Employment Application Form

  • Employment Application Form

    We are committed to safeguarding and promoting the welfare of children. All applicants must complete safer recruitment process, including checks with past employers and an enhanced level DBS. All applicants must answer all questions with no omissions. Failure to disclose information may result in offer of employment being withdrawn. We are an equal opportunities employer.
  • Have you ever been known by a different name or title?*
  • Date Name Changed*
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  • Move in Date*
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  • Format: 00000 000000.
  • Format: 00000 000000.
  • Birth Date*
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  • Have you lived at the same address for the last 5 years?*
  • Move in Date*
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  • Move out Date*
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  • Additional Address History?*
  • Move in Date*
     / /
  • Move out Date*
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  • Additional Address History?*
  • Move in Date*
     / /
  • Move out Date*
     / /
  • How were you referred to us?*
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  • Do you have any relationships with employees?*
  • Will this be your only job role if successful?*
  • Do you have the Right to work in the UK?*
  • Right to Work Expiry Date*
     / /
  • Have you spent more than 90 days overseas in the past 10 years? (aged 18+)*
  • Have you ever worked in the care sector previously?*
  • Are you Qualified?*

  • Safer Recruitment Questions

  • Have you ever been subject to any investigation, fact findings, disciplinary action or dismissed from paid, unpaid, voluntary, other employment, training or other programme with children, young people and/or vulnerable adults that was either substantiated or unsubstantiated?*
  • Have you have any disciplinary action against your name? Depending on the reason for the warning, we may have to write to the relevant company to confirm the action that was taken.*
  • Have you ever been dismissed or resigned after disciplinary procedures have been instigated?*
  • Have you ever had any safeguarding concerns raised against your name include anything that resulted in no further action made?*
  • Have you ever had any safeguarding concerns raised against your name include anything that resulted in no further action made?*
  • Do you have any medical conditions or illness that may impact on your ability to care for children and young people including if required to use physical intervention if this was need to protect a child or young person from harm.*
  • Any other information that you want to disclose or discuss?*

  • DBS & Criminal Information

    All care roles are exempt from the Rehabilitation of Offenders Act. You must disclose both spent and unspent convictions during the selection process. Failure to disclose information may disqualify your application or result in dismissal without notice.
  • Do you have any criminal convictions or cautions against your name? Please detail all convictions/cautions, including the dates*
  • Have you ever received a Caution, Reprimand or Warning?*
  • Are there any alleged offences outstanding against you?*
  • Do you currently have a Valid DBS on the update service?*
  • DBS Certificate Issue Date*
     / /
  • Do you still have the physical certificate?*

  • Employment & Reference Information

    We must have full employment history for all roles paid, unpaid or any other type of role since the age of 16 years old. We reserve the right to request information from any caring role as part of safer recuritment checks. Please provide details of all roles since leaving school. Failure to disclose information may disqualify your application or result in dismissal without notice.

  • Employment Gaps

    We must have a reason provided for all employment gaps
  • Do you have any Employment Gaps?*
  • Do you have any further Employment Gaps?*
  • Do you have any further Employment Gaps?*
  • Do you have any further Employment Gaps?*
  • Do you have any further Employment Gaps?*

  • Education Information

    Please include education information since school age
  • Date Left High School*
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  • Have you attended college or university ?
  • Date Leaving College or University *
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  • Do you have any qualifications?
  • Date
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  • Date
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  • Date
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  • Driving Status

  • Do you hold a valid UK driving licence?*
  • Do you have any current endorsements??*
  • Have you ever been disqualified from driving?*
  • Driving licence issue date*
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  • Driving licence expiry date*
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  • Do you hold Business Insurance?*

  • Supporting Statement

    Please explain how you meet the requirements outlined in the Person Specification. You should give examples from previous paid, unpaid employment including any transferable skills you have gained.
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  • Employee Declaration

    Declaration for all applicants applying for employment
  • Date of Signature*
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  • Should be Empty: