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All information given will be treated in the strictest confidence and not used for any other purposes.

PERSONAL INFORMATION

Title —Mr.Mrs.Miss.Ms.etc.

(If you have a disability are there any arrangements which we can make fo you if you are called to interview?) If YES please specify:

(Are you permitted to work in the UK? YES / NO)*
YesNo

(Do you hold a valid UK driving license? YES / NO )*
YesNo

(Do you have transport? YES / NO )*
YesNo

If successful then we will contact you by text or email. Please specify your preferred method of contact EMAIL or PHONE)*
EmailPhone

EDUCATION

Please give brief reasons why you wish to be considered for the position. Please include details of experience gained in any previous paid employment as well as any relevant voluntary community-based activities, leisure interests, and training

CURRENT EMPLOYMENT (OR MOST RECENT)

Description of main duties and responsibilities

CONVICTIONS

REFERENCES

Please provide names, addresses and telephone numbers of two employers who may be contacted to act as referees, one must be your current / most recent employer. Referees will not be contacted until a job offer is made.

REFERENCE 1

Please provide names, addresses and telephone numbers of reference 1.

REFERENCE 2

Please provide names, addresses and telephone numbers of reference 2.

I confirm that all of the information given on the above form is correct and I understand that any offer of employment will be subject to two satisfactory references, satisfactory medical questionnaire/report; and satisfactory completion of disclosure and barring service and independent safeguarding authority checks in line with GDP regulations I consent to this information being stored on file and used for the purpose of employment. I understand that if necessary it may be shared with authorized legislative bodies in the event of e.g. CQC inspection. If my application is unsuccessful I understand my information will be held for a period of 6 months after which it will be confidentially destroyed.

Signature (tick checkbox)
Signed

Date

EQUAL OPPORTUNITIES

It is the company’s policy to employ the best personnel and to provide equal opportunities for the advancement of employees, including promotion and training and not to discriminate against any persons because of race, color, national origin, sex, sexual orientation, marital status, disability, age, religion or belief.

OFFICIAL DOCUMENTS

Any documents presented in support of your application for employment may be passed to the relevant authorities for verification checks.