Employment Application Form

Employment Application Form

Fill the form below accurately indicating your suitability for the job role you are applying for. You must complete all sections.
Date

MonthDayYear
Date
Position Applied For:*
Personal Details
Title:
Name*

First NameLast Name
Birth Date:*

DayMonthYear
Phone Number:*

Area CodePhone Number
Email:*
example@example.com
National Insurance Number:*
Address*

Street Address

Street Address Line 2

CityState / Province

Post Code
Address History

Please include the last five years - click 'SAVE' to add additional lines if necessary.
Address History:
Right To Work Entitlement (UK)

All applicants will be asked at interview to provide documentary evidence of their right to work in the UK.
Do you have any restrictions that apply to you?*

YesNo
If yes - please give details of any restrictions:
References

Please provide details of two referees who can comment on your suitability for this post. The referee must be a line manager or supervisor. References from relatives or people who only know you as a friend are not acceptable. If you have not worked previously, then please give details of a school/college/university official. As a requirement of this post, we are required to contact your references for verification.
Reference 1 (Current or most recent employer)*
Reference 2*
Current Employment

Please provide details of your most recent employment, if you are currently unemployed then provide the details of your last employment.
Employer Name: *
Employer Address:*

Street Address

Street Address Line 2

CityState / Province

Post Code
Position Held: *
Start Date:*

MonthDayYear
End Date:*

MonthDayYear
(if applicable)
Please give a brief description of current role and responsibilities:
Reason for leaving this role:*
What is your contractual period of notice:*
Current salary:*
Previous Employment

Please list all your employment history. To meet The Children’s Homes (England) Regulations 2015, if you have previously worked in a position involving work with children or vulnerable adults, we may contact these companies to verify the reason why the employment or position ended. Failure to provide a full history may delay the start of your employment or result in an offer of employment being withdrawn.
Click 'SAVE' to add additional lines as required*
Gaps in Employment

Please indicate and explain any gaps in employment since first leaving secondary education. Include specific dates and be sure to account for all gaps, whatever their length.
Click 'SAVE' to add additional lines as required
Education History

If the post requires a particular qualification, you will be asked to produce original evidence at your interview if shortlisted. Please list your education in chronological order starting with your most recent.
Click 'SAVE' to add additional lines as required
Other Training & Development: (include professional, vocational or job related training)
Professional Membership

Include any membership to professional associations or statutory body.
Membership Details
Are you subject to any conditions or prohibitions placed on you by any statutory body in the UK*

YesNo
If yes - please provide details:
Personal Statement

This is your opportunity to tell us of your reasons for applying for this post. Please include what interests you about this role and our organisation, how your skills & experience make you a strong candidate. What you hope to contribute if successful and any relevant career goals or aspirations. Try to keep your statement concise and focused (around 300–500 words). Use specific examples where possible to support your points.
Reason for applying:*
Additional Information
Do you hold a full UK driving licence?*

YesNo
Please confirm whether this will be your only employment?*

YesNo
If 'No' - please provide details (including days and hours worked and if this is full or part-time):
Have you been subject to a formal disciplinary sanction or are you in the process of ongoing disciplinary proceedings in your current employment?*

YesNo
Have you been dismissed from any previous employment?*

YesNo
If 'Yes' - please indicate which employment and specify the reasons for your disciplinary / dismissal:
If shortlisted for interview - the panel will discuss this with your and your current or previous employer.
Enhanced Disclosure & Barring Service (DBS)

All posts defined as “regulated activity” are subject to an Enhanced DBS check so that any criminal background (including “spent” convictions, bind-over orders or cautions) are disclosed to the organisation. We cannot employ someone to this post without this check. If you are successful in applying for this post we will ask the DBS for a Disclosure. The position for which you are applying involves contact with vulnerable groups. It is exempt from the Rehabilitation of Offenders Act 1974 and all subsequent amendments (England and Wales). For this position you are not entitled to withhold information about police cautions, bind-overs, or any criminal convictions that would otherwise have been considered “spent” under the Act.
Have you ever been convicted of any offence, been bound-over, or given a caution? (see notes above)*

YesNo
If 'Yes' - please provide details below.
The information you provided will be treated in confidence.
Are you currently the subject of any police investigations following allegations made against you?*

YesNo
If 'Yes' - please provide details below.
The information you provided will be treated in confidence.
Safeguarding Declaration*

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I declare that the information I have given on this form is complete and accurate. I am not barred or disqualified from working with vulnerable groups, children or young people. I am not subject to any sanctions or conditions on my employment imposed by the Independent Safeguarding Authority, Secretary of State or other regulatory bodies.
General Declaration*

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I understand that to knowingly give false information or to leave out any relevant information could result in - the withdrawal of any offer of employment, or my dismissal at any time in the future, and possible criminal prosecution
Please upload supporting information linked to your application (e.g. previous DBS, training certificates, proof of address).

Cancelof
Data Protection
In line with the General Data Protection Regulations 2018 (GDPR), Future Care Plus Ltd will only use the information given on this application form to determine your suitability for this post. We will keep application forms of unsuccessful candidates for six months before being destroyed.
Should be Empty:

Employment Application Form

Personal Details

Address History

Right To Work Entitlement (UK)

Current Employment

Previous Employment

Gaps in Employment

Education History

Professional Membership

Personal Statement

Additional Information

Enhanced Disclosure & Barring Service (DBS)