Woodberry Care Application Form

Please provide information on any gaps in Employment History*

Please provide information on Trainings Achieved (If None, Type "N/A")*

PENSION
Do you currently contribute to a Pension policy?*

YesNo
I would like to join the Company Pension Scheme and Contribute 3% of my salary.*

YesNo
Do you wish to contribute more than 3% of your salary?*

YesNo

REFERENCES
Please provide the names of at least two people, one of whom MUST be your present or last employer, who may be asked for a reference. All applications for references will be made in the strictest confidence after first having obtained your permission.
Reference 1:
Select Reference Type:

Employment (Professional)AcademicCharacter
Current employer (Enter Organisation Name)*
Employer First Name*
Employer Surname Name*
Job title of Employer:*
Organisation Address (in full):*

Street Address Line 2

CityState / Province

Postal / Zip Code
Postcode:*
Telephone:*
Please enter a valid phone number.
Email:*
example@example.com
Reference 2:
Select Reference Type:*

Employment (Professional)AcademicCharacter
First Name:*
Surname:*
Job title: (if Applicable)*
Organisation address (in full):*

Street Address Line 2

CityState / Province

Postal / Zip Code
Postcode:*
Telephone:*
Please enter a valid phone number.
Email:*
example@gmail.com

DISABILITY has a policy of interviewing applicants who have a disability and who meet the essential short-listing criteria. To ensure that this happens, please complete the following:

a) The Equality Act 2010 defines disability as' a physical or mental impairment which has a substantial and long-term adverse effect on the ability to carry out normal day-to-day activities.

Do you consider yourself to have or have had a disability?
Please click on the box that applies to you.*

YesNo
If yes please give details*
b) If the answer to the above is yes, are there any reasonable adjustments that need to be made, should you progressbeyond this stage?
Please click on the box that applies to you.*

YesNo
If yes please give details*
REHABILITATION OF OFFENDERS ACT (1974) DECLARATION

Because of the nature of the work for which you are applying, the provisions of Section 4(2) of the Rehabilitation of Offenders Act (1974) do not apply by virtue of the Rehabilitation of Offenders Act(1974) (exceptions) Order 1975. Applicants are therefore required to give information about convictions, which for other purposes are ‘spent’ under the provisions of the Act. Any information given will be completely confidential and will be considered only in relation for positions to which the Order applies.
Have you at any time been convicted of an offence?*

YesNo
Signature*

Clear

APPLICATION FORM