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Application Form

Applications received after the closing date will not be considered. The INFORMATION YOU SUPPLY ON THIS FORM WILL BE TREATED IN THE STRICTEST CONFIDENCE. Please give details of any training and development courses which support your application.

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1K views

Application Form

Applications received after the closing date will not be considered. The INFORMATION YOU SUPPLY ON THIS FORM WILL BE TREATED IN THE STRICTEST CONFIDENCE. Please give details of any training and development courses which support your application.

Uploaded by

api-194573443
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as PDF, TXT or read online on Scribd
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Robertson

Sandie Home
[email protected]

Abbeyfield Wirral Extra Care Society Office Use: Post Applied for: Interviewed By:

Post Number: Date Received:

Application Form
Please complete this form fully using black ink or type. C.Vs are not accepted as an application, but feel free to include a CV to support your application. Applications received after the closing date will not be considered. THE INFORMATION YOU SUPPLY ON THIS FORM WILL BE TREATED IN THE STRICTEST CONFIDENCE.
.

Section 1: Personal Details


Title: Address: First Name: Surname: Telephone: (Home) Telephone: (Mob) E-Mail Address:

Postcode:
National Insurance No:

Are you free to remain and take up employment in the UK with no current immigration restrictions? Do you hold a full, clean driving license valid in the UK?
.

YES YES

NO NO

Section 2: Employment Present Employer (If you are currently unemployed give details of your last employer)
Name of Employer: Address: Position: Date From: Date To: Pay Rate:

Postcode: Summary of Duties:

Reason for leaving:


(If no longer employed)

Notice Required:

Last Day of Service:


(If no longer employed)

Employment History (Starting with the most recent)

Name of Employer: Address:

Position: Date From: Date To: Pay Rate:

Postcode: Summary of Duties:

Reason for Leaving:


.

Name of Employer: Address:

Position: Date From: Date To: Pay Rate:

Postcode: Summary of Duties:

Reason for Leaving:


Please continue on a separate sheet is necessary.
.

Section 3: Education & Training


Qualifications obtained from Schools, Colleges and Universities. Please list highest qualification first: Establishment Subject / Course Qualifications / Grade

Please continue on the following sheet

Section 3: Education & Training Continued


Establishment Subject / Course Qualifications / Grade

Continue on a separate sheet if necessary.


Please give details of any training and development courses or non-qualifications courses which support your application. Include any on the job training as well as formal courses. EG. First Aid, Safeguarding Adults Title of Training Programme or Course Duration of Course

Continue on a separate sheet if necessary


.

Section 4: Convictions
Do you have any criminal convictions either spent or unspent?
YES NO This question is raised pursuant to the provisions of the Rehabilitation of Offenders Act 1974 (ROA) (Exceptions) Order 1975 and the ROA (Exceptions) (Amendments) Order 1988. If yes, please give details / dates of offence(s) and sentence:

Section 5: Health
There will be functions within this job description which are intrinsic to the role. Do you have any health issues/conditions that may affect the position you are applying for?
YES NO

Successful applicants will be required to complete a detailed medical questionnaire and may be required to attend a medical examination prior to being appointed.

Number of days absent due to sickness in the last 2 years?


.

Section 6: References
Please give the names and addresses of your two most recent employers (if applicable). If you are unable to do this, please clearly outline who your references are.

Reference 1 Name: Title: Position: Organization: Address: Name: Title: Position: Organization: Address:

Reference 2

Postcode: Telephone: E-Mail: YES

Postcode: Telephone: E-Mail: Do we have permission to contact your referees prior to interview? NO YES NO

Section 7: Declaration
Are you related to or do you have a close personal relationship with staff or committee members at The Robertson Sandie Home? If yes, specify name(s), position(s) and relationship(s) YES NO

B. Statement to be Signed by the Applicant


Please complete the following declaration and sign it in the appropriate place below. If this declaration is not completed and signed, your application will not be considered. All of the information I have provided is correct and all of the questions relating to me are fully answered and I possess all the qualifications I claim to hold.

Signed:

Date:

The Robertson Sandie Home undertakes that it will treat any personal information (that is data from which you can be identified, such as your name, address, e-mail address etc) that you provide to us, or that we obtain from you, in accordance with the requirements of the Data Protection Act 1998.

If you are returning this form by email, you will be asked to sign your application at interview.

RETURNING

THIS FORM
By E-Mail: [email protected] Enquiries: Telephone: (0151) 653 6613

By Hand or Post:
The Manager Robertson Sandie Home 16 Vyner Road South Birkenhead Wirral CH43 7PR

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