3S Adolsecent Care Employment Application Form

Job Application

Please complete the application form below to apply for a position with us.
Job Details
Position applied for*
How did you hear about this vacancy*
If answered 'other' to the above, please specify.
Are you related to or have any personal connection to any employee or associate of 3S Adolescent Care?*
If yes, please provide the name of the personal connection.

Personal Details
Personal Details
Full Name*

First NameMiddle NameLast Name
Date of birth*

MonthDayYear
Current Address*

Street Address

Street Address Line 2

Town/CityCounty

Postcode
Email Address*
Home telephone number*
Mobile telephone number*
National Insurance Number*
Do you have a full driving licence?*
Do you own or have use of a motor vehicle?*
Are you involved in any activity which might limit your availability to work or your working hours?*
Are you subject to any restrictions or covenants which might restrict your working activities?*
Are you able to provide evidence of your eligibility to work in the UK?*

Safeguarding Information
Safeguarding Information
Has your conduct in relation to any vulnerable groups ever been a cause for concern or investigation, (irrespective of whether it resulted in a charge or conviction)? This also includes any workplace investigations.*
Have you ever been subject to any disciplinary proceedings?*
Have you ever been prohibited from being a foster carer?*
Have you ever been refused an application to be a Registered Manager?*
Have you ever been refused an application to be a childcare provider or disqualified from having financial interest in a children’s home?*
Has your child, or a child of which you are or have been the registered guardian of, been the subject of a care order or supervision requirement moving him/her from your care?*
Are you the parent of, or associated with, any child you is on the at risk register?*
It is a criminal offence for barred individuals to apply to work in a regulated activity with children, young people or adults at risk. Are you on, or have you ever been considered for inclusion on, a barred list?*

Disclosure & Barring Service (DBS) Information
Disclosure & Barring Service (DBS) Information
Do you have any convictions, cautions, reprimands or final warnings?*
Have you resided outside of the United Kingdom for more than 18 months in the past 10 years?*
Do you have an enhanced DBS certificate for work with the Child Workforce?*
If yes, are you a current member of the Update Service?*
If yes, do you consent to an Update Service check being carried out by the Company?*

Employment Details
Employment Details
Present/last employer name*
Employer address*
Position held*
Salary/hourly rate*
Main duties and responsibilities*
Start date*

DayMonthYear
End date

DayMonthYear
Reason for leaving*
Period of notice required
Please list below all your other jobs, including those overseas, in chronological order, with the most recent first. You must include details of any gaps or breaks in service, including those outside of employment. There cannot be any unexplained gaps in your employment history. Please note we may contact any former employer, even if they have not been named as one of your chosen referees.
Please check the box to confirm you consent to that we may contact any former employer, even if they have not been named as one of your chosen referees.*

Yes I consent
Employer name and address*
Position held*
Reason for leaving*
Date employed from

DayMonthYear
Date employed to

DayMonthYear
Employer name and address*
Position held*
Reason for leaving*
Date employed from

DayMonthYear
Date employed to

DayMonthYear
Employer name and address*
Position held*
Reason for leaving*
Date employed from

DayMonthYear
Date employed to

DayMonthYear
Employer name and address
Position held
Reason for leaving
Date employed from

DayMonthYear
Date employed to

DayMonthYear
Employer name and address
Position held
Reason for leaving
Date employed from

DayMonthYear
Date employed to

DayMonthYear
Employer name and address
Position held
Reason for leaving
Date employed from

DayMonthYear
Date employed to

DayMonthYear
Employer name and address
Position held
Reason for leaving
Date employed from

DayMonthYear
Date employed to

DayMonthYear
Employer name and address
Position held
Reason for leaving
Date employed from

DayMonthYear
Date employed to

DayMonthYear

Education
Education

Please enter details of any Schools and Colleges attended and/or, University courses completed.
School*
Date attended from*

DayMonthYear
Date attended to*

DayMonthYear
Subject / Qualification and Grade*
Mode of Study (Full/Part Time, Distance Learning)*
College / University
Date attended from

DayMonthYear
Date attended to

DayMonthYear
Subject / Qualification and Grade
Mode of Study (Full/Part Time, Distance Learning)
College / University
Date attended from

DayMonthYear
Date attended to

DayMonthYear
Subject / Qualification and Grade
Mode of Study (Full/Part Time, Distance Learning)
College / University
Date attended from

DayMonthYear
Date attended to

DayMonthYear
Subject / Qualification and Grade
Mode of Study (Full/Part Time, Distance Learning)
College / University
Date attended from

DayMonthYear
Date attended to

DayMonthYear
Subject / Qualification and Grade
Mode of Study (Full/Part Time, Distance Learning)

Training and Qualifications
Training and Qualifications

Please give details of any other training or qualifications not listed above you have attained which are relevant to this role. Please start with the most recent first.
Training / Qualification
Date attained

DayMonthYear
Training / Qualification
Date attained

DayMonthYear
Training / Qualification
Date attained

DayMonthYear
Training / Qualification
Date attained

DayMonthYear

Professional Memberships
Professional Memberships
Are you currently a member of any licensing, regulatory or other professional body?*
Have you ever been, or are you currently, the subject of any investigation into your professional conduct by any licensing, regulatory or other professional body?*
Have you ever been refused admission to, or stuck off from, membership of any licensing, regulatory or other professional body?*
Are you currently suspended from any licensing, regulatory or other professional body on fitness to practice groups?*
If you have answered Yes to any of the above please provide full details below. Please also provide details of the Professional body, level of Membership & membership renewal date.

References
References

Please provide the names of at least two referees, the first one must be your current or most recent employer. Where possible the second reference should be another place of employment, if any of your previous positions have involved working with children or vulnerable people you should put this as one of your references. If you have recently left full time education and do not have two work references one of your references may be your head teacher or college/university tutor. You should only provide character references where you are unable to provide a work or educational references. A character reference should come from someone who is of a professional standing and who has known you for at least three years. We may take up references from any of your previous employers without notifying you.
Please check the box to confirm you consent that we may take up references from any of your previous employers without notifying you.*

Yes I consent
Referees name*
Job Title *
Organisation*
Postal address *
Referees telephone number*
Referees email address*
How does the referees know you?*
Referees name*
Job Title *
Organisation*
Postal address *
Referees telephone number*
Referees email address*
How does the referees know you?*
Referees name
Job Title
Organisation
Postal address
Referees telephone number
Referees email address
How does the referees know you?

Declaration
Declaration

By submitting this form I declare that the information given in this form is complete and accurate. I understand that any false information or deliberate omissions will disqualify me from employment or may render me liable to summary dismissal. I understand these details will be held in confidence by the Company, for the purposes of ongoing personnel administration and payroll administration in compliance with the Data Protection Act 1998. I undertake to notify the Company immediately of any changes to the above details. Given the nature of the job for which I have applied, I understand that any offer of employment will be subject to information on my criminal record being disclosed to the Company by the Disclosure Barring Service. I give my consent for 3S Adolescent Care to approach my previous employers or places of education for the purpose of obtaining employment/education information in support of my application information or any other information they feel is relevant.
Please check the box to confirm you consent that we approach my previous employers or places of education for the purpose of obtaining employment/ education information in support of my application information or any other information they feel is relevant.*

Yes I consent
Personal Statement*
Please provide us with a covering letter detailing your suitability for the role together with any additional details you feel are relevant to support your application and reflect the person specification. This may include additional skills, knowledge or experience not mentioned in the previous sections.
Please upload any further information you feel necessary if not already detailed above.

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Job Application

Job Details

Personal Details

Safeguarding Information

Disclosure & Barring Service (DBS) Information

Employment Details

Education

Training and Qualifications

Professional Memberships

References

Declaration