Information in Support of Application for Employment

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

Position Details

Personal Title

First name

Last name

Multi-line address

Country/Region

Address

Address - line 2

City

Zip / Postal code

Email

Phone

Date of Birth

Are you entitled to live and work in the UK?

Yes

No

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:

Do you hold a UK full driving license?

Yes

No

Do you have the use of a vehicle?

Yes

No

Do you have business insurance?

Yes

No

For some roles, you may be required to have business insurance.

Employment History

Current Employment

Reason for leaving current employment

Other employment history since leaving education

Please include dates of employment and duties / responsibilities.

References

All offers of employment are subject to the receipt of satisfactory written references. One reference must be your present or most recent employer, or an academic referee if more appropriate. The second reference will preferably be a previous employer; alternatively, this can be 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.

Referee 1 Name

Referee 1 Job Title

Referee 1 Company Name

Referee 1 Address

Referee 1 Email

Referee 1 Contact Number

Referee 1: Capacity Known To You?

May we contact referee 1 prior to job offer?

Yes

No

Referee 2: Name

Referee 2: Job Title

Referee 2: Company Name

Referee 2: Addess

Referee 2: Email

Referee 2: Contact Number

Referee 2: capacity know to you?

May we contact referee 2 prior to job offer?

Yes

No

Declaration

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.

Sign Full Name

Tick to agree with the misleading information declaration.

DBS DECLARATION STATEMENT CONFIDENTIAL

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.

Conviction 1:

Conviction 1 Date

Conviction 1 Explanation

Conviction 1 Sentence

Conviction 2:

Conviction 2 Date

Conviction 2 Explanation

Conviction 2 Sentence

Conviction 3:

Conviction 3 Date

Conviction 3 Explanation

Conviction 3 Sentence

Any other convictions

Convictions, Cautions/Reprimands/Warnings

Everything Declared

No Previous

Declaration

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.

Full Name

Tick to agree the convictions declaration

When you press submit, please wait for a pop up confirming your submission before leaving the page. You will also receive an automated email confirming your submission. If this doesn't arrive within 24hrs, please email us to ensure that your application was successfully received. Thank you.