• Application Form

    Application Form

    STRICTLY CONFIDENTIAL - PLEASE COMPLETE THIS FORM FULLY
  • 1.3 Date of Birth:*
     - -
  • Format: (000) 000-00000.

  • Full address History

  • from*
     - -
  • to*
     - -
  • from
     - -
  • to
     - -

  • Immigration Details

  • 2.1 Are you a British Citizen?*

  • Education

    Please provide a full description of your educational history from age 18

  • Previous Employment

    A full employment history must be detailed beginning with your current employment and covering all reasons for gaps in any given year.

  • Rehabilitation of Offenders ACT 1974 - Notice to Offenders

    1. Do you have any convictions, cautions, reprimands or final warnings that are not “protected” as defined by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (as amended in 2013)? 2.     The amendments to the Exceptions Order 1975 (2013) provide those certain convictions and cautions are protected and are not subject to disclosure to employers and cannot be considered.
  • 5.1 Do you have any convictions to disclose?*

  • Failure to declare or the falsification of any of the above details will result in the withdrawal of any job offer.

  • References

    Please give the name and address of two referees, one of whom must be your current or most recent previous employer. If you can only provide one professional reference, please provide two Character references from professional individuals. References from relatives or friends are not accepted.

  • Referral

    Please note down the details of the person who referred you. If you haven't been referred, please leave empty.
  • Format: (0000)-000-0000.
  • Format: (0000)-000-0000.
  • Format: (0000)-000-0000.

  • This organisation seeks to work in a flexible and family-friendly manner with its staff, however, unsocial hours are part and parcel of a quality care service. Weekend working is a requirement for all staff, the frequency of which will be determined at the interview.

  • Rows

  • Please provide details of your Covid-19 Vaccination 

    1st Dose

  • 2nd Dose 

  • Most Recent Booster

  • Equal Opportunities Monitoring

    Equal Opportunities Monitoring

    This section of the application will be detached and used for monitoring purposes only. Our organisation recognises and actively promote the benefits of a diverse workforce and are committed to treating all employees with dignity and respect in line with the Equality Act 2010 legislation. We welcome applications from all sections of the community.

  • Race Relations (Amendments 2000)

    I would describe my ethnic origin as (please select the description most fitting)
  • Asian or Asian British
  • Black or Black British
  • Mixed Race
  • White
  • Other Ethnic Group

  • Sexual Orientation

    Please select the option which best describes your sexuality
  • Please select*

  • Please indicate your religion or belief

    Please select the option which best describes your religion/belief:
  • Please select*
  • Health Questionnaire

    Health Questionnaire

    To comply with the Equality Act 2010, please complete this questionnaire as fully as possible. Failure to do so could impede or delay your application status. All information provided is private and confidential.
  • Have you received your COVID Vacinnations?*

  • Have you ever suffered from any of the following;

    Please select yes or no
  • Epilepsy/Blackouts?*
  • Nervous Mental Disorders?*
  • Chronic Migraine/Headaches?*
  • Sensory Impairment?*
  • Any Allergies?*
  • Back Pain/ Previous Back Injury?*
  • Heart Condition?*
  • Asthma or Any Respiratory Aliments?*
  • Re-occuring Incidence of Illnesss?*
  • Do you have any Chronic Heath Conditions? e.g. High Blood Pressure, Diabetes etc.*
  • Are you registered disabled?

  • Thank you for completing this application form.

     

     


    I declare that to the best of my knowledge, all the information contained and documented herein is complete and truthful.

  • Date*
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  •  
  • Should be Empty: