Application for Employment

Return this form to:

Teresa Lock - Office Administrator

Position applied for:

Name

Title:

Forename(s):

Surname:

Address

Address line 1:

Address line 2:

City:

County:

Postcode:

N.I. number:

Telephone

Landline:

Work:

Mobile number:

Email address


Current driving license?

It is essential that you hold a valid driving license and own transport for this position

Groups:

Expiry Date:

Details of Endorsements:


Are there any restrictions on you taking up employment in the UK?

If yes, please provide details:


Education

Schools/Colleges/University:

Qualifications Gained:

Other training:


Employment history

Please complete in full. If necessary, please complete this in a Word document and upload it below

From:

To:

Name and address:

Job title:

Rate of pay:

Duties:

Reason for leaving:

 

From:

To:

Name and address:

Job title:

Rate of pay:

Duties:

Reason for leaving:

 

From:

To:

Name and address:

Job title:

Rate of pay:

Duties:

Reason for leaving:

 

From:

To:

Name and address:

Job title:

Rate of pay:

Duties:

Reason for leaving:

 

From:

To:

Name and address:

Job title:

Rate of pay:

Duties:

Reason for leaving:

 

If you have run out of space above, please upload a Word document containing any further employment history here:

Notice required in current post:


Current membership of professional bodies

Please note any professional bodies you are a member of or are registered with:


Professional Registration Number (where applicable)

Registration/PIN Number (Nursing):

GMC Certificate Number (Doctors):


Other employment

Please note here any other employment you would continue with if you were to be successful in obtaining this position:


Leisure

Please note here your leisure interests, sports and hobbies, other pastimes etc.:


References

Please note here the names and addresses of two persons from whom we may obtain both character and work experience references:

Name 1:
Name 2:
Position:
Position:
Address:
Address:
Postcode:
Postcode:
Telephone:
Telephone:
May we approach the above prior to the interview?
May we approach the above prior to the interview?

General comments

Please detail here your reasons for this application, your main achievements to date and the strengths you would bring to this post. Specifically, please detail how your knowledge, skills and experiences meet the requirements of this role (as summarised in the person specification):


Cautions, rehabilitation and criminal records

Because of the nature of the work for which you are applying, this post is exempt from the provisions of Section 4(2) of the Rehabilitation of Offenders Act 1974, by virtue of the Exceptions Order 1975 as amended by the Exceptions (Amendment) Order 1986, which means that convictions that are spent under the terms of the Rehabilitation of Offenders Act 1974 must be disclosed, and will be taken into account in deciding whether to make an appointment. Any information will be completely confidential and will be considered only in relation to this application.

In addition you are required to submit to a Disclosure and Barring check/provide a PVG Scheme Record or Scheme Record Update. Any disclosure made by the Disclosure and Barring Service/Disclosure Scotland will remain strictly confidential.

Have you ever been convicted in a Court of Law and/or cautioned in respect of any offence?

If YES, please give details:

Special requirements (care sector)

Because this position involves the care of children and/or vulnerable adults employment is dependent on the following:

1) Your written consent to obtaining a Disclosure and Barring certificate from the Disclosure and Barring Service/Disclosure Scotland or an approved umbrella body or provision of a PVG Scheme Record/Scheme Record Update.

2) Such disclosure being acceptable to us.

3) Proof of identity – birth or marriage certificate (where appropriate) and passport (if available).

4) Two satisfactory written references.

5) That you will supply a photograph of yourself for retention in your records.

6) Evidence of physical or mental suitability for your work.


Declaration (please read this carefully before submitting this application)

1. I confirm that the above information is complete and correct and that any untrue or misleading information will give my employer the right to terminate any employment contract offered.

2. Should we require further information and wish to contact your doctor with a view to obtaining a medical report, the law requires us to inform you of our intention and obtain your permission prior to contacting your doctor. I agree that the organisation reserves the right to require me to undergo a medical examination. In addition, I agree that this information will be retained in my personnel file during employment and for up to six years thereafter and understand that information will be processed in accordance with the Data Protection Act.

3. I agree that my previous employers may be approached for references. I also agree that should I be successful in this application, I will apply to the Disclosure and Barring Service/Disclosure Scotland for a Disclosure and Barring certificate/PVG Scheme Record or Scheme Record Update. I understand that should I fail to do so, or should the disclosure or reference not be satisfactory, any offer of employment may be withdrawn or my employment terminated.


All organisations using the Disclosure and Barring Service and/or Disclosure Scotland to help assess the suitability of applicants for positions of trust and who are recipients of disclosure information must comply fully with the relevant Code of Practice. Amongst other things this obliges them to have a written policy on the recruitment of exoffenders. This must be given to all applicants for posts where a disclosure will be requested. The Code also requires such organisations to have a written policy on the correct handling and safekeeping of Disclosure information. To assist organisations in meeting this requirement a sample policy statement on the recruitment of ex-offenders will be included with any stationery requests for Form AP2(H).


Policy statement on the recruitment of ex-offenders

1. As an organisation using the Disclosure and Barring Service/Disclosure Scotland to assist in assessing applicants suitability for positions of trust, the company complies fully with the relevant Code of Practice (a copy of which is available on request) and undertakes to treat all applicants for all posts fairly. The company will not discriminate unfairly against any subject of a disclosure on the basis of a conviction or other information revealed.

2. We actively promote equality of opportunity for all and we select all candidates for interview on the basis of their talent, skills, qualifications and experience. We welcome applications from a wide range of candidates, including those with criminal records.

3. A disclosure is only requested where it is legally required or after a thorough risk assessment has indicated that one is both proportionate and relevant to the position concerned. Where a disclosure will be required from a successful candidate, all applicants will be made aware of this at all stages of the recruitment process.

4. Where disclosure is to form part of the recruitment process, we encourage all applicants called for interview to provide details of their criminal record at an early stage in the application process.

5. Unless the nature of the position allows the company to ask questions about a candidate’s entire criminal record we only ask about “unspent” convictions as defined in the Rehabilitation of Offenders legislation.

6. We ensure that all those in the company who are involved in the recruitment process have been suitably trained to identify and assess the relevance and circumstances of offences. We also ensure that they have received appropriate guidance and training in the relevant legislation relating to the employment of ex-offenders.

7. At interview, or in a separate discussion, we ensure that an open and measured discussion takes place on the subject of any offences or other matter that may be relevant to the position. Failure to reveal information that is relevant to the position sought could lead to withdrawal of an offer or termination of employment.

8. We undertake to discuss any matter revealed in a disclosure with the person seeking the position before withdrawing a conditional offer or terminating employment.

9. Having a criminal record will not necessarily bar an applicant from working for us. This will depend on the nature of the position and the circumstances and background of the offences.