Application for Employment Cherry Blossom Care Home

Please Write Clearly In Block Capitals.

Post Applied For:

Personal Details

Surname Forenames

Maiden Name Title Mr /Mrs /Ms /Miss

Marital Status Nationality

Present Address

Telephone Number Mobile Number

Email address

National Insurance Number

Do you have a clean Driving Licence? Yes I No

Registration PIN. (Registered Nurses only)

Do you have a current CRB Disclosure Form ? Yes / No

Work Permit Required Yes I No

Name, address and contact telephone number for next of kin

Education

School I University Attended Examinations Gained I Results / Dates

Please continue on a separate sheet if necessary.

Professional Training / Qualifications Gained

Training Venue Examinations Gained I Results / Dates

Please continue on a separate sheet if necessary.

Employment History

List below present and past employment starting with your most recent (Going back 10years) if you need more space please use the reverse of the page, PLEASE LEAVE NO GAPS (to include unemployment, House wife ect) dates should match exactly.

Name & Address / Position Held / From / To / Leaving
Salary
1
2
3
4
5
6

How did you hear of this position?

Are you related to any person already employed at the home? Yes / No

References

Give the names, full postal address, title/position and telephone number of two referees’ one of whom should be your current employer/or last employer with business land line phone number. (Not family members)

(These will only be contacted if you are offered a position)

1. 2.

If appointed when would you be available to start

Rehabilitation of Offenders Act 1974

Due to the nature of the work for which you are applying this position is exempt from the Provisions of Section 4(2) of the Rehabilitation of Offenders Act 1974 by virtue of the Rehabilitation of the Offenders Act 1974 (exceptions) order 1975.

Applicants are therefore, not entitled to with hold information about convictions which, for other purposes are “spent” under the provisions of the Act, and, in the event of employment any failure to disclose such convictions could result in dismissal or disciplinary action by management.

I have been convicted of the following Offences

I confirm that I have never been charged with, awaiting trial or convicted of an offence.

Signature Date

Hobbies and Interests

The facts set out in this application for employment are to the best of my knowledge, true and complete.

Signature Date

Please post your application to:

Alysia Caring, Recruitment, Southgate Office Village, Block F
1st Floor, 288 Chase Road, London N14 6HF

2