Application Form


Thank you for your interest in applying for a job with us.

Please complete all of the fields listed below, fields marked with an * are required fields so you must fill these in before submitting the application.

You may find it useful to read our guidance notes before starting the application; they will open in a separate window and you can refer to them without closing your application.

The personal data you provide will be used, stored and deleted in accordance with our privacy notice.

Application Form
Section One - Personal Details
Would you require a work permit or any other endorsements to work in the United Kingdom? *
Do you have a current, full driving licence? *
If Yes, do you have any penalty points?
Do you have access to a car for business use? *
Have you applied for a position within St Cuthbert's Care before? *

Please give names and addresses of two people who can comment on your suitability for this post.
One of these must be your current or most recent employer and the other should be a professional person, at a business address.

Reference One
May we contact this referee prior to an offer of employment? *
Reference Two
May we contact this referee prior to an offer of employment? *
Section Two - Career History
Current / Most recent employment
Do you have any additional employment which you would like to continue if appointed to this post? *
Previous Employment

Please provide details of your previous employment history, starting with the most recent and accounting for any gaps.
It is essential that we are able to account for all periods of applicants history due to safeguarding requirements.
Please include voluntary, home-based, part-time, unemployment, college, university. St Cuthbert's Care reserves the right to contact any or all of your previous employers.

Previous Employer One
Previous Employer Two
Section Three - Education and Qualifications
Section Four - Health and other relevant information
Do you smoke? *
If there are any health concerns in respect of your application or subsequent employment, a medical examination or information may be required.
Successful candidates will be required to complete a pre-employment health questionnaire.
Have you ever been involved in disciplinary action? *
Section Five - Supporting Statement

This section must be completed.

In the event of a successful application a DBS certificate may be requested from the Disclosure and Barring Services. Having a criminal record will not necessarily exclude you from consideration; this will depend on the nature of the position you have applied for and the circumstances and background of your offences.
Section Six - Declaration
have completed this form and that the information I have provided is correct.
I understand that supplying false or misleading information may lead to automatic disqualification from appointment or dismissal.
Rehabilitation of Offenders Act 1974

The nature of this work for which you are applying, is exempt from the provisions of the Rehabilitation of Offenders Act 1974, by virtue of the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975.

Applicants are not entitled to withhold information about criminal records, which for other purposes are 'spent' under the Provisions Act, and in the event of employment any failure to disclose such criminal records could result in dismissal or disciplinary action. All information supplied will be treated in the strictest confidence and will be considered only in relation to the application for the position to which the order applies.

Do you have any convictions, cautions, reprimands or final warnings which would not be filtered in line with current guidance? *
Should you have any queries about how to respond to this question, guidance is available on the website
or telephone NACRO helpline on 0300123 1999
Are you aware of any police enquiries undertaken following allegations made against you which may have a bearing on this post? *
Information for disabled applicants

The Disability Discrimination Act (1995) says that employers, as providers of goods and services, must make 'reasonable adjustments' to work places and services to make sure disabled people are treated fairly. We are committed to equal opportunities and increasing employment opportunities for disabled people.

The Disability Discrimination Act 1995 defines a disabled person as 'a person with a physical or mental impairment which has a substantial and long term adverse effect on his/her ability to carry out normal day to day activities.'

If you require assistance whilst attending an interview or selection test, please provide details and include with your application form. Alternatively contact us by phone on (0191) 228 0111.

Equal Opportunities Monitoring Form

The Charity is committed to a policy of equality of opportunity and aims to provide a working and learning environment which is free from unfair discrimination and will enable staff and volunteers to develop to their personal potential. In order to monitor the effectiveness of our policies and procedures all applicants are requested to complete this form. The information you provide will be treated as confidential and will not be taken into consideration for short listing or interview purposes.

Gender: *
Marital Status: *
Do you have a disability? *
The Disability Discrimination Act defines disability as a "physical or mental impairment which has a substantial and long term adverse effect on ability to carry out normal day to day activities". If yes, please ensure you have given details within the Information for disabled applicants.
Age: *
How would you describe your cultural/ethnic origin? *
Advertising Source: *