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 q

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 Failure to disclose information may result in offer of employment being withdrawn.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, Others, Don't wish to state
Full name *

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

YesNo
Current Address (We must have five years history)*

Street Address

Street Address Line 2

Town/City State

Post CodeCountry
Home Number
Please enter a valid phone number.Format: (000) 000-0000.
Mobile Number *
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
National Insurance Number*
AB123456C
Birth Date *

MonthDayYear
Date
Have you lived at the same address for the last 5 years?*
Move in Date*

MonthDayYear
Date
How were you referred to us?*

IndeedReferralNewspaper AdFacebookTwitterLinkedInN/AOther
CV - Upload your CV here if applicable

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Upload your BRP here

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Upload your Passport here

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Do you have any relationships with employees?*

YesNo
Will this be your only job role if successful?*

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

Yes, PermanentYes, TemporaryNo
Enter your Share code
(e.g SH1 PPP GH2)
Have you spent more than a 3 month period overseas in the past 10 years? (aged 18+)*

YesNo
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 - {if yes please provide details below}No
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 - {if yes please provide details below}No
Details *
Have you ever been dismissed or resigned after disciplinary procedures have been instigated?*

Yes - {if yes please provide details below}No
Details *
Have you ever had any safeguarding concerns raised against your name include anything that resulted in no further action made?*

Yes - {if yes please provide details below}No
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 needed to protect a child or young person from harm.*

Yes - {if yes please provide details below}No
Details *
Any other information that you want to disclose or discuss?*

Yes - {if yes please provide details below}No
Details *
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 Information }No
Disclosure Information *
Have you ever received a Caution, Reprimand or Warning?*

Yes - {Please provide details in Disclosure Information }No
Disclosure Information *
Are there any alleged offences outstanding against you?*

Yes - {Please provide details in Disclosure Information }No
Disclosure Information *
Do you currently have a Valid DBS on the update service?*

YesNo
Upload your DBS *

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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*
Employment Gaps

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

Yes - Please provide details belowNo
Employment Gap 1*
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

MonthDayYear
Date
Date To

MonthDayYear
Date
Do you have any other Education Attainments?

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

MonthDayYear
Date
Date To

MonthDayYear
Date
Do you have any other Education Attainments?

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

MonthDayYear
Date
Date To

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

ManualAutomaticInternational LicenceProvisionalNo Licence
Do you have any current endorsements?

YesNo
Have you ever been disqualified from driving?

YesNo
Please provide your driving licence number
Driving licence issue date

MonthDayYear
Date
Driving licence expiry date

MonthDayYear
Date
Do you hold Business Insurance?

YesNo
Upload Driver's licence

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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.*
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*
Date of Signature*

MonthDayYear
Date
Click Here*

I agree to my application being submitted
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