Application for Employment

Position applied for

Date of application

1. Personal details

Surname

First names

Previous names

Address

Home Telephone No.

Work Telephone No.

National Insurance Number

Mobile No.

Immigration details

Nationality & Driving

Are you a citizen of the EU?

Yes No

Do you need a work permit?

Yes No

Current driving licence?

Yes No

Do you have a car for work use?

Yes No

Previous Employment

List your most recent jobs first.

From	To	Employer	Position	Salary	Reason for Leaving

4. Rehabilitation of Offenders Act 1974 – Notice to offenders

Because of the nature of the work involved, the post for which you are applying is exempt from Section 4(2) of the Rehabilitation of Offenders Act 1974 ... You are not entitled to withhold information relating to convictions.

Do you have any convictions to disclose?

YES NO

If yes, please give details (or attach a separate sheet)

5. Additional personal details Outside interests, leisure time activities and other personal information which you think may assist us in evaluating your application.

Signature

Date

6. References

Please give the name and address of two referees, one of whom must be your present or previous employer.

Reference 1 - Name Status Address & Telephone

Reference 2 - Name Status Address & Telephone

This organisation seeks to work in a flexible and family friendly manner with its staff, however unsocial hours are part and parcel of a quality care service. Weekend working is a requirement for all staff.

Please indicate holiday dates if already booked

Period of notice required in present post

Earliest start date

I declare that to the best of my knowledge, the information contained herein is complete and truthful.

Signature

Date

For office use only

Applicant shortlisted

Interview Date

References requested / Verbal reference check

Notes for interview / Additional notes

Equal Opportunities Monitoring

This section is detached and used for monitoring only. We are committed to treating all employees with dignity and respect.

Date of Birth

Gender

Male Female I do not wish to disclose

Ethnic origin (please select)

Religion or Belief

Sexual orientation

Health Questionnaire (for appointable applicants)

In order to comply with the Health and Social Care Act 2008 and the Equality Act 2010...

Condition	Yes / No
Epilepsy/Blackouts	Yes No
Nervous / Mental disorders	Yes No
Migraine / Headaches	Yes No
Sensory impairment	Yes No
Skin allergies	Yes No
Back pain / previous back injury	Yes No
Heart condition	Yes No
Asthmatic / respiratory ailments	Yes No
Recurring incidence of illness	Yes No

Are you registered disabled? If yes, please detail

Yes No

Please list any periods spent outside the United Kingdom as a resident (do not include holidays)

Please list any vaccinations or immunisations (date / immunisation / expiry)

Declaration (fitness to undertake post)

Signature

Date

Interview Assessment Form

Questions, notes and a 1–3 score (1 = Poor, 2 = Adequate, 3 = Exceptional)

Applicant Name

Interview Date

Interviewer(s)

Interview Questions

Scenario Questions

Interview Summary

Overall Interview Score

Candidate Banding

Agreed Start Date

Induction Date

Completed by

Bank Payment Details Form

Please fill correctly — errors may result in payment being sent to the wrong account.