Thank You for Applying for a Job at Martlets

Application for Employment

Thank you for applying for a job at Martlets.

The Martlets is a charity that supports adults, including their families, living in Brighton & Hove and the surrounding areas who need supportive care and may also be approaching the end of their lives.

We may be involved from the time an illness is diagnosed up to the time a person dies.

We work to meet the medical, emotional, spiritual, social and practical needs of patients and their families and carers.

We can offer this in our 18-bed ward, in our day services and in patients’ homes. We also offer counselling and support for patients and families through the illness and afterwards.

In addition to our 18 bed ward and our support offices (Administration, Finance, Marketing and Communications, Human Resources) we also have a network of 9 charity shops in and around Brighton, Hove and Lewes to help us raise the vital funds needed for our Hospice care.

Any appointment to the vacancy you are applying for will be subject to a disclosure from the Disclosure and Barring Service (DBS). A conviction does not necessarily mean you will not be able to work for us.
The information provided in this application form may be used for statistical analysis and to obtain references from past and current employers.
Job applications forms will be destroyed will after six months.
Martlets does not discriminate on any grounds including disability, race, gender, colour, age or gender reassignment, marriage or civil partnership, sexual orientation, pregnancy, maternity or religion/belief.

Personal Details

Job you are applying for:
Where did you hear of this job / Do you know anyone who works for Martlets? If so who?
Title: / Last or Family Name:
First Name:
Address: / Home Telephone:
Mobile Telephone:
Work Telephone:
Post Code: / Email Address:
Which contact method do you prefer? (please select) /
Home Telephone Mobile Email
Professional Body:
(Please state your professional registration or certificate number, date of issue and expiry where applicable e.g. Nebosh / Registration No:
Date of Issue:
Expiry Date (if applicable):
National Insurance Number:

Current Employment or Voluntary Work

Please give details of your current job or voluntary role (if unemployed details of last employer)
Name of Employer: / Address:
Job Title
Start Date:
Notice Period or End Date: / Reason for Leaving:
Brief Summary of Responsibilities

Previous Employment or Voluntary Work

Please give details of your previous jobs or voluntary roles covering the last 5 years.
If necessary please continue on separate sheet with your name.
Name of Employer: / Address:
Job Title:
Start Date: / End Date:
Reason for Leaving:
Brief Summary of Responsibilities
Name of Employer: / Address:
Job Title:
Start Date: / End Date:
Reason for Leaving:
Brief Summary of Responsibilities
Name of Employer: / Address:
Job Title:
Start Date: / End Date:
Reason for Leaving:
Brief Summary of Responsibilities

Education, Qualifications and Professional Memberships

School/College/University / Subject/Course / Exam/Grade / Date

Professional Qualifications Already Gained

Course Title / Qualification / Registration No: / Year Obtained +Renewal Date

Professional Qualifications Currently Being Studied

Qualification / Method of Study / Year of Completion

Declarations.

Many jobs within Martlets are exempt from the Rehabilitation of Offenders Act 1974 and you may be asked to disclose spent convictions as a result of this. All offers are subject to a Disclosure Barring Service (DBS) check before the appointment is confirmed. If the answer is yes please include full details on a separate piece of paper and return it with this application form.
Do you have any convictions, cautions or bind-overs? YES/NO
Are you currently the subject of any police investigations and/or prosecution in the UK or another country? YES/NO
Are you currently the subject of any investigation or proceedings by any body having regulatory functions in health/social care professionals including such a regulatory body in another country?
YES/NO
Have you ever been disqualified from your practice or profession or required to practice subject to specified limitations following a fitness to practise investigation by a regulatory body in the UK or another country? YES/NO

Asylum and Immigration Act 1996.

If you are successful in your application for this job you will be required to provide evidence of your entitlement to work in the UK. i.e. National Insurance Number (P45,P60), or a valid European union or Republic of Ireland birth certificate or passport
Do you require a work permit* to work in this Country? YES/NO
If yes please detail any conditions attached to your work permit
*Work Permits and Limited Leave to Remain are not transferable between employers.
Do you hold a current full UK driving licence? YES/NO
Do you have any current endorsements? YES/NO

Additional Information

Please explain your reasons you for applying for this job and give any additional information that you believe will make you suitable for it. (please continue on a separate piece of paper if required)

References

Please give name, address and position of your referees; these should include your current employer and all previous employers including voluntary work to cover at least the last five years. Please write clearly. One personal reference is also accepted.
Professional References
Name: / Position
Organisation: / Address:
Telephone:
Email: / Postcode
Permission to Contact if shortlisted for Interview: YES/NO
Name: / Position:
Organisation: / Address:
Telephone:
Email: / Postcode
Permission to Contact if shortlisted for Interview: YES/NO
Personal Reference:
Name: / Position
Organisation: / Address:
Telephone:
Email: / Postcode
Permission to Contact if shortlisted for Interview: YES/NO

Declaration

I declare that the information I have given in this job application is correct to the best of my knowledge and understand that if employed I could be dismissed if I have given false information. I am prepared to have a medical examination if asked to do so.
Signed: Date:

/Additional Information continued

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