DAYBREAK

Application for employment

All information will be treated as strictly confidential and no approach will be made to any person without your permission. Please print clearly.

Please return completed form to: Daybreak 25 Wootton road KINGS LYNN Norfolk PE30 4EZ

Position Applied for

Please state [√] whether you are looking for

Full Time Part Time Minimum No. Hrs

If you obtained this position, would you continue in any other employment? Yes/no

Is your ability to perform this job limited in any way? If yes, how could we help you to overcome these limitations?

Personal details

Title: Forename(s): Surname:
Home address:
Postcode:
Home telephone: Mobile telephone:
email address:
Date of birth:
Previous address if less than 5 years Dates from and to

Education and training

School, college, etc

/

Dates

/

Qualifications

Previous employment – provide full history since leaving school

(Please continue on separate sheet if necessary)

Name & address of

employer
/

Dates from and to (including months)

/

Job title or duties

/

Detailed reason for leaving

Current salary (if unemployed, please state last salary hourly rate)

Previous relevant experience

(Please continue on separate sheet if necessary)

Interests

Driving licence, etc.
Current driving licence? Yes/no. If yes, type of licence
Any current endorsements? Yes/no. If yes, give details
Any motoring prosecutions pending? Yes/no. If yes, give details
The post for which you are applying is covered by the Disclosure and Barring Service (DBS). NB- The Criminal Records Bureau (CRB) and the Independent Safeguarding Authority (ISA) have merged to become the Disclosure and Barring Service (DBS). It is a criminal offense for anyone on the register to apply for a role supporting vulnerable people. The post is also exempt from the provisions of Rehabilitation of Offenders Act 1974, following the (Exceptions) Order 1975 (“the 1975 Order”). The 1975 Order disapplies specified provisions of the Rehabilitation of Offenders Act 1974 (“the 1974 Act”) so as to permit questions to be asked about spent convictions and cautions in order to assess a person’s suitability for admission to certain occupations or to hold certain types of employment as a result all offenses MUST BE DECLARED within this application.
The information provided will be taken into account in deciding whether to make an appointment or not. It will be completely confidential and will be considered only in relation to this application.
If your application is successful you will be required to co-operate with us in obtaining an enhanced disclosure of criminal convictions from the Disclosure and barring service.
Declaration
Are you included or provisionally included on the ISA/SOVA list? Answer “yes” or “no”
Have you ever been convicted in a court of law or accepted a police caution, reprimand or final warning in respect of any offence? Answer “yes” or “no” ______
If “yes”, give full details______
______
______
______
If you have previously had any other surname(s) or forename(s), you must declare all of them below and state the date of each change and the reason.
______
______
______
______
(Please continue on a separate sheet if necessary).
List any absences from work during your last 12 months (other than holidays) with reasons.
References (Please note: it is our policy to contact you current employer and any previous employers for the past 3 years for a reference) please state most recent first
Please continue on a separate sheet if required
Character reference:
Post code:
Telephone: / Work reference:
Post code:
Telephone: / Work reference:
Post code:
Telephone:
Work reference:
Post code:
Telephone: / Work reference:
Post code:
Telephone: / Work reference:
Post code:
Telephone:

Please detail any further information you wish to put forward in support of your application i.e. Reasons for applying

(Continue on a separate sheet if necessary)

Availability

Evenings Y/N Weekends Y/N Days Y/N Sleep in Y/N Waking nights Y/N

(Please circle all that are appropriate)

We provide a 24/7 service so require all staff to be flexible with availability to accommodate the needs of the individuals

Declaration
I declare that the above information is true. I understand that any job offer made on the basis of untrue or misleading information may be withdrawn or my employment terminated.
Signed: Date:
Number / Reviewed / Issue / Approved
ZZ/HR/ / 11/04/14 / 4 / CLL

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