EMPLOYMENT APPLICATION – REGISTERED CARE

Please return your completed application to:

Human Resources, Longhurst Group, Leverett House, Gilbert Drive,

Endeavour Park, Boston, Lincolnshire, PE21 7TQ

Or email your application to:

Please complete in black ink or type

VACANCY DETAILS
JOB TITLE
JOB REF / LOCATION:
PERSONAL DETAILS
SURNAME / FIRST NAME(S)
ADDRESS / HOME TELEPHONE
MOBILE TELEPHONE
WORK TELEPHONE
NATIONAL INSURANCE NO
EMAIL ADDRESS

REHABILITATION OF OFFENDERS ACT 1974

Have you ever been convicted of a criminal offence / received a police caution reprimand or warning / YES/NO
Are you currently the subject of a criminal investigation or charges / YES/NO

If you have answered YES to either of the above questions, please give details on a separate sheet and put it in a sealed envelope attaching it to the form. This information will only be used if you are short-listed, otherwise it will be destroyed unopened. Please ensure that you write your name and the title of the position you are applying for on the front of the envelope.

1. SECONDARY EDUCATION
SCHOOL ATTENDED / QUALIFICATIONS GAINED
2. FURTHER EDUCATION
UNIVERSITY / COLLEGE ATTENDED / QUALIFICATIONS GAINED
State level of grade and date achieved
3. PRACTICAL TRAINING/OTHER EXPERIENCE
DETAIL APPRENTICESHIPS, TRAINING SCHEMES, IT SKILLS, COURSES AND SEMINARS ATTENDED
DETAIL OF OTHER STUDIES BEING UNDERTAKEN AT PRESENT
4. WORK / VOLUNTARY EXPERIENCE
Please give details of any work / voluntary experience (include positions of responsibility)
5. MEMBERSHIP OF PROFESSIONAL BODIES
NAME OF INSTITUTE / PROFESSIONAL BODY / CURRENT LEVEL OF MEMBERSHIP (EG; Corporate) / MEMBERSHIP NO.
Include date obtained
6. EMPLOYMENT HISTORY

Please list all previous jobs dated to the nearest month, starting with your most recent.

You should include all periods of work experience / work placements

NAME & ADDRESS OF PRESENT / MOST RECENT EMPLOYER:______
______
______
POSITION HELD ______
DATE FROM ______TO______
SALARY & MAIN BENEFITS ______
NOTICE REQUIRED______
DESCRIPTION OF MAIN RESPONSIBILITIES / DUTIES
WHY DO YOU WISH TO CHANGE YOUR CURRENT EMPLOYMENT?
7. PREVIOUS EMPLOYMENT HISTORY
EMPLOYED / NAME & ADDRESS OF EMPLOYER / JOB TITLE
Main Responsibilities / Duties / REASON FOR LEAVING
FROM / TO

If you require further room please continue on a separate sheet, clearly marking it with your name and the position you are applying for.

Are there any gaps in your employment history?YES / NO

If yes, please give details

8. ADDITIONAL INFORMATION
Please add further information below to support your application, providing details of what you think you can contribute to this position and the elements of a job you enjoy. Please giveus details of your experience and skills that meet the requirements of the job.PLEASE DO NOT ENCLOSE A CV AS IT WILL BE REMOVED BEFORE SHORT-LISTING TAKES PLACE.
Please continue on a separate sheet if necessary (up to a maximum of 2 sides of A4)

Are you available for interview on the date advertised? YES / NO

Do you have a full driving licence? YES / NO

Give details of any driving endorsements/disqualifications:

______

Do you have access to a car?YES / NO

9. REFERENCES

We need two references, one of which must be from your current or previous employer. If this is your first job, personal references from college principles, tutors or someone in a position of authority who knows you well will be acceptable. (Please read the guidance notes before completing this section)

Business/Personal (please delete as appropriate)
Mr/Mrs/Miss/Ms/Other______
Name______
Position______
Relationship______
Address______
______
______
______
Telephone______
Email______/ Business/Personal (please delete as appropriate)
Mr/Mrs/Miss/Ms/Other______
Name______
Position______
Relationship______
Address______
______
______
______
Telephone______
Email______
May we contact this referee at any time?
Yes No / May we contact this referee at any time?
Yes No

DECLARATION:

The information I have given in this application is correct. I understand that any false statement could result in my employment being terminated without notice should I be successful.

I note that Longhurst Group conforms to requirements under the Data Protection Act
and I understand that all unsuccessful applications are confidentially destroyed after
6 months.Please tick

Print Name: ______

Signature: ______Dated: ______

10. EQUAL OPPORTUNITIES

We operate an Equal Opportunities Policy and are required to report to our Regulators and Boards on this subject for monitoring purposes. Under the terms of the Data Protection Act, this information will only be used to monitor our compliance with the law. Information collated below will be treated as strictly confidential and is not passed to those involved in the short-listing process. The Human Resources Department detaches these pages. If you do not wish to answer this questionnaire, your application will not be affected in any way.

Ethnicity

White: British /  / Asian/Asian British: Indian / 
White: Irish /  / Asian/Asian British: Pakistani / 
White: Other /  / Asian/Asian British: Bangladeshi / 
Mixed: White and Black Caribbean /  / Asian/Asian British: Other / 
Mixed: White and Black African /  / Black/Black British: Caribbean / 
Mixed: White and Asian /  / Black/Black British: African / 
Mixed: Other /  / Black/Black British: Other / 
Chinese /  / Other / 

Gender

MaleFemaleGender Reassignment

Age

Under 24 25-3435-4445-5455-6465 or over 

Sexual Orientation

HeterosexualHomosexualBisexualPrefer not to state

Religion / Belief

ChristianMuslimBuddhistHindu

SikhJewishNo ReligionScientology

Prefer not to sayOther Religion (please state) ______

Work Permit

If you require a work permit, do you have a current valid permit?YES / NO / Not Applicable

Disability
Longhurst Group is committed to the employment of disabled people. We will offer an interview to anyone with a disability whose application meets the minimum criteria for the job. The Disability Discrimination Act 1995 defines a person as having a disability if he/she has a physical or mental impairment which has a substantial and long term adverse effect on his/her ability to carry out normal day to day activities.

Do you have a disability? YES / NO
If yes, please state your disability:

______

______
If you have particular requirements for an interview or selection test please give us details below: (eg; Signer required)

______

______

10. MISCELLANEOUS INFORMATION

How did you hear about this vacancy?

Newspaper* (please specify)Job centre

Longhurst Group Website Other website* (please specify)

Word of mouthProfessional journal* (please specify)

College/University Other* (please specify)

* Please give details: ______

______

We need to know whether you or a close relative have in the last 12 months worked for the Longhurst Group of Companies as an employee, Board Member, contractor, supplier or consultant. If you think any or all of these statements might apply to you, please provide details:

______

______

DISCLOSURE ATTACHMENT FORM

IMPORTANT NOTICES TO APPLICANTS

  1. Because of the nature of the work for which you are applying, this post is exempt from the provision of Section 4(2) of the Rehabilitation of Offenders Act. Therefore Longhurst & Havelok Homes Limited is entitled to access relevant information regarding criminal convictions from the Criminal Records Bureau. This process is called “Disclosure”.
  1. Please complete this form and return it prior to the interview date. This gives us the opportunity to consider any information it contains before interview.
  1. Applicants are not entitled to withhold information about convictions that for other purposes are “spent” under the provisions of the Act, and, should you be offered employment and it is discovered that you have failed to disclose any convictions then the offer of employment may be withdrawn by Longhurst & Havelok Homes Limited. Any information given will be completely confidential and will be considered only in relation to an application for positions to which the Order applies. Human Resources Staff and Counter-Signatories only, and not the selection panel will see this information.
  1. If you are successful you will be required to fill in a Disclosure Application Form.

PLEASE COMPLETE THE FOLLOWING SECTIONS.

SECTION 1

Have you ever been convicted or cautioned for a criminal offence?Yes/No

Have you been subject to any criminal investigations or bind-over orders?Yes/No

If the answer is YES to either, please state nature of offence and the date and place of the conviction, investigation, caution or bind-over order.

Signature______Date______

SECTION 2

It is the policy of Longhurst & Havelok Homes Limited, because of the nature of the work and the vulnerability of residents/tenants, that references are sought and enquiries made before anyone is appointed to work with children or vulnerable adults.

When enquiries are made it is important that identity is clear and that should you have been previously known by any other name (eg maiden name, former marriage, change by deed poll etc) then you are requested to declare this in the space below.

I have previously been known as:-

______

Signature______Date______

SECTION 3

Please provide details of any time not accounted for since leaving school. (Include dates, whether in work, unemployed, education, domestic circumstances, etc).

SECTION 4

Note to Applicant: Because of the nature of the work you are applying for, references will always be taken from a current employer. One referee noted on the Application Form should be a current or most recent employer.

References may also be requested from any previous employer.

I declare that the information given on this form is to the best of my knowledge true and complete. I understand that Longhurst & Havelok Homes Limited can verify this information and failure to disclose relevant information may lead to any offer of employment being withdrawn.

NAME: ……………………………………………………………………………………………

SIGNATURE: …………………………………………………………………………………..

POST TITLE: …………………………………………………………………..………………..

DATE: ……………………………………………………………………………………………..