Application for Employment

Please use BLACK ink when completing this form. If you have any difficulty in completing this form please call the HR Department on 020 8768 4566

Completed application forms should be returned to: Human Resources, St Christopher’s, 51-59 Lawrie Park Road, Sydenham, SE26 6DZ.

Personal Details
Surname: / Forename(s):
Title: (optional) / Home Telephone No:
Address:
Postcode: / Work Telephone No:
Mobile Telephone No:
Email:
Post Details

Position applied for: ______

Where did you see this vacancy? (please tick all the boxes that apply)

1. I went directly to St Christopher’s Hospice Website 2. Google search and clicked advert
3. Saw advert on back of a bus 4. Indeed.co.uk job search 5. Banner advert on other website
6. Facebook Advert 7. Other: Please state: ………………………………………………………………..

Are you looking for Full-time / Part-time / Temporary / Bank work? Please specify ______

Education & Training
Secondary Education:
Name of School/College / Dates
From / To / Exams Taken / Grade / Date obtained
Further / Higher Education:
College/University / Dates
From / To / Exams Taken / Grade / Date obtained

Please continue on a separate sheet if necessary

Professional Memberships & Registration
Name of Professional Body / PIN Number/Membership Number / Expiry date (if applicable)
Most Recent Employer
Name & address of Employer:
Job Title: / Dates Employed:
From: To:
Current or final salary: / Period of notice required:
Reason for leaving (or seeking other employment):
Please give a brief outline of your main responsibilities:
Previous Employers
Name & address of Employer / From / To / Post Held, Grade & Main Duties / Reason For Leaving
Supporting Statement
Please outline below:
·  Why you are applying for this job
·  How you satisfy the requirements of the job
You may find it helpful to look again at the job description and person specification and review the experience, skills and knowledge we require. If you believe you have the necessary skills and experience please tell us about them.

Please continue on a separate sheet if necessary, writing your name and job applied for at the top.

Rehabilitation of Offenders Act 1974

Posts at St Christopher’s are exempt from the provisions of Section 4(2) of the Rehabilitation of Offenders Act by virtue of the Rehabilitation of Offenders Act (Exceptions) Order 1975. Applicants are therefore not entitled to withhold information about convictions which for other purposes are ‘spent’ under the provisions of the Act. Any such information given will be completely confidential and will only be considered in relation to your application for the post. Having a conviction will not necessarily disqualify your application for the post.

Have you had any convictions Yes No

Please provide details of any convictions on a separate sheet.

Additional Personal Details

Are you legally eligible to work in the UK? Yes No

Do you require a work permit? Yes No

If yes please give details

Have you ever been dismissed from previous employment? Yes No

If yes please give details

Do you hold a valid British Driving Licence? Yes No

References

We require references from your two most recent employers, please provide contact details of the individuals we may write to. Please note that if you have applied for a clinical position and are selected for an interview we will contact your referees prior to the interview unless you notify us otherwise.

Name / Name
Job Title / Job Title
Name of organisation / Name of organisation
Address / Address
Contact tel
Contact fax
Contact email / Contact tel
Contact fax
Contact email
How long have you known this person and in what capacity? / How long have you known this person and in what capacity?
Declaration

I declare that the information contained in this application is complete and correct. I understand that if I have knowingly provided false information, given misleading statements or withheld relevant details this could lead to the withdrawal of an offer or subsequent disciplinary action, which could lead to dismissal.

Data Protection Act, 1998 - I understand that information contained on this form will be used for recruitment processing purposes. Should my application be successful the details will also form the basis of my personnel record.

Signed Date

Thank you for taking the time to give us the information requested.