Where did you hear of the vacancy?
Position applied for:
PERSONAL DETAILS
Mr/Mrs/Miss/Ms*(Delete as applicable) / Surname / Forenames
Previous Surname(s): *(if applicable)
Present Address:
Post Code At current address since:
Home Contact Tel. No: / Mobile Contact Tel. No.
Current Day Contact Tel. No.
Personal Email Address:
RELEVANT SKILLS AND EXPERIENCES
SKILLS: Our Service Users enjoy a variety of activities and life experiences and would expect you to support them in this. What activities and life experiences can you bring to the role to maintain and enrich their lives?
TEAM WORK: Team Work is really important to us at Creative Care; tell us how you have worked well as part of a team and the role that you played.
CHALLENGING SITUATIONS: This role may bring you into situations that are both verbally and physically challenging and stressful. Please give examples of how you would deal with these situations.
COMMUNICATION: We work with young people who communicate in many different ways. What makes you a good communicator?
CARING: We are looking for caring individuals to join us. Tell us how you are a caring person.
FULL EMPLOYMENT HISTORY: Start with your current or most recent employer, leaving NO gaps and give reasons for any periods of unemployment.
NOTE: We will not contact current employers unless you have been offered and accepted a position with this Company.
Employers Name, Address & Tel. No. / From
month/year / To
month/year / Job Title / Main Duties / Salary on leaving / Reason for Leaving

We are an equal opportunities employer and are committed to employment policies, procedures and practices which do not discriminate on the grounds of age, ethnic or national origin, disability, gender, sexual orientation or marital status.

EDUCATION: Full and part time study to be detailed
Schools/Colleges/University attended / Qualifications obtained & subject taken
GENERAL INFORMATION (*Delete as applicable)
Have you worked for this Company before?
If YES, Dates: From To
Reason for leaving: / YES/NO*
Do any of your friends or relatives work for this Company?
If YES, please provide name(s) and relationship / YES/NO*
Do you require any specific arrangements to attend an interview?
If YES, please specify: / YES/NO*
When would you be available to start?
Are you legally eligible for employment in this country?
(You will be asked to provide proof of this before employment) / YES/NO*
Do you require a work permit for this country? / YES/NO*
Do you hold a current MANUAL driving licence?
(Please give details of any endorsements) / YES/NO*
Do you do any other work paid or unpaid not previously declared?
If yes please give details: / YES/NO*
In the past five years, have you been the subject of any investigations or disciplinary procedures and/or been given any verbal or written warnings?
If yes please give details: / YES/NO*
What is your wage rate/salary expectation?
Do you have any criminal convictions? Please give details:
NB: Jobs working with vulnerable adults are exempt from the Rehabilitation of Offenders Act 1974. “Spent” convictions under the Act must be declared by law (they will show up on your DBS/CRB check). / YES/NO*
ADDITIONAL INFORMATION
(Use the space below to provide any additional information that may strengthen your application)
HEALTH DETAILS
Are you disabled YES/NO* If YES, please give details and specify any special needs in relation to your disability:
Please list any diseases, disorders, allergies, muscular skeletal injuries from which you have suffered or do suffer:
Please detail any form of medicine, drugs or treatment you are currently and/or regularly receiving:
Please list all absences from work in the past 12 months and the reason for such absences:
REFERENCES: Please provide the name of two people that can be contacted on your behalf to gain a work reference; normally your current and most recent employers should be given.
Your referees will not be contacted until a firm offer of employment is made and accepted by you.
Name / Name
Company / Company
Job Title / Job Title
How do you know this person? / How do you know this person?
Company Address
Post code / Company Address
Post code
Company Tel No: / Company Tel No:
E-mail: / E-mail:
IMPORTANT: Please read carefully before signing this form. An offer of employment made by this Company is conditional upon:
1. You producing satisfactory documentary evidence e.g. UK Passport or EU National Identity Card.
2. The facts given by you on this application being accurate and truthful.
3. The Company obtaining satisfactory references (including satisfactory discharge papers if ex-forces).
4. The Company obtaining a satisfactory CRB/DBS Check.
DECLARATION: By signing this form you authorise the Company to disclose to its insurers any of the information you have provided.
I declare that the information given in this application is full and true to the best of my knowledge. I understand that if, at a later date, it is discovered that I have knowingly withheld information, disciplinary action may be taken against me, which may include dismissal. I also consent to the information being held on file under the terms of the Data Protection Act 1998.
Signature ______Date completed ______
Please return this form to: Misty Davis, HR Officer Creative Care East Midlands Ltd., Head Office, i-Centre, Hamilton Way, Mansfield NG18 5BR
FOR OFFICE USE ONLY
APPLICATION FORM EVALUATED BY:
DATE:
COMMENTS:

In accordance with its equal opportunities statement, the Company will provide equal opportunities to all employees and job applicants and will not discriminate either directly or indirectly on the grounds of race, colour, ethnic origin, nationality, national origin, sex, marital status, disability, sexual orientation, religion or age.

In order to enable the Company ensure compliance with its policy statement, a system of monitoring has been set up. We have only asked for your name so that monitoring can take place both at the short listing for interview stage and at the appointment stage.

You may, of course, decide not to answer one or any of these questions but if you do respond, all information provided will be treated in confidence and will be used solely by the Office Administrator for the purpose of providing statistics for equal opportunities monitoring. The monitoring form does not form part of your application and will be detached from it on receipt and stored separately therefore this information will not be used for short-listing. You can always mail this form separately if you wish.

Thank you for your assistance in completing this form.

Name:
Post Title:
Please Tick
Gender: / Male
Female
Prefer not to say
Marital Status: / Married
Single
Other (please specify)
Prefer not to say
Age Band: / Under 18
18 – 29
30 – 39
40 – 49
50 – 59
60 – 65
Over 65
Prefer not to say
Sexual Orientation: / Heterosexual
Homosexual
Bisexual
Transsexual
Prefer not to say
Disabilities: / None
Physical disability
Mental disability
Prefer not to say
Race/Nationality/Ethnic Origin: / White / English
Scottish
Welsh
Irish
British
Other white background (please specify)
Mixed / White and Black Caribbean
White and Black African
White and Black British
White and Asian
Other mixed background (please specify)
Asian / Indian
Pakistani
Bangladeshi
British
Other Asian background (please specify)
Black / Caribbean
African
British
Other black background (please specify)
Chinese
Other ethnic group (please specify)
Prefer not to say
Religion: / Christian
Catholic
Jewish
Sikh
Muslim
Hindu
Buddhist
Rastafarian
None
Other religion (please specify)
Prefer not to say

For the purposes of compliance with the Data Protection Act 1998, I hereby confirm that by completing this form I give my consent to the Company processing the data supplied on this form for the purpose of equal opportunities monitoring.

Signature of applicant
Date

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