APPLICATION FORM - IN CONFIDENCE

INTERNAL USE ONLY
JOB REFERENCE & CANDIDATE NUMBER:
POST APPLIED FOR

Please complete this form as fully as possible. If you are unsure of anything there are guidance notes on the website, or call and speak with someone in the HR department. This form is an integral part of our recruitment process; please do not substitute your CV for this document.

PERSONAL DETAILS – PART A

Preferred Title (Mr Mrs Miss Ms Other (specify)
First Name(s)
Surname/Family Name
Address
Postcode
Telephone Numbers.
Please indicate preferred daytime contact number / Home:
Mobile:
Work:
Email Address
Current UK Driving Licence / YES or NO (please delete as applicable)

ASYLUM & IMMIGRATION ACT 1996

We are required to check the eligibility of potential employees to work in the UK and as an employer could face a civil penalty if we employ any person who is not entitled to work here.

You will be required to bring proof of eligibility to work in the UK with you to your interview. If you have a work permit please bring this to the interview

National Insurance No

AVAILABILITY TO WORK – COMPLETE ATTACHED AVAILABILITY FORM

REFERENCES

Please give names, addresses and contact numbers of two people who can provide a reference for you; they cannot be related to you. They should be your last two employers. If you aren’t currently in employment please see the enclosed Guidelines on Completing the Application Form. We do not approach referees until after interview. Please also let us know if you were know by another name to these referees

Present Employer
Name
Job Title
Organisation
Address & Postcode
Telephone Number
Email Address
How is this referee known to you?
Do you wish to be contacted before we approach this referee? / YES or NO (please delete as applicable)
Previous Employer (Please indicate if this referee is not a previous employer)
Name
Job Title
Organisation
Address & Postcode
Telephone Number
Email Address
How is this referee known to you?
INTERNAL USE ONLY
JOB REFERENCE & CANDIDATE NUMBER:

EDUCATION & WORK HISTORY - PART B

Please complete as much as you can. You will be asked to bring supporting evidence (for example qualification and training certificates) if you are invited to interview

EDUCATION & QUALIFICATIONS

Please tell us about your education and the school/college you attended,

Names of Schools / Colleges attended since age 11 / Dates
(from & to) / Exams passed, Qualifications gained or being sought – including grades

VOCATIONAL TRAINING

Please tell us of any other education or courses you have completed, either at your present or previous employer(s), that you think are relevant to this application. See Guidelines on Completing the Application Form for more detail.

Course Title & Content / Date & duration of training / Organisation that ran the training

VOLUNTARY WORKor OTHER SUPPORTING INFORMATION

Please give details of any voluntary work, community activity or other information that you think we should know that would support your application

PRESENT and MOST RECENT EMPLOYMENT

Employer’s Name
Employer’s Address & Postcode
Your Job Title
Brief description of duties
Salary/Wages/Benefits / £ pw/pa
Date Employed From/To
Notice period
Reason for leaving

PAST EMPLOYMENT

Please give a full work history and explain any gaps in your employment history

Employer’s name and address / Dates
(from & to) / Job title & brief description of duties / Reason for leaving

If you need more space please continue on a separate sheet of paper.

REHABILITATION OF OFFENDERS ACT

Because of the nature of the work for which you are applying, you must provide information about any criminal record. This includes convictions, cautions, reprimands and final warnings. Our power to require this lies in the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 which removes the normal operation of the Act in relation to specific occupations, including the provision of Home Care Services. In the event of being employed in connection with this application, any failure to disclose such convictions could result in dismissal or disciplinary action.

If you have no convictions please write NONE

If you have any previous or outstanding convictions, cautions, reprimands or final warnings, you will only be asked to supply details of the type of offence, date, sentence, fine etc if you are invited for interview. Please see Guidelines on Completing the Application Form for further details.

DISCIPLINARY / GRIEVANCES

Have you been involved in any Disciplinary/Grievance procedures in the last two years, or do you have any issues pending? / YES or NO (please delete as applicable)
If yes, please provide further information

DECLARATION

I declare that all the information I have given on this form is true and accurate, to the best of my knowledge. Please note that if you give untrue or inaccurate information any employment contract may be invalidated and the employee subject to disciplinary action or dismissal.
Signed: Date:

All short listing will be carried out on a completely fair basis in accordance with Equal Opportunities Legislation and our organisations Policy.

Please return the completed form to the address below:
Carers Trust Cambridgeshire, Peterborough & Norfolk
4 Meadow Park, Meadow Lane, St Ives,
Cambridgeshire, PE27 4LG /

Tel: 0345 241 0954 or 01480 499090

Where did you see this post advertised?

Newspaper and Date / Job Centre
Website / Word of Mouth
Referred by a friend / Other

West Anglia Crossroads Caring for Carers (known as Carers Trust Cambridgeshire, Peterborough, Norfolk) is a company limited by guarantee.

Registered Charity No. 1091522A company limited by guaranteeRegistered in England No. 4379948

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