Please return completed form to:
Riverside Business Centre
Suites 1 & 5
Foundry Lane
Milford
Belper
Derbyshire
DE56 0RN / Esland Group Ltd
Riverside Business Centre, Suites 1 & 5,Foundry Lane, Milford, Derbyshire, DE56 0RN
Tel: 01773 823989

APPLICATION FOR EMPLOYMENT

PERSONAL DETAILS

Surname: / Title:
Forename(s): / Date of Birth:(Due to the nature of the Service and Regulations only age 21+ are eligible to apply).
Name by which you like to be known: / Previous surname if applicable:
Address: / Home telephone number:
Mobile telephone number:
Work telephone number: / May we use this number?
Yes No
Postcode: / Email address:
Which contact method/number do you prefer? Email / Post / Telephone (home/mobile/work)* delete as appropriate
Position applied for: / Location:
Where did you hear of this vacancy / Do you know anyone who works for Esland Group? If so who?
Please state your professional registration or certificate number, date of issue and expiry (where applicable) e.g. NMC/DfES/ISA/
National insurance number:
Do you require a work permit * to work in this country? Yes No
If yes, please detail any conditions attached to your work permit:
Will you be working as a dependant on another persons work permit? Yes No
* Work Permits and Limited leave to Remain are not transferable between employers and any job offer made will be subject to obtaining a new work permit. Any documents provided by applicants in support of their application may be shown to the Home Office.
Do you hold a current full UK driving licence?
Yes No / Do you have any current endorsements?
Yes No
Safer Recruitment
Please give details of any allegations against you (that did not result in any disciplinary action in any of your current or previous employment)
Company
Date
Allegation
Explanation
Company
Date
Allegation
Explanation
Please give details of any disciplinary action that has been taken against you in any of your current or previous employment
Company
Date
Warning
Explanation
Company
Date
Warning
Explanation
If more than 2 x disciplinary offences, please write on separate sheet of paper and attach to this application form.
Safer Recruitment Continued
Many of the posts within Esland Care are exempt from the Rehabilitation of Offenders Act and you will be asked to disclose spent convictions as a result of this.
At this stage however please detail any cautions or convictions that are not spent under the Rehabilitation of Offenders Act, including any imminent cautions or convictions that are due to appear on your record:
Date:
Detail of:
Outcome:
If this question does not apply to you, please highlight/circle Not applicable
Esland Care is able to offer employment after an enhanced DBS check has been successfully completed (Care Standards Act 2000). Enhanced Disclosure for ALL staff at ALL levels apply.
I am aware that if listed on the POVA Register it is an offence to apply for work with the Vulnerable Adult / Child group and it could necessitate referral to the Local Authorities and / or Secretary of State.
Signed: Date:
I understand that failure to disclose information or the provision of incorrect information may result in an offer of appointment being withdrawn or in disciplinary action being taken leading to dismissal at a later date. I agree to you approaching any of my previous employers to verify my employment history.
All offers of employment are subject to satisfactory references and DBS check. If the company are not satisfied we will withdraw an offer of employment.
I agree that, if I am appointed, the information may be used as part of the permanent personnel record of my employment under the Data Protection Act.
I CERTIFY THAT I HAVE READ AND UNDERSTOOD THE ABOVE AND THAT THE INFORMATION I HAVE GIVEN IS TRUE AND CORRECT.
Signature: Date:

Any appointment to the vacancy for which you are applying will be subject to a Disclosure from the Criminal Records Bureau / Scottish Criminal Records Office, which is satisfactory to the Company. A conviction will not necessarily be a bar to obtaining a position

Overseas check
Were you born outside the UK? (this includes Scotland or Northern Ireland) Yes No
Have you ever lived abroad for more than one month? Yes No
Have you ever travelled abroad for more than one month? Yes No
Have you ever worked abroad?*Yes No *This must be included in your employment history with country detailed.
If you have answered yes to any of the above questions, please give full details below:
Example:
Country / Details / Date from Date to
Scotland / I was born in Scotland and lived in Scotland until I was 20. / Birth 14/02/89 18/02/09
Egypt / I worked as a holiday rep in Egypt. / 19/02/09 01/03/11
Germany
Italy
France / I travelled around Europe for 2 months. / 01/04/11 01/06/11
Country / Details / Date from Date to

If necessary, please continue on a separate sheet (headed with your name)

Education
Name and location of secondary schools, colleges and university / Qualifications and grades obtained / Date from Date to
Vocational and non vocational training
Other courses attended / Qualifications/skills obtained / Date from Date to
Details of membership of professional bodies:

Please note that you will be required to provide original certificates at interview stage.

Updated Dec 2016

EMPLOYMENT DETAILS Example

Please provide details of all your employment history (from leaving fulltime education and including temporary and voluntary work) putting your current or most recent employment first. For regulatory reasons, please explain any gaps in employment history e.g unemployed, looking after family, illness and include any service within HM forces.

Please ensure you have written the Month and Year From and To for all employment.

References: Upon successful Offer of Employment, Esland will write to your 2 x most recent employers. If one of these employers was for less than 6 months, Esland will also write to the next most recent employer. If you are happy for Esland to write to your most recent employer before an offer of employment is made, please tick the following box

If you worked in Care previously to your 2 x most recent employers, Esland will also request a reference from this company.

An example of how to complete full employment history this is below:

Dates / Employer’s name, address and telephone number / Job title and main responsibilities / Reason for leaving / Referee Details
(Name, Email, Tel)
From
mm/yy / To
mm/yy
03/14 / To date / ChildrenPlus Homes
55 Midland Street, Derby, DE55XT
01332 000 111 / RCP – sleep ins, complete relevant paperwork, update log books. Take children out on supervised visits. Take children out on activities. Complete petty cash tasks. Clean the home. Set rewards for the children. Calm the children down when getting stressed. De-escalate the situation. / To further my career / HR Department

01332 000 111
04/12 / 12/12 / Kiddie Youth Centre
61 London St, London, SW112EN / RCP – Create activities for children, manage timetables, liaise with schools. Write reports, sit in on lessons. Manage challenging behaviour / To work in residential care / R. Ball, Manager

0207 946 1111
01/12 / 03/12 / Unemployed / n/a / n/a / n/a
09/10 / 12/11 / Tesco, Market Place, Heanor, Derbyshire, DE55XT
01332 555 111 / Cashier – serve customers, use a till, handle money. Answer queries, / Made redundant / Fred Smith, Store Mgr.

01332 555 111 ext 222
06/10 / 09/10 / Left full time education and was looking for work / n/a / n/a / n/a
01/09 / 06/10 / Teddybear Soft Play
11 London Rd, Middlesex, TW11 111.
0208 947 5111 / Part Time position whilst doing my A levels
Cashier, handled money, completed paperwork. / to start a career / P.Ting, Manager.

0208 947 5222

EMPLOYMENT DETAILS

Dates / Employer’s name, address and telephone number / Job title and main responsibilities / Reason for leaving / Referee Details
(Name, Position, Email, Tel)
From
mm/yy / To
mm/yy

EMPLOYMENT DETAILS CONTINUED

Dates / Employer’s name, address and telephone number / Job title and main responsibilities / Reason for leaving / Referee Details
(Name, Position, Email, Tel)
From
mm/yy / To
mm/yy
If successful in this application will you continue with any current employment? Yes No If “Yes” for how many hours per week? ______
Current notice period:
Date first employed in Social Care (if applicable):

If necessary, please continue on a separate sheet (headed with your name)

Updated Dec 2016

ADDITIONAL INFORMATION

This section should be used to state the reasons you are applying for this post and to give any additional information that you believe will demonstrate your suitability for the post.
Please continue on separate sheet if required

I confirm that everything I have written on this application form is a true.

Print Name:Signature:

Date:

Updated Dec 2016