Application

Section one - Personal Details

Application for appointment as: *

Name: *

Address line one: *

Address line two:

Town:

City:

Postcode: *

Home telephone number: *

Contact number:

Email address: *

Would you require a work permit or any other endorsements to work in the United Kingdom? * Yes No

Do you have a current, full driving licence? * Yes No

If Yes, do you have any penalty points? Yes No

Do you have access to a car for business use? * Yes No

Have you applied for a position within St Cuthberts Care before? * Yes No

References

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.

Section Two - Career History

Current / most recent employment

Current employer's name: *

Current employer's address: *

Employed from (month / year): * /

Job title and main details: *

Salary: *

Why you wish to leave this post: *

Length of notice required:

Do you have any additional employment which you would like to continue if appointed to this post? * Yes No

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.

Number of previous employers 1 2 3 4 5 6 7 8 9 10

Previous employer one

Name:

Employed from (month / year): /

Employed to (month / year): /

Job title and main details:

Reasons for leaving:

Section Three - Education and Qualifications

Education history and qualifications obtained: *

Professional qualifications (including membership of professional bodies)
Please give details of the organisation and level of membership

Other courses attended (including short training courses and seminars)
Please give details and dates

Section Four - Health and other relevant information

Do you smoke? * Yes No

Most jobs will involve some degree of physical and mental activity that can affect certain health conditions.
Is there anything concerning your medical history or state of health that is relevant to your application, or do you require any reasonable adjustments for the job for which you are applying?

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? * Yes No

Please declare any other issues that have been raised in respect of your working practice.

Section Five - Supporting Statement

This section must be completed.
Please use this space to comment on your experience and on the qualities you feel would make you suited to this post. Please refer to the guidance notes. *

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

 

If you have answered 'yes' to the above questions, please give full details and dates below.