Application for the position of:

______

Name / ......
Address / ......
...... / Post Code ......
Telephone
Email / ......
......

Employment History (in reverse order, most recent first)

dates (from:to) / employer / position / reason for leaving

Education & Training Qualifications

date / school, university, training centre / course / qualification

Voluntary work you have been involved in

Dates (from:to) / Organisation / Responsibilities

Personal Statement

Please describe why you consider yourself suitable for this position. It will be helpful if you address the points within the job description.

The post for which you are applying involves substantial opportunity for access to vulnerable adults.

It is therefore exempt from the Rehabilitation of Offenders Act 1974 and all convictions must be disclosed.

The successful candidate will be required to have an enhanced Criminal Records Bureau check.

However, a criminal record will not necessarily bar you from obtaining a position.

Have you been convicted, cautioned, reprimanded or warned for any criminal offence?

YesNo

Is there any court action pending against you?

YesNo

Are you eligible to work in the UK?

YesNo

Are you registered as disabled? If yes, please give details.YES/NO

Have you had any illness or condition which has necessitated medication or treatment for more than one month during the past 10 years? If yes, please give details. YES/NO

How many days leave due to sickness have you taken in the past twelve months? ......

Are you, or have you been, subject to disciplinary proceedings or suspension during your current/previous employment? YES/NO

References. Please provide the names of two people who can comment on your suitability for this position. One should be your current or most recent employer/tutor.

Name / ...... / Name / ......
Address / ......
......
...... Post Code...... / Address / ......
......
...... Post Code......
Telephone / ...... / Telephone / ......
Relationship
to applicant / ...... / Relationship
to applicant / ......

Declaration

I confirm that the information I have given on this form is correct and complete and that misleading statements may be sufficient for cancelling any agreements made. Because of the sensitive nature of the duties that the post holder may sometimes be expected to undertake, I understand that should I be invited for interview, a “Declaration of Criminal Record” form will have to be completed. This will include details of any criminal convictions, cautions, reprimands and final warnings and any other information that may have a bearing on my suitability for the post whether spent or not.

Signed ...... Date ......

BLANK PAGE

DECLARATION OF A

CRIMINAL RECORD

The post for which you are applying involves substantial opportunity for access to vulnerable adults.

It is therefore exempt from the Rehabilitation of Offenders Act 1974 and all convictions must be disclosed.

Please include details of any criminal convictions, cautions, reprimands and final warnings and any other information that may have a bearing on your suitability for the post whether -spent or not.

Offence / Sentence / Date of Sentence / Length of Sentence / Spent/
Unspent

A criminal record will not necessarily bar you from obtaining a position.

Please return this completed form marked ‘private and confidential’