMBERSHIP/REGISTRATION OF PROFESSIONAL BODIES # 2
Professional Body
Registration Number
Conditions Affecting Registration
Date Gained
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Expiry Date
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
MEMBERSHIP/REGISTRATION OF PROFESSIONAL BODIES # 3
Professional Body
Registration Number
Conditions Affecting Registration
Date Gained
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Expiry Date
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Please give details of any former registration with any professional bodies
Entry #1
Professional Body
Registration Number
Conditions Affecting Registration
Date Gained
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Expiry Date
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Reasons for ceasing to be registered
Please give details of any former registration with any professional bodies
Entry #2
Professional Body
Registration Number
Conditions Affecting Registration
Date Gained
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Expiry Date
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Reasons for ceasing to be registered
PART 7 -OTHER INFORMATION
(A) Do you have a full clean driving licence? (If not, please give details of all endorsements and accidents over the last 5 years including dates below)
Do you have a full clean driving licence?
Yes
No
Details of all endorsements and accidents over the last 5 years including dates
(B) Do you have a current PVG check? (If yes, please provide the membership scheme record)
Do you have a current PVG check?
Yes
No
If yes, please provide the membership scheme record
(C) Are you in any way connected to an existing FTS CARE LTD employee or anyone else who may be connected with FTS CARE LTD in any way?
E.g. family, friend, Councillor (If yes please provide their name, position and location below)
Yes
No
If yes, please provide their name, position and location below
(D) Where did you hear about this vacancy?
PART 8 - SUITABILTY TO MEET PERSON SPECIFICATION
Essential Attributes
Number
Essential #1
Number
Essential #2
Number
Essential #3
Number
Essential #4
Number
Essential #5
Desirable Attributes
Number
Desirable #1
Number
Desirable #2
Number
Desirable #3
Number
Desirable #4
Number
Desirable #5
PART 9 - ADDITIONAL INFORMATION
Additional information
References
Most recent/current Employer and Previous Employer
Most recent or Current Employer
Name of Referee
Referee's Job title
Dates Covered by this employment
Business address
Business Post Code
Business Phone Number
Please enter a valid phone number.
Format: 00000 000 000.
Business Email
example@example.com
Previous Employer
Name of Referee
Referee's Job title
Dates Covered by this employment
Business address
Business Post Code
Business Phone Number
Please enter a valid phone number.
Format: 00000 000 000.
Business Email
example@example.com
Can we contact these referees?
YES
NO
PART 11 - DECLARATION
I certify that, to the best of my knowledge, all the statements made above are true and accurate
and, in particular, that I have not omitted any facts which may have a bearing on my application.
I give explicit consent that the information given on this form may be stored and processed in
accordance to the Data Protection Act 1998.
FTS CARE LTD may take steps to verify the information that I have provided by contacting referees
and checking professional registers.
I am aware that providing false information could result in my application being rejected or may lead
to summary dismissal if I am selected for a position within FTS CARE LTD. If I am registered with
any professional body FTS CARE LTD will inform them that I have provided false information on my
application form.
Signature
Date
/
Day
/
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Copyright © 2021 FTS CARE LTD. All rights reserved
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