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Application Form
Position Applied For:
(required)
Full or Part time:
Full time
Part time
Where did you see the vacancy advertised:
Personal Details
Surname:
Title:
Forenames:
Maiden Name:
Nat Ins No:
Address:
Postcode:
Telephone Home:
Telephone Work:
Telephone Mobile:
May we contact you at work:
yes
no
Do you hold a current driving licence:
yes
no
How long have you held a driving licence:
Has your driving licence been endorsed:
yes
no
If yes please give brief details:
Do you hold any other licences:
yes
no
if so which:
Do you need a work permit to work in the UK:
yes
no
Schools Attended from Age 11 years
Name/Address
Dates from - to
Qualification/Grade
Further Education
College/University Name
Dates from - to
Qualification/Grade
Other Qualifications - Training - Achievements
Where Attained
Dates from - to
Qualification/Grade
Membership of Relevant Professional Bodies
Relevant Professional Bodies:
Employment Details - Present-Last
Date started:
Date left if applicable:
Name and address of employer:
Job Postcode:
Job Telephone:
Title of Job:
Salary:
Length of notice required:
Outline of duties:
Reason(s) for leaving post:
Previous Employment
Dates from - to
Name and Address
Position Held
Reason for Leaving
New Field
* Any breaks in continuity must be explained
Other information
Please give reasons why you are applying for this post and evidence of how you meet the requirements of the person specification. Please also give details of community / volunteer experience.
Details:
Difficulties with working shifts?
The company operates various shifts operating over 24 hours and 7 days, 52 weeks per year. Please note: If you are applying for a Residential Educator post you will need to be flexible in the hours you are available to work including unsociable hours, waking night duties, sleeping-in duties and weekend working. Please detail any difficulties that you envisage with working shifts:
Details:
Health
Do you enjoy good health:
yes
no
Are there any disabilities that may affect your application:
If yes, please describe disabilities:
Any reasonable adjustments which you feel should be made to the job itself which would enable you to carry out the job:
How many days absence have you had from work in the past two years:
Number of occasions:
Please specify reasons:
Give details of any operation hospital treatment or serious illness in the last five years:
Have you any present medical condition which may affect your application:
yes
no
If yes please give brief details below:
Do you suffer from any allergies:
yes
no
Are you receiving any medical treatment from your GP or hospital:
yes
no
Do you or have you ever suffered from any back problems:
yes
no
Declaration and consent
Have you ever been convicted. cautioned or reprimanded of any criminal offence?
yes
no
If yes, please give full details:
Because of the nature of the work for which you are applying, this post is exempt from the provisions of the Rehabilitation of Offenders Act 1974 (Exemptions) Order 1975 Applicants are not entitled therefore, to withhold information about convictions which for other purposes are 'spent' under the provisions Of the Act. In the event of employment, any failure to disclose such convictions could result in dismissal or disciplinary action. Any information given will be completely confidential and a past conviction will not necessarily bar you from a post *I understand that any offer of employment with this company is subject to the verification of the details I have supplied, the receipt of satisfactory references and the successful passing of medical screening conducted by the Company Nurse/Company Doctor. *I authorise approaches to be made to former employees, educational establishments. govemment agencies and personal referees for verification of the information. *To this end I hereby declare that the information I have given is accurate and complete to the best of my knowledge and I accept that misrepresentation or omission of any information may be grounds for refusal of employment or disciplinary proceedings (and perhaps criminal charges).
Enter your name to confirm:
Data Protection
The Data Protection Act 1998 ("The Act") sets out certain requirements for the protection of your personal information against unauthorised use or disclosure. The Act also gives you certain rights. Except to the extent we are required or permitted by law, the information whiCh you provide in this application form, and any other information obtained or provided during the course of your application ("the Information") will be used solely for tile purpose of assessing your application. If your application is unsuccessful or you choose not to accept any offer of employment we make. the information will not be held for longer than is necessary, after which time it will be destroyed, although relevant information will be retained in the longer term to facilitate our equal opportunites monitoring. If your application is successful, the information will form part of your employment file and we will be entitled to process it for all purposes in connection with your employment. So that we may use the information for the above purposes and on the above terms, we are required under the Act to obtain your explicit consent Accordingly we would be grateful if you would sign your consent below:
Enter your name to confirm:
CVs will not be accepted.
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