Application Form
Please complete all relevant sections of this application. If completing by hand, use black ink and write clearly. Please refer to guidance notes contained toward the back of the form to assist in completion of this application form.
Job DetailsApplication for Post of:
Department/Location: / Post Ref:
Where did you see the post advertised?
1. Personal Details
Surname: / Forename(s):
National Insurance Number:
Address:
County: / Post Code:
Telephone:
(please specify daytime and evening if different) / Mobile:
Email address:
Do you hold a full current driving licence? / Yes No
If yes, do you have access to your own car? / Yes No
Please give details of any driving endorsements that you have on your licence:
Details of endorsement
(i.e. points, fine, conviction) / Issued by: / Date:
*Please continue on a separate sheet if necessary.
2. Previous Employment with Embrace(Embrace)
Have you previously been employed by Embrace? / Yes No
Please give details of your previous employment with the Company:
Dates of employment: / Location:
Position held: / Line Manager:
Reason for Leaving:
*Please continue on a separate sheet if necessary.
3. Application DetailsIn the space provided below, explain why you are applying for this post.
Please indicate all relevant skills and experience you have, which you believe would enable you to successfully carry out the duties and responsibilities of this position.
In particular you should consider both the essential and desirable criteria provided in the Job Description, and provide evidence of skills and experience that meet those criteria.
4. Availability
Please give below your availability for interview, and any upcoming breaks or holidays planned.
5. Employment History
Please provide details of your employment history including your current employer and all previous employment, from school leaving age. Any gaps must be fully explained. Please use a separate box for each position held, starting with the most recent and working back.
*Please continue on a separate sheet if necessary.
Current Employer: / Contact Number:
Address:
Date from: / Date to: / Position held:
Main duties/responsibilities:
Grade/Level/Salary: / Reason for Leaving:
Previous Employer: / Contact Number:
Address:
Date from: / Date to: / Position held:
Main duties/responsibilities:
Grade/Level/Salary: / Reason for Leaving:
Previous Employer: / Contact Number:
Address:
Date from: / Date to: / Position held:
Main duties/responsibilities:
Grade/Level/Salary: / Reason for Leaving:
6. Qualifications
Please give details of the qualifications you have achieved starting with the highest level (i.e. bachelor’s degree, A-Levels, etc. or equivalent) and working back to your secondary / high school education.
*Please continue on a separate sheet if necessary.
Course Title / Qualification Level / Date Achieved / Name of Institution/School
7. Training Courses
Use this space to detail any relevant training or development that you have completed, including vocational training that you feel is relevant to your application.
Subject Title / Course Type / Date Completed / Training Provider
If selected for interview, you will be asked to provide evidence of relevant qualifications achieved.
8. NursesAre you a qualified Nurse? / Yes No / Pin/Registration Number:
If yes, please state your grade or title
Do you have any unresolved investigations or complaints with the NMC? / Yes No
If yes, please give details:
9. Working Hours
Service/Home based roles are required to operate on a 24-hour rota basis which will include nights and weekends. Please state whether there are any restrictions that would prevent you from doing this?
10. Additional Information
Please detail any additional relevant information that you wish to use to support your application (i.e. voluntary work)
11. Overseas Police Checks
Have you in the last 10 years lived outside of the UK continuously for more than six months? / Yes No / If yes, please give details of countries and dates
If Yes, during that time did you receive any convictions/cautions/etc / Yes No
If yes, please give details:
If you are offered employment with us then you will be required to provide a copy of your overseas police check/good conduct certificate as appropriate, before you can commence employment.
12. Convictions and Cautions and Previous Disclosure ChecksPlease give details of any Criminal Convictions and/or cautions.
(Note: this employment is exempt from the provisions of the Rehabilitation of Offenders Act 1974 (Exemption Order 1975).
Do you have any convictions, cautions, reprimands or final warnings that are not "protected" as defined by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (as amended in 2013)
Date / Nature of Offence / Sentence or Court Order including costs
Have you ever been subject to a Disclosure and Barring Service (previously CRB) Enhanced Disclosure/Scotland Disclosure (PVG) made by an employer? Yes No
Please provide details including dates and results:
13. Employment References
Please provide details of three employment referees which must include your current employer and must cover at least the last 5 years of employment.
Referee Name:
Company Name:
Address:
Telephone: / Fax:
Email address:
Can we follow up this reference now? / Yes No / If not now, when?
Referee Name:
Company Name:
Address:
Telephone: / Fax:
Email address:
Can we follow up this reference now? / Yes No / If not now, when?
Referee Name:
Company Name:
Address:
Telephone: / Fax:
Email address:
Can we follow up this reference now? / Yes No / If not now, when?
14. Declaration
I certify that the information given by me in this application is accurate and complete to the best of my knowledge. I understand that if any of these statements are found to be false, this will be grounds for dismissal. I also understand that should the application be successful, at least the first three months of employment will be a probationary period.
Signed: Date:
Office Use Only
Application Short-listed? Yes No
Interview Outcome: Successful Unsuccessful
If unsuccessful please state reasons:
Details/Comments1 / Suitable vacancy confirmed / Yes No
2 / Outcome notified verbally / Yes No
3 / Induction foundation course booked / Yes No
4 / DBS application form completed / Yes No
5 / New employee form completed / Yes No
6 / HR/Recruitment Notified / Yes No
Statement of main terms and conditions:
Main place of work:
Line Manager:
Contracted hours per week:
Hourly rate:
Days / Nights / Both:
Holiday entitlement:
Authority to issue a contract with the above terms and conditions is to be signed by operations managers only!
Signed: Date:
Job Title:
Guidance Notes for Completing your Application Form
All applications are processed in accordance with the Equal Opportunities Policy and Recruitment, Selection and Retention Policy.
The job description and person specification provide information about the purpose, requirements and skills required for the role.
Please continue on a separate sheet where required indicating the section of the application form that the additional information refers to.
Personal Details
Please provide us with your personal and contact details including daytime and evening contact numbers and an email address.
You will also need to detail all driving endorsements such as points, fines or convictions.
Previous employment with Embrace
If you have previously worked for Embrace or in either the Care Homes or Lifestyles division, please let us know by completing this section of the application form.
Application Details
Applications will be scored against a standard set of criteria detailed in the job description and person specification. It is important, therefore, that you complete your application form to show you possess the necessary skills and competencies and are capable of carrying out the duties of the role as listed in the job description and person specification.
It is recommended that for each element within the Job Description you should highlight specific examples of your experience to support your application.
You should NOT:
· Go into excessive detail
· Make claims unsupported by evidence e.g. “I work well under pressure”.
Availability
Please let us know of any dates that you will be unavailable to attend interviews or assessments during the application process. We will try where possible to take your availability into account; however, we are unable to make any guarantees as this will not always be possible.
Employment History
We need details of your employment history including the company details, the position you held and the dates you were employed by each company.
Qualifications
Please give details of the qualifications that you have attained starting with the most recent or highest level and working back to your secondary /high school education (i.e. Master’s Degree, Bachelor’s Degree, A Levels).
Training Courses
If you have completed any training or development courses that you believe to be relevant to your application please detail them in this section.
Nurses
If you are a qualified nurse please detail it here and provide us with any details relating to unresolved or on-going complaints or investigations with the NMC.
Working Hours
Our services operate on a 24-hour basis so we need our staff to as well. Within the services and homes staff are required to work on a rota-basis to ensure service is covered 24/7. Use this section to detail if you have any restrictions that would prevent you from doing this.
Additional Information
If you have any additional information that would support your application such as voluntary work and you are unable to detail it in any other sections of the application form, please let us know in this section.
Convictions and Cautions and Previous Disclosure Checks
Embrace provides support to vulnerable people both within care homes and in the community. As a result employment is subject to an Enhanced DBS Disclosure/Scotland Check.
Employment to these roles is exempt from the provisions of the Rehabilitation of Offenders Act 1974 (Exemptions Order 1975) and all previous convictions and cautions will need to be disclosed. The amendments to the Exceptions Order 1975 (2013) provide that certain spent convictions and cautions are 'protected' and are not subject to disclosure to employers , and cannot be taken into account.
Guidance and criteria on the filtering of these cautions and convictions can be found on the Disclosure and Barring Service website.
If you are appointed and it is later found that you have convictions or cautions that you did not disclose at the application stage, this will be treated as gross misconduct and may result in dismissal.
Employment References
Please provide us with the details of 2 employment referees covering the last three years. Your referees should be either your manager or a contact within the HR Department for the company and should cover a minimum of the last five years of employment.
If you are unable to provide employment referees, please contact the Home/Service that you are applying to or the HR Department who will be able to advise you accordingly.
Diversity Monitoring Form
When submitting your completed application you should also include the Diversity Monitoring Form. This should be enclosed within your application pack. Contact the Home/Service that you are applying to or the Group HR Department if this has not been provided. This will not formulate part of the selection process.
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