Aquila Care Employment Application Form

Aquila Care Agency & Academy Application Form
Position Applied for:*
Date of Application*

DayMonthYear
How did you hear about this vacancy?
Personal Details
.*

MrMrsMsMissOther
Name:*

First NameLast Name
Full Name:*
Please include any other names by which you have been known since the age of 18. E.g. Maiden name
Mobile Number:*
E-mail Address:*
Date of Birth:*

DayMonthYear
National Insurance Number:*
Current Address:*

Street Address

Street Address Line 2

CityState / Province

Postcode
Date moved into current address:*

DayMonthYear

Have you changed your address in the last 5 years? If YES, please give details using the month and year for all dates.

	Date From	To	Address Details
.
.
.
.

Health:*
Describe your general state of health
Driver Details
Do you own a car?*

YesNo
Do you have a valid driving licence?*

YesNo
Do you have any current endorsements?*
Please provide details
Select the type of licence you hold*

FullAutomaticProvisionalOther
Education

Secondary Education*

	Secondary Education	Date From - To	Examination (Subjects)	Results
.
.
.
.

If you have anymore, please continue here:

Further Education*

	College/University	Date From - To	Examination (Subjects)	Results
.
.
.
.

If you have anymore, please continue here:

Any other training

	Dates	Type/Details
.
.
.
.

If you have anymore, please continue here:

Occupational Qualification / Institute Membership

	College / Institute Or other name	Date From - To	Qualification / Level	Registration / Membership number and expiry date
.
.
.
.

Previous Employment

Please include ALL YOUR EMPLOYMENT SINCE LEAVING FULL-TIME EDUCATION.

With your most recent employment first, use the spaces below to give details of employment working backwards from the most recent.

Where there are gaps in employment, please stipulate the reason for this.
Present/Previous Employer*
Type of Business*
Address*
Start Date*

DayMonthYear
Date
Leaving Date*

DayMonthYear
Date
Job Title*
Salary
Duties/Responsibilities*
Reason for Leaving*
Present/Previous Employer*
Type of Business*
Address*
Start Date*

DayMonthYear
Date
Leaving Date*

DayMonthYear
Date
Job Title*
Salary
Duties/Responsibilities*
Reason for Leaving*
Present/Previous Employer
Type of Business
Address
Start Date

DayMonthYear
Date
Leaving Date

DayMonthYear
Date
Job Title
Salary
Duties/Responsibilities
Reason for Leaving
Present/Previous Employer
Type of Business
Address
Start Date

DayMonthYear
Date
Leaving Date

DayMonthYear
Date
Job Title
Salary
Duties/Responsibilities
Reason for Leaving
If you have anymore, please continue here:
Community / Volunteer Experience
Please provide details of any and all volunteer work you have completed.
Interests and Hobbies*
References

Please indicate if you prefer your current employer NOT to be contacted immediately after a job offer.

Employment and voluntary work references:

Please provide reference details. Full address / Company Name (and setting/branch if applicable) including postcode must be given for each reference.

PLEASE NOTE THESE MUST INCLUDE ALL YOUR EMPLOYMENT IN THE LAST 5 YEARS.

Where employment is with an agency, please provide details of the agency as opposed to the place of work. Please also include details for any voluntary work

	Company (please insert current/most recent first)	Company Address	HR email address where employment reference can be sent. (This must not be a personal email address)	Contact Number	Can we contact immeadiately? (Yes/No)
.
.
.
.

If you have anymore, please continue here:

Character References - Please provide details of 2 character referees. These must have known you for 2 or more years and cannot be a family member, spouse or partner. If your application is successful, we will send off for both but only require one for safer recruitment purposes.*

	Contact Name	Contact Number	Email Address	Length of time known	Capacity known (e.g. friend, neighbour)
.
.

Have you ever been convicted of a criminal offence?*
Rehabilitation of Offenders Act 1974. Because of the nature of the work for which you are applying, this post is exempt from the provision of the above Act. Applicants are therefore not entitled to withhold information about convictions, which for other purposes would be regarded as "spent", and in the event of employment any failure to disclose information about convictions will result in dismissal. if you have been convicted of a criminal offence, please give details including all relevant dates. Information given will be treated with the strictest confidence.
Please give details of any allegations that did or did not result in disciplinary action taken against you in any current or previous employment.
Are you related to, a neighbour or friend of any current or recent member of staff? If yes, please state the name of the staff member and how you know them.*
Are you related to / connected to / know any of the young people in our care? if yes, please state their name and how you know them.*
If offered this position, will you continue to work in any other capacity? If yes, please state in which capacity. (Job role, hours etc)*
Additional Personal Information

Applicants are requested to select the relevant options below to enable the company to monitor its equal opportunity policy. Monitoring is recommended by the Code of Practice for the elimination of racial discrimination and for the elimination of discrimination on the grounds of gender and marital status. This information is used for no other purpose and will be treated as confidential.
Gender*

MaleFemaleRather not sayOther
Ethnic Group*

WhiteBlack-CaribbeanBlack-AfricanBlack-IndianPakistaniBangladeshiChineseOther
Do you consider yourself to be disabled?*

YesNo
Are you registered disabled?*

YesNo
Are you a permanent resident of the UK?*

YesNo
Is there any restriction on your residence in the UK?*

YesNo
Is there any restriction in you taking up employment in the UK?*

YesNo
If not, do you have a valid work permit?

YesNo
Were you born in the UK?*

YesNo
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Recruitment Policy

It is the company's policy to employ the best qualified personnel and provide equal opportunity for the advancement of the employees including promotion and training and not to discriminate against any person because of race, colour, national origin, sex, marital status or disability.

I authorise the company to obtain references to support this application once an offer has been made and accepted and release the company and referees from any liability caused by giving and receiving information.

Declaration: I confirm that the information given on this form is, to the best of my knowledge, true and complete. Any false statement may be sufficient cause for rejection or if employed, dismissal.
Signature*

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DayMonthYear
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