Care and Case Management Services Ltd APPLICATION FOR EMPLOYMENT

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1 CCMS, The Old Smithy 1 North Road, Stokesley North Yorkshire, TS9 5DU Tel: Care and Case Management Services Ltd APPLICATION FOR EMPLOYMENT Please complete the application form and it to Alternatively, you can return to the above address. FULL NAME (Block Capitals) POSITION APPLIED FOR SWTS3 If you wish to apply for a job with CCMS you must complete this form. The information you give will be treated in confidence and will be seen only by persons employed by the Company who need to use it, in the course of their work. The information is asked for because: It helps the Company in deciding whether to take your application further. It will be used as the basis for your employment records should your application be successful and you join the Company CCMS Ltd is committed to Safeguarding and Protecting Vulnerable Adults and Children. As such, all successful applicant s identities and their right to work in the UK will be thoroughly checked and an Enhanced DBS will be undertaken alongside a Protection of Vulnerable Adults check, if required. For Office Use Only Page 1 of 9

2 PERSONAL DETAILS PLEASE COMPLETE THIS PAGE IN BLOCK CAPITALS BASIC INFORMATION Preferred Name Surname Forenames Mr / Mrs / Miss / Ms / Other (please indicate) Current Address (incl. Postcode) All previous surnames Telephone No: (inc Code) Mobile No: Address: DRIVING INFORMATION Do you hold a current UK Driving License? YES NO Do you own your own vehicle? YES NO Do you have current endorsements/penalty points? YES NO (if yes please give details) OTHER INFORMATION Have you ever been found guilty by a Court of Court Martial of any offence, which is not treated as spend under the Rehabilitation of Offenders Legislation, or, is any case against you pending? YES NO (if yes please give details) (unspent convictions will not necessarily bar you from employment). Have you admitted or committed any offence for which you have been cautioned or convicted by the Police or a Government Body? YES NO (if yes please give details) (unspent convictions will not necessarily bar you from employment) Are you, or have you been, on the Protection of Children Act (POCA) List or Protection of Vulnerable Adults (POVA) List? (if yes please give details) YES NO Have you been subject to any disciplinary proceedings? (if yes please give details) YES NO Page 2 of 9

3 EDUCATION AND TRAINING PLEASE INFORM US OF LEARNING ACQUIRED TO DATE (You are welcome to continue on additional sheets if necessary) EDUCATION AND QUALIFICATIONS School Subject/Qualifications/Level Date Achieved Page 3 of 9

4 FIRST DEGREE COURSE/ HIGHER DEGREES/ POST GRADUATE/PROFESSIONAL QUALIFICATIONS: Qualification(s) Gained Main Subjects studied Full/Part time From/To University/ College TRAINING Employer Training Course From/To MEMBERSHIP OF PROFESSIONAL ORGANISATION Organisation Grade of Membership Page 4 of 9

5 EMPLOYMENT PLEASE PROVIDE DETAILS OF PRESENT/PAST EMPLOYMENT Are you currently employed YES NO If NO, how long have you been unemployed? If YES please state 1. Notice required by present employer 2. May we contact your present employer YES NO 3. Current salary / Hourly rate Please complete the following section in date order beginning with your current/most recent employer. You must complete details of ALL your employment since leaving full time education including all start and finish dates. Please also account for any gaps in your employment history, e.g. dates of unemployment or at home with your family, etc. (You are welcome to continue on additional sheets if necessary) Dates From / To Employers full name, address and telephone number Job Title and brief resume of tasks and responsibilities Reason for leaving (including dismissal or resignation) Page 5 of 9

6 Dates From / To Employers full name, address and telephone number Job Title and brief resume of tasks and responsibilities Reason for leaving (including dismissal or resignation) Page 6 of 9

7 THIS IS YOUR OPPORTUNITY TO TELL US MORE ABOUT YOURSELF AND YOUR SUITABILITY FOR THE POST YOU ARE APPLYING FOR What skills and experience can you bring to the job? What outside interests and activities do you pursue? Please include any other information that you feel is relevant to this application and state why you are applying for this post? (You are welcome to continue on additional sheets if necessary) Page 7 of 9

8 REFERENCES Current Employer:- Name: Job title: Address: Incl. Postcode Tel no (incl code): Previous Employer:- NB If no previous employer, please state details of character reference, etc Name: Job title: Address: Incl. Postcode Tel no (incl code): Employment with the Company is subject to satisfactory written/verbal references being obtained from your current and previous employers. Unless agreed otherwise, the Company may contact your current employer before you have accepted an offer of employment DECLARATION OF APPLICANT In line with the Immigration, Asylum and Nationality Act 2006, I hereby confirm I have a right to work in the UK and will provide documentary evidence upon request. I understand that giving any incorrect or misleading information, or any omission made with the intention of misleading the Company, could lead to my dismissal Signature: Date: Page 8 of 9

9 EQUAL OPPORTUNITIES MONITORING We are committed to ensuring that all job applicants and members of staff are treated equally, without discrimination because of gender, sexual orientation, marital or civil partner status, gender reassignment, race, colour, nationality, ethnic or national origin, religion or belief, disability or age. This form is intended to help us maintain equal opportunities best practice and identify barriers to workforce equality and diversity. The information on this form will be used for monitoring purposes only and will not be used in any decision affecting you. All questions are optional. You are not obliged to answer any of these questions. All information supplied will be treated in the strictest confidence. Thank you for your assistance. Please state which job you have applied for and the closing date given for applications Job applied for Closing Date Where did you hear about this job? Newspaper Job Centre Friend GENDER what is your gender? Male Female Prefer not to say ETHNIC GROUP how would you describe your nationality and/or ethnicity? Company website Other (please specify) White A B C D E Asian or Asian Black or Black Mixed Race British British British (English, Scottish, Welsh) Irish Prefer not to say White and Black Caribbean White and Black African Chinese and other Groups Indian Caribbean Chinese Pakistani African Other black Other ethnic group WHAT IS YOUR AGE? Prefer not to say RELIGION OR BELIEF Please describe your religion or other strongly-held belief: I would describe my religion as I have no particular religion or belief Prefer not to say DISABILITY The Equality Act 2010 defines a disability as a physical or mental impairment which has a substantial and long term adverse effect on a person s ability to carry out normal day-to-day activities. An effect is long-term if it has lasted, or is likely to last, more than 12 months. Do you consider that you have disability under the Equality Act? Yes No Don t Know Used to have but have now recovered Prefer not to say Page 9 of 9