Employment Application Form

Position Applied For*
Ref No:
Employment Application Form

Please complete the application in full.
Full Name*

PrefixFirst NameLast Name
Address*

Street Address

Street Address 2

CityCounty

Post CodeCountry
Phone Number

Area CodePhone Number
Mobile Number*
Please enter a valid phone number.
E-mail*
example@example.com
UK National Insurance Number
Right to work - Do you have the right to take up employment in the UK, without the need for visa sponsorship? *
Right to work - If no, please provide further details.
How did you hear about us?*
Disability - If you have a disability, please give details of any special arrangements or adjustments you would require to attend interview (this enables us to comply with our obligations under the Equality Act 2010).
Do you know, or are you related to, any other employees or Trustees of the Hospice? If your answer is “yes”, please provide the name or names of the employee(s) and either the capacity in which you know them or your relationship to them.

Education/Professional Qualifications

	Subject/Qual	Place of Study	Grade	Year
1.
2.
3.
4.

Training Courses

	Training Course Name	Duration	Year
1.
2.
3.
4.
5.

Professional Memberships

	Professional Body	Registration number	Renewal date
1.
2.

Employment History
Current/Most recent employer*
Summary of duties
Previous employer
Summary of duties
Previous employer
Summary of duties
Supporting Information*
Please provide reasons for applying for this post and additional information which shows how you match the person specification for the job. This can include relevant skills, knowledge, experience, voluntary activities, training etc.
Referees

Please give the names and addresses of two work related referees who are not related to you, who we can approach for a confidential assessment of your suitability for this job. One of these must normally be your present or most recent employer. We will only contact your referees with your prior consent.
Referee 1*
Referee 2
CV upload: If you would like to add a CV to your application, please upload here.

Cancelof

Application Form
Name

First NameLast Name
Declaration

In order to protect the public, the post you have applied for is exempt from certain provisions of the Rehabilitation of Offenders Act 1974. So that we can perform or exercise our obligations or rights under employment law, you are therefore required to disclose all and any past or pending cautions or convictions, whether spent or otherwise, unless it is either a “protected caution” or a “protected conviction” under the terms of the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975. All information provided about criminal cautions, convictions and offences will be kept in the strictest confidence and only used for the purpose of assessing your suitability for the post you have applied for.
Have you ever been convicted of any criminal offence (other than driving offences not resulting in disqualification)?
If you have selected Yes, you will be asked to supply further information should you be offered a role
DATA PROTECTION

The Hospice will process the personal data that you have supplied on this application form in accordance with the terms of the privacy notice for job applicants which can be found on the Hospice website. The Hospice will only process your personal data where it has a lawful basis for such processing.

DECLARATION

I declare that the information I have given on this application form is, to the best of my knowledge, true and complete. I understand that if it is subsequently discovered any statement is false or misleading, or that I have withheld relevant information, my application may be disqualified or, if I have already been appointed, I may be dismissed.
Signature

Clear

EQUAL OPPORTUNITIES MONITORING
St Joseph’s Hospice will provide equal opportunities to all employees and job applicants and will not discriminate either directly or indirectly because of age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race (including colour, nationality and ethnic or national origins), religion or belief, sex or sexual orientation.

In order to enable the Hospice to ensure compliance with its policy statement, a system of monitoring has been set up. We have only asked for your name so that monitoring can take place both at the shortlisting for interview stage and at the appointment stage. Once an appointment has been made, the data given on this form will be stored on computer in an entirely anonymised format and the form will then be securely and effectively destroyed.

This form does not comprise part of your job application and it will therefore be detached from it on receipt and stored separately. It will not be seen by the people shortlisting, interviewing or making the recruitment decision.

You are under no obligation whatsoever to complete this form if you do not wish to do so. If you do complete it, thank you for your assistance in doing so.
Gender Identity - What best describes your gender identity?
Gender Identity - Is your gender identity the same as the sex you were assigned at birth?
Age?
What is your Nationality?
Martial Status?
Marital Status - other
Sexual orientation?
How would you describe your sexual orientation?
Sexual orientation - prefer to self describe
Do you consider yourself to have a disability?
Disability - please specify
Religion and belief
Ethnic origin: Please indicate how you would describe your cultural background
Relates to a sense of identity/belonging to a race/culture, not a place of birth or citizenship.
Asian, British - Please specify
White- Please specify
Black- Please specify
Mixed/Multiple Ethnic Group- Please specify
Other Ethnic group- Please specify
Should be Empty:

Employment Application Form

Employment History

Referees

Application Form

Declaration

EQUAL OPPORTUNITIES MONITORING