Online Application

Personal Details

Title (required)

Full Name (required)

Date of Birth

Full Address

Contact Number

Email address

Do you have a current driving licence? (required)

Yes

No

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

Yes*

No

*If yes please provide details

National Insurance Number

Employment History

Employment History 1

Employer Name

From

To

Employer Telephone Number

Employer Address

Job Title

Job Description

Employment History 2

Employer Name

From

To

Employer Telephone Number

Employer Address

Job Title

Job Description

Employment History 3

Employer Name

To

From

Employer Telephone Number

Employer Address

Job Title

Job Description

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 Criminal Records Bureau check. Any standard or enhanced disclosure made by the CRB/SCRO will remain strictly confidential.

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

Yes

No

Please provide details.

Special Requirements (Care Sector)

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

Your written consent to obtaining a standard/enhanced disclosure certificate from the Criminal Records Bureau or an approved umbrella body, you will be responsible for the full cost of this which will be deducted from your pay roll.
Such disclosure being acceptable to us.
Proof of identity – birth or marriage certificate (where appropriate) and passport (if available).
Two satisfactory written references.
That you will supply a photograph of yourself for retention in your records.
Evidence of physical or mental suitability for your work.

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Declaration

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.
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 right 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.
I agree that my previous employers may be approached for references. I also agree that should I be successful in this application, I will, if required, apply to the Criminal Records Bureau/Scottish Criminal Records Office for a standard or enhanced (as appropriate) disclosure. 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.

Please check the box to confirm you agree to the above

I agree

Personal Details

Employment History

Employment History 1

Employment History 2

Employment History 3

Cautions, Rehabilitation and Criminal Records

Special Requirements (Care Sector)

Declaration

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