Application for Employment

Job Role Details

Post Title:(Required)

Closing Date:

Personal Details

Name:(Required)

Prefix First Last

Address:

Street Address Address Line 2 Town / City County Postcode

Home Tel:

Mobile:

Email:(Required)

National Insurance No.

Educational Qualifications

Please give details of secondary, further and higher Education qualifications achieved. Start with the most recent.

Name and location of School/College/University:

Dates of study:

Subject & type of qualification or course:

Grade:

Add more Educational Qualifications?

No

Yes

Educational Qualifications 2

Name and location of School/College/University:

Dates of study:

Subject & type of qualification or course:

Grade:

Add more Educational Qualifications?

No

Yes

Educational Qualifications 3

Name and location of School/College/University:

Dates of study:

Subject & type of qualification or course:

Grade:

Add more Educational Qualifications?

No

Yes

Educational Qualifications 4

Name and location of School/College/University:

Dates of study:

Subject & type of qualification or course:

Grade:

Care Qualifications

Please list below any Care related qualifications (and the level of the qualification) that you hold or are currently working towards, for example, Health and Social Care Diploma’s / NVQ’s.

Date:

Qualification Title:

Level:

Organiser:

Add more Care Qualifications?

No

Yes

Care Qualifications 2

Date:

Qualification Title:

Level:

Organiser:

Add more Care Qualifications?

No

Yes

Care Qualifications 3

Date:

Qualification Title:

Level:

Organiser:

Add more Care Qualifications?

No

Yes

Care Qualifications 4

Date:

Qualification Title:

Level:

Organiser:

Training

Please list below relevant job-related training you have undertaken, and any professional qualifications achieved.

Date:

Course Title:

Organiser:

Length:

Add more Training?

No

Yes

Training 2

Date:

Course Title:

Organiser:

Length:

Add more Training?

No

Yes

Training 3

Date:

Course Title:

Organiser:

Length:

Add more Training?

No

Yes

Training 4

Date:

Course Title:

Organiser:

Length:

Present Employer

Are you currently employed?

No

Yes

Employer Name:

Employer Address:

Street Address Address Line 2 Town / City County Postcode

Post Title:

Brief outline of duties:

Email:

Phone:

May we contact them on this number?

No

Yes

Salary:

Date appointed:

Hours per week:

Reason for leaving:

Notice period:

Previous Employment

We are required by law to have a full record of your employment history from the time you left school. Any breaks in employment must be accounted for in the next section.

Employer’s name:

Job title:

Date started:

Date left:

Address:

Street Address Address Line 2 Town / City County Postcode

Brief outline of duties:

Reason for leaving:

Salary:

Hours:

Add another previous employment?

No

Yes

Previous Employment 2

Employer’s name:

Job title:

Date started:

Date left:

Address:

Street Address Address Line 2 Town / City County Postcode

Brief outline of duties:

Reason for leaving:

Salary:

Hours:

Add another previous employment?

No

Yes

Previous Employment 3

Employer’s name:

Job title:

Date started:

Date left:

Address:

Street Address Address Line 2 Town / City County Postcode

Brief outline of duties:

Reason for leaving:

Salary:

Hours:

Add another previous employment?

No

Yes

Previous Employment 4

Employer’s name:

Job title:

Date started:

Date left:

Address:

Street Address Address Line 2 Town / City County Postcode

Brief outline of duties:

Reason for leaving:

Salary:

Hours:

Add another previous employment?

No

Yes

Further Previous Employment

Please provide details of any previous employment not already mentioned:

Breaks in employment history since leaving school

Any gaps in employment since leaving school and reasons must be detailed below; this should include voluntary work, unemployment, domestic reasons, etc.

From:

To:

Reason:

Add another break in employment?

No

Yes

Break in employment 2

From:

To:

Reason:

Add another break in employment?

No

Yes

Break in employment 3

From:

To:

Reason:

Add another break in employment?

No

Yes

Break in employment 4

From:

To:

Reason:

References

Please give details of at least two referees whom we may ask about your suitability for the post. Referees must not be related to you. References may be sought prior to interview. One of these must be your current or most recent employer and if you have previously worked in the care sector you must include your last care employer.

Permission:

Please do not contact my current employer prior to interview.

Name of current or most recent employer:

Employer address:

Street Address Address Line 2 Town / City County Postcode

Job Title or Occupation:

Telephone number:

Email:

Last care sector employer (where applicable)

Employer name:

Employer address:

Street Address Address Line 2 Town / City County Postcode

Job Title or Occupation:

Telephone:

Email:

Additional Reference

Name:

First Last

Address:

Street Address Address Line 2 Town / City County Postcode

How do you know this person?

Telephone:

Email:

Details of current employment and supporting statement

Please set out below further information that you feel supports your application. This should include a description of any duties and responsibilities in your current or most recent post. Include any other experience that you feel is relevant to your application. In completing this section take as a guide the contents of the job description and person specification of the post for which you are applying.

Further information:

Other Information

Are you related to or have a personal relationship with anyone who works Condover College Ltd now or in the past?(Required)

No

Yes

Please provide details

Name:

Relationship:

Important notice: Please read

CCL is committed to providing equality of opportunity in all applicants. We welcome all applications from people who feel they are able to carry out the required duties regardless of previous experience. Successful applicants will be asked to provide an Enhanced Disclosure Certificate, detailing all current criminal convictions against your name, as supplied on application from The Disclosure Barring Service (DBS). Disclosure information will not be used for any other purpose than in connection with this application and a criminal record will not necessarily be a bar to employment.

Disciplinary Matters

Have you been subject to any Disciplinary investigation or action including suspension from duty during your periods of employment with any employer?(Required)

No

Yes

Please provide details below of action taken. Include any pending investigation:

Right to work in the UK

All employers are subject to a legal requirement under the Immigration, Asylum and Nationality Act 2006 to check that anyone to whom they offer employment has the right to work in the UK. You will need to provide satisfactory documentation to prove your right to work in the UK.

Do you have the right to work in the UK?(Required)

No

Yes

Are there any restrictions on your right to work in the UK?(Required)

No

Yes

If yes, please provide details of your driving convictions:

Criminal Convictions

This post is Exempt under the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (as amended in 2013 and 2020).

The amendments to the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (2013 and 2020) provides that when applying for certain jobs and activities, certain convictions and cautions are considered ‘protected’. This means that they do not need to be disclosed to employers, and if they are disclosed, employers cannot take them into account.

Guidance about whether a conviction or caution should be disclosed can be found on the Ministry of Justice website.

Do you have any unspent conditional cautions or convictions under the Rehabilitation of Offenders Act 1974?(Required)

No

Yes

Please provide full details:

Do you have any adult cautions (simple or conditional) or spent convictions that are not protected as defined by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (Amendment) (England and Wales) Order 2020?(Required)

No

Yes

Please provide full details:

Please note

It is illegal for somebody who is on one of the Barred Lists to attempt to work or volunteer in regulated activity with the group that they are barred from.

Additional Details

Do you hold a current full driving licence valid in the UK?(Required)

No

Yes

Do you have any driving convictions?(Required)

No

Yes

Please provide details:

Guaranteed interview for applicants with disabilities

We have made a commitment to improve employment opportunities for people with disabilities and have adopted the Employment Department’s two ticks symbol ‘Positive About Disabled People’. This means that Condover College Ltd has undertaken to guarantee an interview to all applicants with a disability who meet the essential requirements of the job as contained in the person specification.

Do you consider yourself to be a disabled person?

No

Yes

Do you require any support or adjustments to enable you to take part in the selection process for this job?

No

Yes

Please provide details:

Your Health

The Care Homes Regulations require that all employees who work in care homes are both physically and mentally fit to undertake their duties if you are successful you will be asked to complete a declaration to this effect.
We encourage all staff, who are not medically exempt, to have the Covid-19 vaccination, which is offered to frontline care workers as a priority group. We further encourage all colleagues to remain fully vaccinated as part of our wider infection control procedures.

Data Protection Act

All of the information collected in this form is necessary and relevant to the performance of the job applied for. We will use the information provided by you on this form, by the referees you have noted, and the educational institutions with whom we may undertake to verify your qualifications with, for recruitment purposes only. CCL will treat all personal information with the utmost confidentiality and in line with current data protection legislation.

Should you be successful in your application, the information provided, and further information which will be gathered at the relevant time, will be subsequently used for the administration of your employment and in relation to any legal challenge which may be made regarding our recruitment practices.

Your Signature

I certify that details provided on this form and supporting papers are true. I understand that the provision of false or misleading information given in response to any questions on this form or failure to disclose information will result in the termination of any contract of employment entered into, or the withdrawal of any offer of employment. I also hereby give my explicit consent to the processing of data contained or referred to on this from, in accordance with the Data Protection Act 2018 and any amending legislation.

Name of applicant:(Required)

Date:(Required)