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Information in support of Application for Employment

It is important that this form is completed accurately. The Northam Care Trust is unable to interview an applicant prior to this form being completed.

Please state all the details of the position your are applying for below, to include; position, location and service. If you are open to working more than one location or service, please state as so.

Personal Details

The Asylum and Immigration Act 1996 makes it illegal to employ a person who is not entitled to live or work in the UK.

It is a requirement for some roles that you are licensed to drive a vehicle:

Employment History

We need the following information for each of your previous employments. Employers name, address, telephone number and nature of business. The dates of your employment, your main duties and responsibilities, your salary or rate of pay. Your notice period and reason for leaving/wanting to leave.


All offers of employment are subject to receipt of satisfactory written references. Please provide details of two referees, one of whom must be your present or most recent employer, or an academic referee if more appropriate. It may also be necessary to contact any of your previous employers for a reference. The second reference will preferably be a previous employer or if your previous employer no longer exists or if there are breaks in your employment history over the past three years, please give the name of a responsible person (someone who holds a professional qualification or position in public office) to act as a personal referee. Your personal referee must not be related to you and must have known you for at least three years.


I understand that if I have deliberately used misleading information to gain employment within The Northam Care Trust, then I may be instantly dismissed at a later date. The information contained in this application form is, to the best of my knowledge, correct, and gives an accurate representation of my application and employment history. I authorise The Northam Care Trust to process this application in accordance with the Data Protection Act 1998.


Rehabilitation of Offenders Act 1974

The Northam Care Trust will undertake an enhanced DBS check on all its employees and volunteers

Applicants are not entitled to withhold information about convictions, cautions/reprimands/warnings which for any other purposes are 'spent' under the provisions of The Act. In the event of employment, any failure to disclose such convictions could result in dismissal.

Any information given will be confidential and will be considered only in relation to an application for positions to which The Order applies. Therefore, please state below, any convictions, and cautions/reprimands/warnings spent or otherwise. Please note that not all criminal offences will preclude you from this post.

Have you been convicted of a criminal offence, cautioned, or are currently the subject of any police investigations, which might lead to a conviction, or a caution in the UK or any other country?

If YES, please provide details of the criminal offence, including approximate date, the offence, and the authority and country, which dealt with the offence.

Convictions, Cautions/Reprimands/Warnings


I understand that if I am offered employment, it is on condition that any future convictions or cautions for a criminal offence be notified to my manager immediately. Each case would be taken on its merits and suspension or dismissal would not automatically follow. Failure to disclose, however, may result in dismissal.

I hereby declare that the information given here is true. Fabrication of any other information may also lead to dismissal at a future date.

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