JOB APPLICATION FORM
STRICTLY CONFIDENTIAL
Application for the Post of:
Post Reference Number:
Where did you see this post
advertised? / ☐Optalis Website
☐Jobs Go Public
☐WBC website
☐Google Search
☐Directory (Please specify)…………………………
Flyer/leaflet (where did you see it?)………………………… / ☐Newspaper (Please specify)…………………………..
☐Recruitment Open Days
☐Through a Friend
Name…………………………......
☐Other (Please Specify)………….
…………………………………….
Hours per week / ☐Part-time (Please specify how many hours)…………………
☐Casual basis / ☐Full-time (37hrs)

PERSONAL DETAILS

Surname: / Title:
First names: / Tel no. (home):
Previous surnames: / Mobile:
Address: / Work:
Email:
Postcode:
QUALIFICATIONS AND TRAINING / YEAR
SECONDARY AND FURTHER EDUCATION
(Most recent education first. Please include predicted grades where applicable)
Name of School/University/College / Subjects/Qualification / Year / Grade
TRAINING AND QUALIFICATIONS
Give details of any other certificates with dates: vocational training, professional qualifications, membership of professional Institutions
Are you related to any members of staff within the Company? / Yes / No
If yes, please give details
EMPLOYMENT DETAILS: CURRENT OR LAST EMPLOYMENT
Name and address of current/most recent employer or college/school / Job title:
Start date:
Notice required:
Date of leaving (if applicable):
Basic salary:
Allowances:
Please briefly outline your main duties and responsibilities or details of your studies if leaving education.
Why do you wish to leave your present employment/why did you leave your last employment?
EMPLOYMENT DETAILS: PREVIOUS EMPLOYMENT

(Start with your most recent employment first. If necessary, continue at end of application form until all employment history is shown since leaving full-time education). Please also include any voluntary work or unpaid work experience if relevant, and explain any breaks in employment since you finished full-time education.

Name of Previous Employer:
Post Held:
Dates Employed From: To: Salary:
Brief details of duties and responsibilities:
Reason for leaving:
Name of Previous Employer:
Post Held:
Dates Employed From: To: Salary:
Brief details of duties and responsibilities:
Reason for leaving:
Name of Previous Employer:
Post Held:
Dates Employed From: To: Salary:
Brief details of duties and responsibilities:
Reason for leaving:
Name of Previous Employer:
Post Held:
Dates Employed From: To: Salary:
Brief details of duties and responsibilities:
Reason for leaving:
Name of Previous Employer:
Post Held:
Dates Employed From: To: Salary:
Brief details of duties and responsibilities:
Reason for leaving:
Name of Previous Employer:
Post Held:
Dates Employed From: To: Salary:
Brief details of duties and responsibilities:
Reason for leaving:
Name of Previous Employer:
Post Held:
Dates Employed From: To: Salary:
Brief details of duties and responsibilities:
Reason for leaving:
Name of Previous Employer:
Post Held:
Dates Employed From: To: Salary:
Brief details of duties and responsibilities:
Reason for leaving:
FURTHER INFORMATION

The information in this section plays an essential part in the selection procedure. It enables you to provide us with the additional information you consider relevant to your application.

Under the Data Protection Act 1998, your consent is required to process the information you have supplied for the purposes of recruitment and selection. The information required is necessary for selection purposes and will be:

  • Passed to relevant third parties for the selection and interview process
  • Sent to referees to release personal information in connection with the current vacancy
  • Used to confirm the facts contained in the application
  • Used in assessing your qualifications where necessary for this position.

Where you have been not been successful in your application for a post within Optalis the information will be retained for a period of 6 months for monitoring purposes.

Please use the space below to detail how you meet the job requirements:

(Please continue on a separate sheet if necessary)

GENERAL INFORMATION
Do you possess a current driving licence? / Yes / No
If yes, Manual / Automatic
Do you have the daily use of a vehicle? / Yes / No
Are there any legal restrictions upon your employment in this country? / Yes / No
If yes to any of the above, please provide additional information
The position you are applying for is exempt from the Rehabilitation of Offenders Act 1974. Subject to the rules above you must disclose any convictions you may have - even if they would otherwise be regarded as ‘spent’ under this Act, and any cautions or bind-overs. Any information you give will be treated in strictest confidence and will only be taken into account in relation to this application.
Have you been convicted of a criminal offence / Yes/No
If YES please give details of all convictions and cautions, including ‘spent’ convictions and cautions.
REFERENCES
Please provide details of two referees to whom confidential enquiries will be made. They must have recent knowledge of your work or studies, and at least one must be your current employer (or last employer if not currently employed). Referees cannot be members of your family, or spouse/partner.
It is Optalis’ policy to take up references prior to interview, unless requested otherwise.
Name, address and telephone number of current employer: / Name, address and telephone number of last employer/tutor:
Name: / Name:
Address: / Address:
Tel. no: / Tel. no:
Fax No: / Fax no:
Email: / Email:
Job Title: / Job Title:
Can we contact the referee before the interview? / Yes/No / Can we contact the referee before the interview? / Yes/No

Information contained in this application form is considered personal data, and as such, is subject to the Data Protection Act 1998.

DECLARATION:
The information I have provided is correct to the best of my knowledge. I understand that false information may render me liable for dismissal if appointed.
Sign (please print):……………………………………………………..
Date:…………………………………………

Please return this form to the Optalis recruitment team

or to Freepost: RTEK-JBGE-GTBH, Optalis Recruitment, Trinity Court, Molly Millars Lane, Wokingham, RG41 2PY

Recruitment Coordinators

Optalis is a local authority trading company owned by and delivering adult social care on behalf of
the Royal Borough of Windsor and Maidenhead and Wokingham Borough Council

Trinity Court, Molly Millars Lane, Wokingham, Berkshire, RG41 2PY (0118) 977 8600

Optalis Ltd. 7630156

EQUAL OPPORTUNITIES MONITORING

PRIVATE AND CONFIDENTIAL

Optalis is an equal opportunities employer and aims to ensure people are recruited, selected, trained and promoted on the basis of job requirements, skills, abilities and other objective criteria. The Company will ensure that no job applicant or employee receives less favorable treatment on the grounds of race, colour, nationality, ethnic or national origins, sex, marital status, sexuality, disability, age, or is disadvantaged by conditions or requirements which cannot be shown to be justified as being necessary for the safe performance of the job.

To ensure equal opportunities policies are being implemented and to comply with legislation, please complete the form below and return with your application form. The information will be used for monitoring purposes and to implement changes to improve equal opportunities, and will not be available to those involved in the selection process, (except in relation to disability when we guarantee any applicant with a disability an interview, should they meet the minimum requirement for the job as contained in the person specification).

Please complete or select entry
Post applied for:
Full name
Gender: / Female / Male
Date of birth
Marital status / Single / Married / Divorced / Separated / Widowed
I would describe my cultural and ethnic origin as:
(Please select the appropriate description to indicate your cultural background.)
White / White / Irish / any other White background (please specify)
Chinese or Other Ethnic Group / Chinese / any other ethnic group (please specify)
Black or Black British / Caribbean / African / any other Black background (please specify)
Mixed / White and Black Caribbean / White and Black African / White and Asian / any other mixed race background (please specify)
Asian or Asian British / Indian / Pakistani / Bangladeshi / any other Asian background (please specify)
Optalis seeks to make reasonable adjustments to the work environment and work practice in need to promote the employment of people with disabilities. To assist us in fulfilling our obligations under the Equality Act 2010, please answer the following question:
Do you consider you have a disability or impairment? Yes /No (If yes, please provide details)
Printed Signature:
Date:

Optalis is a local authority trading company owned by and delivering adult social care on behalf of
the Royal Borough of Windsor and Maidenhead and Wokingham Borough Council

Trinity Court, Molly Millars Lane, Wokingham, Berkshire, RG41 2PY (0118) 977 8600

Optalis Ltd. 7630156