APPLICATION FOR EMPLOYMENT

PERSONAL DETAILS

Position Applied For *

Preferred Location *

Where did you hear of this vacancy? *

Surname *

Title *

Forename(s ) *

Date and place of birth *

Home Address *

Tel. (Home) *

Tel. (Mobile) *

Email *

National Insurance Number *

Do you hold a current full driving license? *YesNo

Do you have any current endorsements? *YesNo

Do you require a Work Permit to work in the U.K? *YesNo

EDUCATION AND TRAINING

School/College/University *

Examinations Passed/Qualifications gained *

EDUCATION AND TRAINING

Date of Graduation/Qualification *

Location / Details *

Notes

EMPLOYMENT HISTORY

Name and address of your recent/last employer *

Date Employed From *

Date Employed To *

Position held and duties undertaken *

Salary / Rate *

Reason for leaving *

Are there any gaps in your work History? *YesNo

Please Explain The Gaps *

Name and address of Employer prior to the employer listed above *

Date Employed From *

Date Employed To *

Position held and duties undertaken *

Salary / Rate *

Reason for leaving *

Name and address of Employer prior to the employer listed above

Date Employed From

Date Employed To

Position held and duties undertaken

Salary / Rate

Reason for leaving

Other Employment History

ADDITIONAL INFORMATION

Do you have any mental or physical disability or illness (currently or recurring) which is relevant to the post for which you are applying? *YesNo

What adjustments (if any) need to be made to the working environment to accommodate your disability? *

Please give details of all absences from work in the last 12 months, except holidays *

Please give details of any illness/accidents/injuries in the last 2 years *

ELIGIBILITY TO WORK IN THE UK

Are there any restrictions to your residence in the UK which might affect your right to take up employment in the UK? *YesNo

If you are successful in the application would you require a work permit prior to taking up employment? *YesNo

REFERENCES

You must provide references from your two most recent employers. Please provide an additional character referee. All will be contacted, therefore please inform the referees of the fact that you have used their name. If you are unable to provide the required references, please inform your interviewer immediately if you do not meet these specifications.

CURRENT OR MOST RECENT EMPLOYER

Name *

Job Title *

Phone *

Email Address *

Address *

PREVIOUS EMPLOYER TO THE ONE ABOVE

Name *

Address *

Phone *

Email Address *

CHARACTER REFERENCE

Name *

Address *

Phone *

Email Address *

Relationship with you *

APPLICATIONS DECLARATION

DECLARATION

EQUAL OPPORTUNITIES

The Caring Partners Healthcare is opposed to discrimination on any grounds. In particular, we oppose discrimination on the grounds of race, religion, ethnic origin, sex, sexuality, marital status, disability or age. The Caring Partners Healthcare is committed to ensuring that ability and potential for the job are criteria used for all staff selection.

MONITORING

The Company has adopted the provisions contained in the Code of Practice published by the Equal Opportunities Commission for Racial Equality and the Code of Practice published by the Equal Opportunities Commission that employers should regularly monitor the effects of selection decisions to assess whether equal opportunities is being achieved. For this purpose you are asked to complete and return the form below with your application form. This information is for statistical reasons only and will be treated as confidential.

Application Form

APPLICATION FOR EMPLOYMENT

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