If you require this form in a different format (large print, or printed on different coloured paper), please contact Esther Coules

APPLICATION FOR EMPLOYMENT

The information on this form will be regarded as strictly confidential
Position Applied for:

Office Use only. Department: Ref No:

PERSONAL DETAILS
Last Name: / First Name:
Address:
Postcode:
Home Telephone No. / Daytime Contact No.
E-mail address:
Driving Licence
Do you hold a full, clean driving licence valid in the UK? / Yes  / No 
EDUCATION/QUALIFICATIONS
(academic qualifications achieved, e.g. GCSE’s, NVQ’s, BTEC, ‘A’Level, Diploma, Degree, etc.)
Subject / Grade Achieved / Year Obtained
TRAINING/PROFESSIONAL QUALIFICATIONS
Please use the space below to give details of any professional qualifications, training or non-qualification based development which is relevant to the post and supports your application.
Course/Subject / Duration / Outcome / Date Completed
Current Membership of any Professional Body/Organisation
Please give details:

EMPLOYMENT HISTORY

Please note a FULL employment history is required, including any breaks in employment you may have had, along with the reasons for those breaks. We understand that this may require you to use separate sheets and would ask that any additional sheets be numbered sequentially where inserted. Please include any previous experience (paid or unpaid), starting with the most recent first.

Current or most recent employer

Name of Employer:
Address:
Post Code
Position Held:
Date Started: / Leaving Date:
Reason for Leaving:
Salary on Leaving this post / Contact Name of Line Manager for reference:
Period of Notice
Required:

Previous Employer

Name of Employer:
Address:
Post Code
Position Held:
Date Started: / Leaving Date:
Reason for Leaving:

Previous Employer

Name of Employer:
Address:
Post Code
Position Held:
Date Started: / Leaving Date:
Reason for Leaving:

Previous Employer

Name of Employer:
Address:
Post Code
Position Held:
Date Started: / Leaving Date:
Reason for Leaving:

ADDITIONAL INFORMATION

Please give any additional information you consider important (including details of previous positions, relevant experience and why you think you should be considered for the post) and any special interests or activities. Please use this section to demonstrate how your experience, skills and knowledge meet the required essential and desirable qualities described in the person specification. (If necessary, please continue on separate sheets and state how many pages are attached.).

Continue on separate sheet if necessary

DISABILITY

Do you consider yourself to have a disabilityYes  No 
If you require any reasonable adjustment to be made in order to attend interview, please contact Kate Young.

REHABILITATION OF OFFENDERS ACT 1974(Exemptions Order 1975)

Because the nature of the work involves direct or indirect contact with vulnerable adults who are receiving treatment, we are obliged to ask you, in connection with this application, to disclose:

  • Any conviction for which you have received a custodial or non-custodial sentence
  • Any investigation or charges made against you, whether as an adult or juvenile
  • Any criminal record held against you, including cautions

Under the conditions of the above order, you are not entitled to withhold any information which otherwise might be considered ‘spent’. In the event of employment, failure to disclose such information could result in dismissal or disciplinary action. Any information given will be treated as strictly confidential and will only be used in relation to an application for positions to which the exemption order applies.

Do you have anything to declare?Yes ☐ No ☐

If yes, please list details e.g. date, type of offence/sentence/fine imposed/caution etc. If necessary, please continue on separate sheets and state the number of sheets attached

REFERENCES

Please give the detail of two references – An offer of employment is subject to suitable references being obtained. A reference will not be sought from your current employer without your prior agreement.
Name of Referee:
Address:
Postcode:
Telephone No.
E-mail address:
Name of Referee:
Address:
Postcode:
Telephone No.
E-mail address:
PERSONAL DECLARATION
I declare that the information on this form is to the best of my knowledge, true and complete. I understand that any wilful false statement or omission may render me liable to dismissal if engaged and that any appointment will be subject to receipt of satisfactory references, DBS (formerly CRB) check and other enquiries. I declare that I am physically and mentally fit and able to undertake this role as detailed in the job description. I understand that it is my responsibility to inform my employer of any condition that affects my fitness to work.

Signature Date
If you submit this form electronically, you will be required to sign a paper copy if you are shortlisted for interview

Please return completed form to:

Esther Coules

HR Administrator

Broadreach

465 Tavistock Rd

Plymouth

Devon

PL6 7HE

01752 790000

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