Employment Application Form

Application For Employment
Before you start ...

Please note that for this role, you will need to:-
- Complete a new DBS, which Jubilee House will pay for, unless you are already on the DBS Update System
- Provide two satisfactory references that meet our criteria
- Have the correct ‘Right to Work’ status
- Gain medical clearance to work in this role, this will be carried out on your behalf
To complete this application, we will require details about your education/qualifications, two references and two forms of ID (if you do not have this to hand right now, we can do that later)

If you are happy with all of the above, please complete the application below.

We look forward to receiving your application and getting to know you!

Thank you

The HR Team
Name*

PrefixFirst NameLast Name
The Role - Position Applied for

Support WorkerSenior Support WorkerWaking Night Support WorkerAdministratorOther
The Role - Area Applied for

Adult ServicesChildren ServicesSupport Services (HR, Finance, Administration etc)
The Role - What Type Is It

Full TimePart TimeBank
Date of Birth

DayMonthYear
Phone Number

Area CodePhone Number
Mobile Number
E-mail Address*
example@example.com
Address*

Street Address

Street Address Line 2

CityCounty

Post Code
Do you have a Drivers Licence*
If yes, do you own your own vehicle?
As this post is classed as having substantial access to children and vulnerable adults, appointment will be subject to the receipt of a satisfactory enhanced disclosure by The Disclosure and Barring Service. Please give details above of any criminal conviction, cautions, or bind over orders. The post applied for is exempt from the provisions of Rehabilitation of Offenders Act 1974 (Exemptions Amendment) order 1986 and therefore you are required to disclose any criminal background.
Safe Guarding - Have you ever been placed on The Protection of Vulnerable Adults/Children Register?*

YesNo
If yes, please give details?
Do you have a criminal record?*

YesNo
If yes, please give details?
Permission to work in the UK - are there any restrictions to your residence in the UK that might affect your right to take up employment?*

YesNo
This may mean that we cannot progress your application.

Please call 01707 390 107 to discuss further.
If you are successful in your application would you require permission to work in the UK?*

YesNo
Please supply details of any Visa currently held
Does your Visa have a condition restricting employment or occupation in the UK?

YesNo
This may mean that we cannot progress your application.

Please call 01707 390 107 to discuss further.
Working Time Directive - If offered this position, do you intend to work in another capacity?*

YesNo
If yes, please give details
Equality Act 2010

The Disability Discrimination Act protects disabled people. The Equality Act defines disability as a physical or mental impairment with long-term, substantial effects on the ability to carry out normal day to day activities. This includes people with long term health conditions. If you tell us that you have a disability, we can make reasonable adjustments for your interview and your workplace.
Do you consider yourself to have a disability?

YesNoI do not wish to discuss
Please state the type of impairment which applies to you. People may experience more than one type of impairment, in which case, you may indicate more than one. If none of the categories apply, please mark other
Physical ImpairmentSensory ImpairmentMental HealthLong Standing IllnessLearning Disability/DifficultyOther
If you answered yes to the above, please describe your impairment /disabilities and any reasonable adjustments which you feel should be made to the job itself which would enable you to carry out this job.
References

Please supply the names and addresses of two referees. One must be from your last/current employer or from your school or college. Please include at least one work related referee whom we may contact prior to selection for interview.

References from relatives and friends will not be accepted.

Reference One
Name:*

First NameLast Name
Organisation*
Company
Position*
Address*

Street Address

Street Address Line 2

CityCounty

Post CodeCountry
Phone Number

Area CodePhone Number
Mobile Number
E-mail Address*
Years Known*
I authorise the organisation to obtain this reference before an interview is offered to support my application and accept and release the organisation and referees from any liability caused by giving and receiving information.
YesNo
Reference Two
Name:*

First NameLast Name
Organisation*
Company
Position*
Address*

Street Address

Street Address Line 2

CityCounty

Post Code
Phone Number

Area CodePhone Number
Mobile Number
E-mail Address*
Years Known*
I authorise the organisation to obtain this reference before an interview is offered to support my application and accept and release the organisation and referees from any liability caused by giving and receiving information.
YesNo
Previous Employment

Please give details of emplyoment with most recent first, ensuring any gaps are explained in the Employment Gap Section below
Type of Business*
Address*

Street Address

Street Address Line 2

CityCounty

Post Code
Job Title*
Salary*

Hourly RateMonthly SalaryAnnual Salary
£*
Duties and Responsibilities*
Start Date*

DayMonthYear
End Date

DayMonthYear
Reason for Leaving*
Type of Business*
Address*

Street Address

Street Address Line 2

CityCounty

Post Code
Job Title*
Salary*

Hourly RateMonthly SalaryAnnual Salary
£*
Duties and Responsibilities*
Start Date*

DayMonthYear
End Date

DayMonthYear
Reason for Leaving*
Type of Business*
Address*

Street Address

Street Address Line 2

CityCounty

Post Code
Job Title*
Salary*

Hourly RateMonthly SalaryAnnual Salary
£*
Duties and Responsibilities*
Start Date*

DayMonthYear
End Date

DayMonthYear
Reason for Leaving*
Details of Employment Gaps
Education

Please list the most recent first and add the dates attended
School/College/University
Start Date

DayMonthYear
End Date

DayMonthYear
Subject
Qualification Gained
Date Gained

DayMonthYear
School/College/University
Start Date

DayMonthYear
End Date

DayMonthYear
Subject
Qualification Gained
Date Gained

DayMonthYear
School/College/University
Start Date

DayMonthYear
End Date

DayMonthYear
Subject
Qualification Gained
Date Gained

DayMonthYear
Please let us know what your reasons are for applying for this post and what you think you would bring to the role?*
Please use this section for any further information that you think may be relevant to your application :*
Please upload two types of ID

Browse Files
Optional Cancelof
Please state if you have a partner, blood relative or close friend working at Jubilee House Care Trust (failure to do so may invalidate your application) :*
How did you hear about this job? If it is via our "Refer a Friend Scheme", please state clearly who you have been referred by :*
DECLARATION

I declare that the information in my application is true and I acknowledge that, if appointed, any false information or deliberate ommissions later discovered may lead to the termination of the appointment.
YesNo
Signature

Clear
Signature
Date*

DayMonthYear
Date
Please be aware that incomplete applications may not be considered.
Should be Empty:

Application For Employment

References

Education