Application Form

Application Form

Please ensure you complete the application form in full.
Position
Position applied for: *
Location applied for:*
Contracted Hours (per week):*
The people we support require their teams to work flexibly, are you able to work:*

MorningsEveningsWeekendsBank Holidays
Personal Details
Name*

First Name(s)Surname
Preferred name *
Preferred pronoun's *
Address*

Address Line 1

Address Line 2

TownCountry

Post Code
Phone Number*
Please enter a valid phone number.
Email Address*
example@example.com
National Insurance Number*
Are you are related to a member of staff or service user at the organisation?*
Please insert their name here:*
Additional Information
Are you on the DBS update service?*
The Update Service is an yearly online subscription that lets employers carry out an instant online check to view the status of an existing enhanced DBS certificate.
Please enter your DBS certificate number:*
Do you have a valid UK Driving Licence?*
Driving is not essential but is preferred for some services that have a Motability vehicle.
Please upload your CV *

Cancelof
Supporting Statement
Why are you interested in working with us?*
What is your experience in working with vulnerable people?*
Tell us about your strengths! What are your aspirations and qualities that make you different?*
Equality Act
Under the Equality Act 2010 the definition of disability is if you have a physical or mental impairment that has a “substantial” and “long term adverse effect” on your ability to carry out normal day-to-day activities.

Further information regarding the definition of disability can be found at: www.gov.uk/definition-of-disability-under-equality-act-2010.
For the purposes of this application and the interview stage only, is there anything you would like us to be aware of so that we can make reasonable adjustments during the process?*
Please provide additional information below:*
Education
Secondary School*

Name of School

Address

TownCountry

Post Code
Start Date *

DayMonthYear
End Date *

DayMonthYear
Grades Achieved*
Employment History
Under the Health and Social Care Act (Regulated Activities) Regulations 2014, individuals involved in regulated activity must provide a full employment history from the time they left school.

Please ensure you provide a complete historic timeline from the date you left school up until the present day. If you was not in further education or employed, please enter 'gap of employment' and the reason for the gap.

Please ensure dates run consecutively and there are NO Gaps between dates, this may cause a delay in your application being processed.

1. Employment History*
Start Date *

DayMonthYear
End Date *

DayMonthYear

DO NOT DELETE

Additional Information
Employment History*

Additional Information
Reason for gap of employment*

Additional Information
Further Education*

DO NOT DELETE
2. Employment History
Start Date

DayMonthYear
End Date

DayMonthYear

DO NOT DELETE

Additional Information
Employment History*

Additional Information
Reason for gap of employment*

Additional Information
Further Education*

DO NOT DELETE
3. Employment History
Start Date

DayMonthYear
End Date

DayMonthYear

DO NOT DELETE

Additional Information
Employment History*

Additional Information
Reason for gap of employment*

Additional Information
Further Education*

DO NOT DELETE
4 Employment History
Start Date

DayMonthYear
End Date

DayMonthYear

DO NOT DELETE

Additional Information
Employment History*

Additional Information
Reason for gap of employment*

Additional Information
Further Education*

DO NOT DELETE
5 Employment History
Start Date

DayMonthYear
End Date

DayMonthYear

DO NOT DELETE

Additional Information
Employment History*

Additional Information
Reason for gap of employment*

Additional Information
Further Education*

DO NOT DELETE
6 Employment History
Start Date

DayMonthYear
End Date

DayMonthYear

DO NOT DELETE

Additional Information
Employment History*

Additional Information
Reason for gap of employment*

Additional Information
Further Education*

DO NOT DELETE
7 Employment History
Start Date

DayMonthYear
End Date

DayMonthYear

DO NOT DELETE

Additional Information
Employed History*

Additional Information
Reason for gap of employment*

Additional Information
Further Education*

DO NOT DELETE
8 Employment History
Start Date

DayMonthYear
End Date

DayMonthYear

DO NOT DELETE

Additional Information
Employment History*

Additional Information
Reason for gap of employment*

Additional Information
Further Education*

DO NOT DELETE
9 Employment History
Start Date

DayMonthYear
End Date

DayMonthYear

DO NOT DELETE

Additional Information
Employment History*

Additional Information
Reason for gap of employment*

Additional Information
Further Education*

DO NOT DELETE
10 Employment History
Start Date

DayMonthYear
End Date

DayMonthYear

DO NOT DELETE

Additional Information
Employment History*

Additional Information
Reason for gap of employment*

Additional Information
Further Education*

References
Character Reference*

First NameLast Name
Relationship*
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.
Safeguarding
Ex-Offenders Declaration

Please note this section will only be seen by those involved in the recruitment process and will be treated with the strictest of confidence.

We undertake not to discriminate unfairly against applicants on the basis of a criminal conviction or other information declared.

Answering 'yes' to the questions below will not necessarily prevent your employment. This will depend on the relevance of the information you provide in respect of the nature of the position and the particular circumstances.

The amendments to the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (2013 and 2020) provides that when applying for certain jobs and activities, certain convictions and cautions are considered ‘protected’. This means that they do not need to be disclosed to employers, and if they are disclosed, employers cannot take them into account.
Do you have any unspent conditional cautions or convictions under the Rehabilitation of Offenders Act 1974??*

YesNo
Do you have any adult cautions (simple or conditional) or spent convictions that are not protected as defined by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (Amendment) (England and Wales) Order 2020??*

YesNo
Privacy
We will only collect data for specified, explicit and legitimate use in relation to the recruitment process. By signing this application form, you consent to us holding the information contained within this application form. If successfully shortlisted, data will also include shortlisting scoring and interview records. We would like to keep this data until the vacancy is filled. (We cannot estimate the exact time period, but we will consider this period over when a candidate accepts our job offer for the position for which we are considering you). When that period is over, we will either delete your data or inform you that we would like to keep it in our database for future roles. We have privacy policies that you can request for further information. Please be assured that your data will be securely stored by the Recruiting Manager. You have a right for your data to be forgotten, to rectify or access data, to restrict processing, to withdraw consent and to be kept informed about the processing of your data. If you would like to discuss this further or withdraw your consent at any time, please contact the Recruitment Manager.
Declaration
I agree that any deliberate omission, falsification or misrepresentation in the application form will be grounds for rejecting this application or subsequent dismissal if employed by Rosebuds Supported Living. Where applicable, I consent that the organisation can seek clarification regarding professional registration details.
Name*

First NameLast Name
Signature*

Clear
Date*

DayMonthYear
Date
Should be Empty:

Application Form

Position

Personal Details

Additional Information

Supporting Statement

Equality Act

Education

Employment History

References

Safeguarding

Privacy

Declaration