Application Form

Fields marked with an asterisk (*) must be filled out before submitting

Post applied for*
If you are applying for a Carer post, pelase select preferred area

Personal Details

Name*
Surname*
Email Address*

Contact Details

Address*
City*
Postcode*
Home Tel
Mobile Tel
Work Tel
Do you own a car?*YesNo
Do you have a full driving licence?*YesNo
Do you have any endorsements? (Give Details)

Education and Training

Provide details of education and qualifications obtained from secondary school, further and higher education. Please list place of study, dates between and qualification including grades

Education / Qualifications*

Please give details of any course you have attended or specialist skills training undertaken, please List organising body, dates between and course title / subject

Work Related Training

Please start with your most recent employment and work back, giving reasons for any gaps in your employment, please list dates between, employers name, location and nature of business, and job title including an outline of duties and reasons for leaving – if part-time, state hours worked

Previous Employment*

Present Employment, or most recent if unemployed

Your Job Title
Salary
Date Commenced
Notice Required
Employer Name, Address and Nature of Business
Please give brief description of your duties
If currently unemployed, give reason for leaving and date left

Additional Information

Please use this section to describe particular skills, knowledge and experience RELEVANT TO THIS POST (including voluntary or community activity, public duties, member of professional organisation or research and published work). This section must be completed.*

Personal Statement

Please state why you consider yourself suitable for this post and why you applied for it*
Have you ever been dismissed from any employment? If yes, give details*

Health

Successful applicants will be required to complete a confidential health questionnaire

Reference / Contact with present and recent employers

Please give the name, address, telephone numbers and where appropriate the e-mail addresses of two people who have agreed to act as referees for you. One should be your most recent of present employer with whom contact can be made to verify the details of your present or most recent employment. The person should be in a management or supervisory position. The other should be a recent employer or if you do not have a suitable employment referee please provide the details of a person willing to provide you with a character reference. We will contact both referees prior to interview unless you indicate otherwise

Referee 1

Name*
Position*
Organisation
Address*
Telephone No.*
Email address

Referee 2

Name*
Position*
Organisation
Address*
Telephone No.*
Email address

Eligibility To Work In The Uk

If you are not a British or European Economic Area citizen you may need a work permit to be able to work in the UK. If you are successful in being offered a post, the University can apply for a permit for you but you may not start work without one

a) Do you need a work permit to be able to work in the UK?*YesNo
b) Are you the spouse/dependant of someone who requires a work permit or visa to work or study in the UK?*YesNo
c) Do you have a travel document, United Kingdom residence Permit or letter issued by the Immigration and Nationality Directorate of the Home Office which provides the appropriate endorsement in relation to residency and permission to work in the UK?*YesNo
If you have answered ‘Yes’ to b or c, please provide Expiry Date
If offered this position will you continue to work in any other capacity? (Give details)

Equal Opportunities

Orchard Home Care Services Ltd is committed to making its Equal Opportunities policy fully effective. To assist in monitoring this policy please complete this section. This information is not used in selection for the post

GenderMaleFemale

Disability Status: Do you have a disability which fits the definition in the Disability Discrimination Act – a physical or mental impairment which has a substantial and long term (i.e. over at least 12 months) adverse effect on your ability to carry out normal day-to-day activities?

DisabilityYesNoPrefer not to provide information

If you have a disability, and if you were shortlisted, please indicate any reasonable adjustments that would be required for you to attend the interview

Reasonable adjustments required to attend interview

Ethnic Origin: This refers to people who share the same cultural background and identity, not country of birth or nationality. Please note these categories are those used in the National Census.

White BritishWhite IrishOther White backgroundAsian or Asian British – IndianAsian or Asian British – PakistaniAsian or Asian British – BangladeshiOther Asian backgroundChineseMixed – White and Black CaribbeanMixed – White and Black AfricanMixed – White and AsianOther Mixed backgroundOther Ethnic backgroundPrefer not to provide information
Nationality

Convictions / Cautions

Successful applicants will require an enhanced Criminal Records Bureau Disclosure. This disclosure does show all cautions and convictions no matter how old they are

Have you ever been convicted of a criminal offence?*YesNo
Convictions / Cautions – if yes to above, please include date, name of court / police station / unit , offence and result
Enter details of any charge or summons at present outstanding against you, include date of alleged offence, nature of offence and court / police station / unit dealing:

Declaration

Due to the nature of the work for which you are applying, this is exempt from the provisions of the Rehabilitation of Offenders Act 1974, by virtue of the Rehabilitation of Offenders Act, (exemptions) order 1975. Applicants are therefore not entitled to withhold information about convictions which for other purposes are ‘spent’ under the provisions of the Act and, in the event of employment; any failure to disclose such convictions could result in dismissal or disciplinary action. Any information given will be completely confidential and will be considered only in relation to the application for positions to which the order applies.

PLEASE READ AND CLICK “I UNDERSTAND” AFTER YOU HAVE COMPLETED ALL PARTS OF THIS FORM I certify to the best of my knowledge that the information given on this form is correct. I understand that deliberately giving false or incomplete information would disqualify me from appointment, or in the event of discovery after appointment, make me liable for dismissal.

I understand and digitally sign this application form*