JOB APPLICATION FORM

Please contact us if you require this application form in a different format or require any adjustments at interview

Please ensure the finished form issigned, dated and returned to the address given at the end of the form.

Job title:
Where did you see this post advertised?
YOUR DETAILS / Are you over 18?:
Title: / First name: / Middle names: / Surname:
Current:
Previous
(if any):
Home address:
POST CODE:
Home Telephone (inc. code):
Mobile (where possible):
email address (where possible):
Do you hold a current full, clean driving licence? / Yes/No / Details if no:
Do you declare yourself physically and mentally fit to carry out the role for which you’ve applied? / Yes/No
*If you answer No please supply details on a separate sheet of paper.
Do you declare that you have no criminal convictions? / Yes/No
*If you answer No please supply details on a separate sheet of paper
Are there any restrictions regarding your employment?
e.g do you require a Work Permit? / Yes/No
*If you answer Yes please supply details on a separate sheet of paper
EMPLOYMENT EDUCATION – please explain any gaps
How much notice do you need to give to your current employer?

Please start with your most recent employment. Briefly describe the main duties and responsibilities of your post. If you wish to expand on specific areas of responsibility, please do so in Section 5: Experience /skills.

1. Current/most recent employer/organisation
Name:
Address:
Job Title: / From: / To:
Brief description of duties:
Reason for leaving/changing:
2. Employer/organisation
Name:
Address:
Job Title: / From: / To:
Brief description of duties:
Reason for leaving/changing:
3. Employer/organisation
Name:
Address:
Job Title: / From: / To:
Brief description of duties:
Reason for leaving/changing:
4. Employer/organisation
Name:
Address:
Job Title: / From: / To:
Brief description of duties:
Reason for leaving/changing:
5. Employer/organisation
Name:
Address:
Job Title: / From: / To:
Brief description of duties:
Reason for leaving/changing:

Please tell us about your education and any qualifications which you feel are relevant to the post. Include relevant courses which you are currently undertaking. Please start with the most recent.

Name of school/college/ university/training body / Subjects studied / Qualification/ Level / Date gained / Original
certificate seen

Training

Please list any training you have received or courses which did not lead to a qualification but which you feel are relevant to the advertised post.

Training Course / Date / Original certificate seen

Experience / Skills

This section is for you to give specific information in support of your application.
Your experience need not have been gained in paid employment and may include special interests relevant to the post. It is important that you provide evidence of your achievements by giving examples to support your application.

Proof of identity/skills/qualifications etc

If you are invited to interview, you must please bring original documents of each document with you.

Item / What is required / Original seen – office use
Verification of identity / Either passport, driving license or birth certificate
Driving license / Both parts
Qualifications/training / Originals of certificates

next of kin

Please give the name, address and contact number of someone we would contact in an emergency

Name:
Address:
Tel:

references

Please give name, address and position/occupation of two referees. One must be your present or most recent employer. References will only be taken up for the successful candidate. Testimonials or references from friends and relatives are not acceptable.

1. Name:
Position:
Organisation:
Address:
Tel:
2. Name:
Position:
Organisation:
Address:
Tel:

declaration and signature

The information supplied in this application form is accurate to the best of my knowledge.
......
SignedDate

By signing and returning this application form you consent to SARACEN CARE SERVICES using and keeping information about you provided by you – or third parties such as referees – relating to your application or future employment. This information will be used solely in the recruitment process and will be retained for six months from the date on which you are informed whether you have been invited to interview, or six months from the date of interview. Such information may include details relating to ethnic monitoring and disability: these will be used solely for internal monitoring and will not be disclosed to any third party, other than the National Minimum Data Set (NMDS) for social Care.

Thank you for completing the form. Please return it to Saracen Care Services, 114 Bath Road, Cheltenham GL53 7JX (Tel - 01242 515162) or