Confidential Application Form

Please complete the form, save it to your desktop and email as an attachment

to: , alternatively please send to

Human Resources Department, Park House, 184 Kennington Park Road, London SE11 4BU

Personal Details
Forename / Surname
Title / Email address
Address / Preferred telephone number/s:
Position applied for / Where did you see the vacancy?
Your Application
Are there any dates when you cannot be contacted in relation to this application?
If appointed, how soon could you start work?
Disability
Under the Equality Act 2010 a person has a disability if they have a physical or mental impairment and the impairment has a substantial and long-term adverse effect ontheir ability to perform normal day-to-day activities.
Do you consider yourself to have a disability? Yes No
If yes, please provide details:
Disabled applicants who meet the essential criteria in the skills knowledge and abilities section of the job description will be shortlisted for interview. If you need us to make particular arrangements for completing the application form and/or attending interview please contact HR on 020 7840 9778, or recruitment @hcpc-uk.org
Convictions
Do you have any convictions, which are ‘unspent’ as defined under the terms of the Rehabilitation of Offenders Act 1974? Yes No
If yes, please provide specific details:
If shortlisted, Fitness to Practise candidates will be required to provide further details about convictions and undergo a DBS check. Please refer to the application guidance for further information.

The HCPC’s recruitment practices encourage equality of opportunity in employment; therefore the first sheet of your application form, along with the ‘additional details’ and ‘declaration’ pages will be detached prior to being submitted for shortlisting.


Current Position

Position Title / Employer / Dates employed (From - To)
Reason for leaving / Salary on leaving
Main duties and responsibilities:

Employment History (most recent first)

Employer / Position held / Dates
(From – To) / Main duties and responsibilities
and reason for leaving

Education

Please give details of your secondary and higher education (or equivalent), starting with the most recent. If appointed, you will be required to produce evidence of the qualifications cited in your application.

Dates
(From - To) / College/ University / Subject/ Qualifications/ Grades
School / Subject/ Qualifications/ Grades

Other Qualifications/ Training

Please list any other relevant training, courses or professional qualifications/ membership you have undertaken/ achieved.

Dates
(From - To) / Course/ Workshop Title/ Membership body / Awards e.g. certificate/ membership level
Supporting Statement
Please use this space, and a continuation sheet if necessary, to:
·  Explain why you are applying for the job
·  Demonstrate how your skills, knowledge, experience, education and training are relevant to and meet the skills, knowledge and abilities section of the job description
·  Provide any other information that is relevant to your application
·  Examples can relate to work and non-work experience
Additional Details Pages
The information provided on this page is for HR use only and will not be seen by the panel during the decision making process.

Right to Work in the UK

Are there any restrictions, conditions or time limits on your rights to reside and/or work in the UK, either at the present time or which may come into effect in the future? / Yes No
If yes, please provide details:

References

Please give the names and addresses of 2 professional referees (either a line manager, or someone in a position of responsibility) who can confirm your employment and comment on your work performance.

Referees should be from your 2 most recent employers and should ideally cover your last 3 years of employment. Referees will not usually be contacted until a preliminary job offer has been made, and will not be contacted without your consent.

1. Referee name / Referee Contact Details
Email:
Referee position / Phone:
Address:
Organisation/ Company name
How do you know this referee? / How long have you known this referee?
2. Referee name / Referee Contact Details
Email:
Referee position / Phone:
Address:
Organisation/ Company name
How do you know this referee? / How long have you known this referee?

Data Protection

The information on this application form will be held securely, both manually and electronically by HCPC and will not be divulged to anyone outside the organisation. Information on unsuccessful candidates will be held for a reasonable period of time in relation to the recruitment process.

We reserve the right to verify the information you have provided and seek information from other sources.

Declaration

I declare that all the information given on this form is, to the best of my knowledge, complete and correct. I understand that if I am employed and any of the information I have provided is false, my contract may be terminated.

Signature Date

Equal Opportunities and Diversity Monitoring Form

Thank you for applying for a vacancy at the HCPC. The purpose of this form is to help us monitor and improve our standards of recruitment and employment practice.

Any information gathered for statistical analysis will be used anonymously and will not be used to assess or score your application.

The HCPC is committed to equal opportunities and reflecting the diversity of the public. To monitor our recruitment process we collect diversity data on all applications, which is stored separately from the rest of your application and is not seen by any short-listing or interview panel. It is used to produce statistics so that we can analyse the diversity profile of those applying to the HCPC and meet the obligations of our Equality and Diversity Scheme.

Date of Birth (dd/mm/yyyy) / Prefer not to disclose
Gender / Male Female Transgender Prefer not to disclose
Please describe your marital status
Single Married Divorced Prefer not to disclose
Civil Partnership Partner Widowed
Do you have dependent children?
Yes No Prefer not to disclose
If yes, please indicate number:
Please select the option which best describes your sexual orientation
Lesbian Heterosexual Bisexual
Gay Prefer not to disclose
Please indicate which of the following describes your ethnic group
Asian
Bangladeshi
Indian
Pakistani
Any other Asian background
Black
African
Caribbean
Any other Black background
White
British
Irish
Any other White background / Chinese
Chinese
Any other Chinese background
Mixed
Asian & White
Black African & White
Black Caribbean & White
Any other mixed background
Other Ethnic Group
Any other ethnic group
Undisclosed
Prefer not to disclose
If any other background, or any other ethnic group chosen, please specify:
Please indicate your religion or belief
Atheism
Buddhism
Christianity
Hinduism / Islam
Jainism
Judaism
Sikhism / Prefer not to disclose
Other (please specify)
Do you consider yourself to have a disability? / Yes No Prefer not to disclose
Please state the type of disability which applies to you. People may experience more than one type of disability, in which case you may indicate more than one.
Physical Learning Disability/Difficulty
Sensory Long-standing illness
Mental health condition Other (please specify if you wish)

2