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 Failure to disclose information may result in offer of employment being withdrawn.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.
Job Role *
Role Location (If known)
Closing Date (If known)
Title*
Mr, Mrs, Miss, Ms, Dr, Other, Don't wish to state
Full Name*

PrefixFirst NameMiddle NameLast Name
Have you ever been known by a different name or title?*

YesNo
Previous Title*
Mr, Mrs, Miss, Ms, Dr, Other, Don't wish to state
Full Name*

PrefixFirst NameMiddle NameLast Name
Reason for Change*
Date Name Changed*

DayMonthYear
Date
Current Address (We must have five years history)*

Street Address

Street Address Line 2

Town/CityState / Province

Post Code Country
Move in Date*

DayMonthYear
Date
Home Number
Please enter a valid phone number.
Mobile Number*
Please enter a valid phone number.
Email*
example@example.com
National Insurance Number*
AB123456C
Birth Date*

DayMonthYear
Date
Have you lived at the same address for the last 5 years?*

YesNo
Previous Address*

Street Address

Street Address Line 2

Town/CityState / Province

Post Code Country
Move in Date*

DayMonthYear
Date
Move out Date*

DayMonthYear
Date
Additional Address History?*

YesNo
Previous Address*

Street Address

Street Address Line 2

Town/CityState / Province

Post Code Country
Move in Date*

DayMonthYear
Date
Move out Date*

DayMonthYear
Date
Additional Address History?*

YesNo
Previous Address*

Street Address

Street Address Line 2

Town/CityState / Province

Post Code Country
Move in Date*

DayMonthYear
Date
Move out Date*

DayMonthYear
Date
How were you referred to us?*

IndeedReferralNewspaper AdFacebookTwitterLinkedInOtherN/A
Please tell us name of Referral
CV - Upload your CV here if applicable

Cancelof
Do you have any relationships with employees?*

YesNo
Please tell us the relationship*
Will this be your only job role if successful?*

YesNo
Reason*
Do you have the Right to work in the UK?*

Yes PermanentYes TemporaryNo
Right to Work Expiry Date*

DayMonthYear
Date
Right to Work Conditions*
Have you spent more than a 3 month period overseas in the past 10 years? (aged 18+)*

YesNo
Overseas Details (Dates, Country, Reason)*
Have you ever worked in the care sector previously?*

YesNo
Are you Qualified?*

YesNo
Qualification*
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?*

Yes - Please Provide Details BelowNo
Details*
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.*

Yes - Please Provide Details BelowNo
Details*
Have you ever been dismissed or resigned after disciplinary procedures have been instigated?*

Yes - Please Provide Details BelowNo
Details*
Have you ever had any safeguarding concerns raised against your name include anything that resulted in no further action made?*

Yes - Please Provide Details BelowNo
Details*
Have you ever had any safeguarding concerns raised against your name include anything that resulted in no further action made?*

Yes - Please Provide Details BelowNo
Details*
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.*

Yes - Please Provide Details BelowNo
Details*
Any other information that you want to disclose or discuss?*

Yes - Please Provide Details BelowNo
DIsclosure Information*
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.
Are you aware that this post is exempt from the Rehabilitation of Offenders?*

Yes
Do you have any criminal convictions or cautions against your name? Please detail all convictions/cautions, including the dates*

Yes - Please Provide details in Disclosure InformationNo
DIsclosure Information*
Have you ever received a Caution, Reprimand or Warning?*

Yes - Please Provide details in Disclosure InformationNo
DIsclosure Information*
Are there any alleged offences outstanding against you?*

Yes - Please Provide details in Disclosure InformationNo
DIsclosure Information*
Do you currently have a Valid DBS on the update service?*

YesNo
DBS Number*
Subscription update service Number (C Number)*
DBS Certificate Issue Date*

DayMonthYear
Date
Do you still have the physical certificate?*

YesNo
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.
Current or Most Recent Employment *
Previous Employment *
Do you have additional employment history?*

Yes - Please Provide Details BelowNo
Previous Employment *
Do you have additional employment history?*

Yes - Please Provide Details BelowNo
Previous Employment *
Do you have additional employment history?*

Yes - Please Provide Details BelowNo
Previous Employment *
Do you have additional employment history?*

Yes - Please Provide Details BelowNo
Previous Employment *
Do you have additional employment history?*

Yes - Please Provide Details BelowNo
Previous Employment *
Do you have additional employment history?*

Yes - Please Provide Details BelowNo
Previous Employment *
Do you have additional employment history?*

Yes - Please Provide Details BelowNo
Previous Employment *
Do you have additional employment history?*

Yes - Please Provide Details BelowNo
Previous Employment *
Do you have additional employment history?*

Yes - Please Provide Details BelowNo
Previous Employment *
Employment Gaps

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

YesNo
Employment Gap 1*
Do you have any further Employment Gaps?*

YesNo
Employment Gap 2*
Do you have any further Employment Gaps?*

YesNo
Employment Gap 3*
Do you have any further Employment Gaps?*

YesNo
Employment Gap 4*
Do you have any further Employment Gaps?*

YesNo
Employment Gap 5*
Education Attainments

Please include all education attainment since school age
Do you have any Education Attainments?

YesNo
Full Details of School / College/ University / Institution
Details of Qualification gained
Date From

DayMonthYear
Date
Date To

DayMonthYear
Date
Do you have any other Education Attainments?

YesNo
Full Details of School / College/ University / Institution
Details of Qualification gained
Date From

DayMonthYear
Date
Date To

DayMonthYear
Date
Do you have any other Education Attainments?

YesNo
Full Details of School / College/ University / Institution
Details of Qualification gained
Date From

DayMonthYear
Date
Date To

DayMonthYear
Date
Do you have any other Education Attainments?

YesNo
Full Details of School / College/ University / Institution
Details of Qualification gained
Date From

DayMonthYear
Date
Date To

DayMonthYear
Date
Driving Status
Do you hold a valid UK driving licence?*

ManualAutomaticInternational LicenceProvisionalNo Licence
Do you have any current endorsements??*

YesNo
Endorsement Details *
Have you ever been disqualified from driving?*

YesNo
Disqualification Details *
Please provide your driving licence number*
Driving licence issue date*

DayMonthYear
Date
Driving licence expiry date*

DayMonthYear
Date
Do you hold Business Insurance?*

YesNo
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.
Please provide your supporting statement for your application.*

0/2000
Employee Declaration

Declaration for all applicants applying for employment
I declare that the details on this application form are true as far as I know*

Yes
I agree to you approaching any of my previous employers to verify my employment history and I understand that all conditional offers of employment are subject to satisfactory recruitment checks. If we are not satisfied, or unable to verify safer recruitment checks we reserve the right to withdraw any conditional offer of employment.*

Yes
I consent for the use of my personal information and data for safer recruitment purposes.*

Yes
I agree that, if I am appointed, the information may be used as part of the personnel record of my engagement under GDPR regulations.*

Yes
I agree to for the company to access relevant details as part of safer recruitment regarding any points, convictions or cautions from the DVLA*

Yes
I understand that if I give false information or withhold relevant information it could result, in termination of employment.*

Yes
Current Notice Period*
Full Name*
Please include Middle Name(s)
Signature*

Powered by Jotform SignClear
Date of Signature*

DayMonthYear
Date
Click Here*
Should be Empty:

Employment Application Form

Safer Recruitment Questions

DBS & Criminal Information

Employment & Reference Information

Employment Gaps

Education Attainments

Driving Status

Supporting Statement

Employee Declaration