JOB APPLICATION FORM For Office Use only Name of Applicant: Area: Role: Date Application Submitted: Application Form V 2 June 2016
JOB APPLICATION FORM Before completing this application form, please read attached guidance notes which will help you to complete your application. Role Applied for : How did you hear of the vacancy? (If through a friend who works a Delta Care please confirm their ) Are you permitted to work in the United Kingdom? Yes No I require a work permit PERSONAL DETAILS Sur : Home Tel : First Name : Mobile Tel Home Address : Work Tel : Postcode : Email : DBS Number National Insurance No : Date of Birth * Do you have a full Driving Licence that allows you to drive in the UK? Yes No * Do you have access to a car that you can use for work? Yes No * Have you ever been banned from driving, or do you have any current endorsements on your licence? * Does you car insurance include Class 1 business insurance? Yes No Yes No 2
EDUCATION/QUALIFICATIONS/TRAINING Please give information about qualifications gained relating to the role you are applying for please continue on a separate sheet where necessary: EDUCATION / QUALIFICATIONS Qualifications Date Grade TRAINING (If you have undertaken any relevant training to this post please give details) Course details Date Training provider 3
EMPLOYMENT BACKGROUND (please continue on a separate sheet if necessary) CURRENT / MOST RECENT JOB Reason for leaving Salary Notice required From To PREVIOUS JOBS (PAID AND VOLUNTARY) Please detail the most recent first. Where there are gaps between jobs please indicate why, for example; continuing education, family, child care, unemployment or travelling. Continue on a separate sheet if necessary From To Employment History Continued on next page 4
From To From To 5
SHORT LISTING INFORMATION Skills and Abilities/ Knowledge & Experience/ Qualities This is an important part of the application. Tell us why you are applying for this job. You should also show how you meet the requirements of the person specification by providing details of your experience, skills & knowledge gained in employment, voluntary work or elsewhere. Please continue on a separate sheet if necessary 6
References Please provide us with two references, one of whom should be your present or most recent employer Name : Name : : : Organisation : Organisation : Address : Address : Tel Number : Tel Number : Dates from / to : Dates from / to : Capacity in which they know you (e.g. Line Manager) May we contact this reference prior to interview? Capacity in which they know you (e.g. Line Manager) May we contact this reference prior to interview? The Data Protection Act 1998 requires that any staff handling personal data on others must follow certain principles in relation to the data that they hold. Individuals have rights of access to data that is held on them and rights to claim for damages if various offences occur. This covers manual as well as computerised records. In implementing the legislation, Delta Care Ltd adopts a simple and straightforward policy that is, so far as is possible, easy to understand and unambiguous in its application. If you are unsuccessful in this application, we will keep this form on file for 6 months should you wish to be considered for other vacancies within the organisation. Please tick to show your agreement to this. Previous Application : If you have previously applied to us for work, when did you apply and what was the vacancy? Were you interviewed? Yes No If yes, what was the outcome? 7
REHABILITATION OF OFFENDERS ACT 1974 NOTICE TO OFFENDERS The position for which you are applying is exempt from Section 4(2) of the Rehabilitation of Offenders Act 1974 by virtue of the Rehabilitation Offenders Act (Exemption Order 1975). This means that you are not entitled to withhold information relating to any convictions you may have had. Delta Care Limited is required under the Health and Social Care Act 2008, to obtain a criminal record check. This will be processed through the Disclosure and Barring Service (DBS). This was formed by merging together the functions of the Criminal Records Bureau (CRB) and the Independent Safeguarding Authority. This has to be completed in relation to any person who is a domiciliary care worker. Therefore, if your application is successful we will need to obtain this Disclosure before your appointment is confirmed. Please advise us of any criminal convictions (excluding minor road traffic offences), cautions, reprimands or warnings you have received before we obtain an Enhanced Criminal Record Bureau Disclosure. Having a criminal record will not necessarily mean that you will not be able to work in the care sector but will depend on the nature of the position, the circumstances and background of your consequences. Do you have any convictions to disclose? YES NO Have you been convicted of a criminal offence or received a caution, warning or reprimand? Yes No Date of conviction, caution, warning or reprimand Details Any information should be given on a separate sheet and sent with this application form. This information will be treated as strictly confidential and will not necessarily preclude you from employment. I declare all information I have provided regarding the Rehabilitation Act 1974 is true Name: Signature: Date: 8
DECLARATION I confirm that I am eligible to work in the UK. I fully accept that I am applying for Employment within Delta Care Ltd. I declare that all the information given is true and I understand that any false or misleading information may result in my removal from Delta Care Ltd register of applicants. I consent to the processing of sensitive personal data as referred to on the front page of this form. Print Name: Signed: Date: PLEASE RETURN THE APPLICATION FORM TO: Delta Care Limited Head Office HR Department 17 Charlotte Street Preston Lancashire PR1 3RE Should you have any queries regarding the progress of your application please call : 01772 559933 and ask for HR 9