Elementor #722 – LifeCare4u

EMPLOYMENT APPLICATION FORM

Name *

First

Middle

Last

Address *

Address Line 2

City *

County *

Country *

Post Code *

Email *

Date Of Birth *

Phone Number *

NI Number

POSITION APPLIED FOR: *

I am seeking a: *

Full Driving Licence? *

Own Transport? *

Endorsements? *

* If YES, please give further details below including dates.

Are you involved in any activity which might limit your availability to work or your working hours e.g., local government? *

If YES, please give full details below.

Please list any endorsement(s) and penalty point(s) put on your driver record including dates.

Please list any endorsement(s) and penalty point(s) put on your driver record including dates.

Please list any activity which might limit your availability to work or your working hours e.g., local government?

Please list any activity which might limit your availability to work or your working hours e.g., local government?

Are you subject to any restrictions or covenants which might restrict your working activities? *

* If YES, please give further details below including dates.

Are you willing to work overtime and weekends if required? *

* If YES, please give further details below including dates.

Please list any restrictions or covenants which might restrict your working activities?

Please list any restrictions or covenants which might restrict your working activities?

Please list any days you are willing to work overtime and weekends if required?

Please list any days you are willing to work overtime and weekends if required?

Are there any hours or days which you would not wish to work? *

Please give details of any hours or days which you would not wish to work:

Do you have any convictions (other than spent convictions under the Rehabilitation of Offenders Act 1974)? *

* If YES, please give further details below including dates.

Are there any hours or days which you would not wish to work?

Please list any hours or days which you would not wish to work.

Do you have any convictions (other than spent convictions under the Rehabilitation of Offenders Act 1974)?

Please list any convictions (other than spent convictions under the Rehabilitation of Offenders Act 1974).

Have you ever worked for this Company before? *

* If YES, please give further details below including dates.

Have you applied for employment with this Company before? *

* If YES, please give further details below including dates.

Have you ever worked for this Company before?

Please list any positions held & dates you worked.

Have you applied for employment with this Company before?

Please list any info in regards to that application.

How did you find out about this position? *

* If Other, please give further details below.

Single Line Text

Do you need a work permit to take up employment in the UK? *

How much notice are you required to give to your current employer?

Week(s) Notice: 0

You may be required, if offered employment, as part of your application to complete a Pre-Employment Medical Questionnaire. Are you prepared to undergo a medical examination prior to employment? *

List any foreign languages spoken & fluency.

Example: Urdu from India - Fluent. ¬Lingala from DR Congo - Proficient. ¬Otomi from Mexico - Novice.

EDUCATION:

School(s) attended

Start Date - End Date

Examination(s) and Result(s)

Certificate(s)/Qualification(s)

College / Formal Training

Start Date - End Date

Courses and Results

Certificate(s)/Qualification(s)

University

Start Date - End Date

Courses and Results

Diploma(s) / Degree(s)

Please give details of membership of any technical or professional associations:

EMPLOYMENT DETAILS:

Company Name *

First

Last

Address Line 1

Address Line 2

City

Post Code

Length of Service:

May we contact this employer? *

Reason for leaving

Job Description

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

Company Name *

First

Last

Address Line 1

Address Line 2

City

Post Code

Length of Service:

Dropdown

Reason for leaving

Job Description

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

SUPPLEMENTARY INFORMATION:

Please set out above any further information to support your application, e.g. past achievements, future aspirations, personal strengths.

REFERENCES:

Please give the names of two people (one of which should be your present or most recent employer) whom we may approach for a reference.

Name

Name

Position

Position

Address

Address

Post Code

Post Code

Phone Number

Phone Number

Email *

Email *

DECLARATION UNDER THE PROTECTION OF FREEDOMS ACT 2012: The post for which you are applying is a ‘regulated activity’ within the meaning of Part 5 Chapter 1 of the Protection of Freedoms Act 2012 and it is a criminal offence for a ‘barred person’ to apply to work in a regulated activity. If you are a barred person, you must not proceed with this job application. If your application is successful, you will be required to co-operate with us in obtaining a disclosure of criminal convictions and in checking your barred status with the Disclosure and Barring Service. Any information given will be completely confidential and will be considered only in relation to the application.

Have you any information to declare?

Please give details of any declarations in respect of yourself below.

Are you a barred person?

If YES, please give details of any criminal convictions in respect of yourself below.

Declarations

Please give details of any declarations in respect of yourself above.

Criminal convictions

Please give details of any criminal convictions in respect of yourself above.

Have you had clearance from the Disclosure and Barring Service to work with vulnerable adults and children?

(If YES please give details below)

Standard or enhanced?

Who arranged this?

Can you produce a certificate to this effect?

What is your Certificate Number?

Declaration: The above information is true. I understand that any job offer made on the basis of untrue or misleading information may be withdrawn or my employment terminated.

Date Signed.

Any additional information: