APPLICATION FOR EMPLOYMENT
Return this form to:
Email:
Post: NOAH’S ARK CHILDREN’S HOSPICE
3 Beauchamp Court
10 Victors Way
Barnet
EN5 5TZ
POSITION APPLIED FOR: Ref:
Title: / Address:
Forename(s):
Surname:
Tel. Nos (please include code):
(Home)
(Work)
(Mobile) / Email Address:
Are there any restrictions on you taking up work in the UK?
Yes No
(If yes please provide details)
Are you part of a family (or do you know a family) who either currently receive or have in the past received support from Noah’s Ark Children’s Hospice?
Yes No
If yes, please give details:
NI No: / NMC PIN (if applicable)
Current driving licence?
Yes No
Groups:
Expiry Date: / Details of any endorsements:

EDUCATION

Schools - Qualifications gained and dates
College/University - Qualifications gained and dates
Other training - please include details & dates

ADDITIONAL EMPLOYMENT

Please note any other employment you would continue with if you were to be successful in obtaining this position.

LEISURE

Please note here your leisure interests, sports and hobbies, or other pastimes, etc.

EMPLOYMENT HISTORY

Please complete in full using a separate sheet if necessary, starting with your most recent employment and give reasons for any gaps in employment

Name & Address of employer / Job Title & Duties / Dates of employment & Salary on leaving / Reason for leaving / explanation of any gaps
GENERAL COMMENTS
Please detail here your reasons for this application, your main achievements to date and the strengths you would bring to this post. Specifically, please detail how your knowledge, skills and experiences meet the requirements of this role (as summarised in the person specification).Continue on a separate sheet if necessary.

REFERENCES

Please provide details of 2 references who can provide information relating to your competency in a caring role.
  • One should be your present or most recent employer (referees for qualified Nurses must be professionals).
  • Students should provide an academic reference.
  • References should have known you for over 12 months and should not be a family member.
If you are applying for a post which requires unsupervised access to children/vulnerable adults, Noah’s Ark reserve the right to approach any past employer for a reference.
Referee 1 / Referee 2
Name: / Name:
Position: / Position:
Organisation: / Organisation:
Address: / Address:
Tel No: / Tel No:
Email: / Email:
May we approach the above prior to interview?
Yes No / May we approach the above prior to interview?
Yes No
Please indicate where you saw the post advertised

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 your role may require you to submit to a DBS check. Any standard or enhanced disclosure made by the DBS will remain strictly confidential.
Have you ever been convicted in a Court of Law and/or cautioned in respect of any offence?
Yes No
If YES, please give details

DECLARATION (Please read carefully before signing this application)

  1. I confirm that the information provided is, to the best of my knowledge, true and complete, and understand that providing false or misleading information, or canvassing the charity employees, will disqualify me from appointment or, if appointed, could lead to dismissal without notice.
In accordance with the Data Protection Act 1998 the information provided on this form and in the accompanying papers will be used to assess my suitability for the post and, if employed, this information will form the basis of my employee personnel file. I understand that the information provided on this form may be entered onto a computerised database.
  1. 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 Disclosure and Barring Service /Scottish Disclosure and Barring 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.
  1. Additionally I understand that it may be necessary for the information I have supplied to be shared with a third party organisation where required (e.g. security request, pre-employment checks etc). Under the terms of the Data Protection Act 1998 I give my consent , by signing below that the information I have supplied be shared with Noah’s Ark Children’s Hospice as necessary as part of the selection process.
Signed:
Date:
(type name if submitting electronically)
If you are submitting this form electronically then you should note that in the absence of this signature the emailing of this application constitutes your personal certification that the details are correct.
Additional Information Form
Surname: / First Names(s)
1. Do you have any criminal convictions?Yes No
If YES please give details
PLEASE NOTE: Depending on the role, continued employment may be dependent on a satisfactory DBS check – this will be initiated once the candidate has been appointed)
2. Asylum and Immigration Act 1996
In order to comply with all the legislation including the Asylum and Immigration Act 1996. If you are offered employment with Community Aid UK you will need to show evidence of proper immigration status in the UK.
Do you require a work permit?Yes No
If YES please give details
3. Is there any other information, which may impact on your functioning within the above post, which, as your prospective employer, you feel we should be aware of?
(Please continue on a separate sheet, if necessary, in responding to any of the above questions.)

DECLARATION

I certify that the information given on this form is correct to the best of my knowledge.
I understand that, if appointed, this application form will become part of my personal file.
I understand that should any false statements or omissions be made, this may lead to dismissal.
Signed:
Date:
(type name if submitting electronically)
If you are submitting this form electronically then you should note that in the absence of this signature the emailing of this application constitutes your personal certification that the details are correct.
Returning your application
Completed application and personal information forms must be returned by the closing date shown on the job advertisement to the relevant email address shown on the job vacancies website: by post or fax to:
Human Resources Division
Noah’s Ark Children’s Hospice
We will only acknowledge receipt of completed applications where a stamped addressed envelope is sent to us for this purpose.
If you have not been contacted within 3 weeks of the closing date, please assume that your application has been unsuccessful.
If you are a disabled person and require adjustments to be made to the selection process please contact us on 020 8449 8877 to discuss your requirements. Please let us know if you require the documentation in an alternative format or by email.