Application For Employment

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Position Applied For (required)

Full Time / Part Time (required)

How did you hear about this vacancy?

Accommodation Required? (required)

Full Name (required)

Maiden Name

Title (required)

Your Address (required)

Telephone Number (Home)

Telephone Number (Mobile)

Email Address (required)

Person to contact in emergency

Name

Address

Tel No.

Nationality

Date of Birth (required)

National Insurance Number

Registration with Professional Bodies e.g. NMC or HCPC

Membership

Registration Number

Date of registration

Date of Expiry

Investigations Pending

Right to Work in the UK

Please tick relevant category

Not RequiredRequiredAlready granted to previous employerOther

Other (Please Explain)

Referees

(please give two names and addresses one of which should be that of your most recent employer) We will not contact referees unless employment is offered or permission is given

Referee 1

Name

Address

Telephone No.

Referee 2

Name

Address

Telephone No.

References will not be contacted without your permission. May we approach the above referees when a job offer has been made?

Education & Qualifications

School/College/University/Other

Dates Attended

Qualifications Attained

Grades

Present Employment

Name & Address of Employer

Position Held

Date Appointed

Notice Required

Employment History

Because of the nature of the work you will be undertaking it is important for you to give a complete history from leaving school to the present day. All gaps in employment must be explained in writing

From Month and Year

To Month and Year

Employer

Position

Reason for leaving

Requirements under the rehabilitation of offenders act 1974

The post you are applying for is ‘exempt’ from the Rehabilitation of Offenders Act 1974 and therefore you are required to declare any convictions, cautions, reprimands and final warnings that are not "protected" (i.e. filtered out) as defined by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (as amended in 2013)

Guidance and criteria on the filtering of these cautions and convictions can be found on the Disclosure and Barring Service website.

Do you have any convictions, cautions, reprimands or final warnings that are not ‘protected’ as defined by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (as amended in 2013)?

If you are successful as an applicant, a disclosure will be carried out with the Disclosure and Barring Service.

If you have registered with the Update Service please provide your details below as your consent for Rodwell House to carry out an individual certificate check.

User Details

For further information about the Disclosure Scheme please go to www.disclosure.gov.uk

Other Information

Please add any information which you feel may be relevant to your application

Safeguarding of Vulnerable Adults (SOVA)

Have you been referred to SOVA or are you barred by Independent Safe Guarding Authority

Leisure Interests

What are your main interests and hobbies

Did you complete this application form yourself?

If No please give name of person who completed it on your behalf

I hereby apply for employment and understand that any false information stated herein may result in disqualification of my application, or in dismissal if I am employed by the Company.
I understand that any personal information stored may be accessed from time to time by authorised inspectors from the Care Quality Commission (CQC) I give permission for these individuals to have access to my records

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All offers of employment will be subject to the receipt of a satisfactory DBS/Adults First disclosure and two professional references.

Equal Opportunities

We are committed to achieving a working and living environment which provides equality of opportunity and freedom from discrimination on the grounds of race, religion, sex, class, sexual orientation, age, size, disability or special needs. The company is also committed to building a workforce which is diverse and reflects the community around us.

If you are invited for interview please bring the following (All documents must be originals)

Documentation of your National Insurance Number e.g. NI card, P60, P45 or other official Inland Revenue document
Proof of identity – photo ID Passport or birth certificate only
Two forms of proof of current address are required for the Disclosure & Barring Service e.g. utility bill, bank statement. A link to what documents can be accepted is below: https://www.gov.uk/government/organisations/disclosure-and-barring-service
Immunisation record
Original Certificates for training undertaken and qualifications gained

Non EU citizens also bring

Evidence of your right to work in the UK: visa, work permit and Home Office confirmation
Evidence that you are a student if studying in the UK

For nurses also bring

NMC statement of entry
PIN card
Post qualification certificates relevant to practice

If you are offered a position we will require

Bank details

Rodwell House Application Form

Application For Employment

Person to contact in emergency

Registration with Professional Bodies e.g. NMC or HCPC

Right to Work in the UK

Referees

Referee 1

Referee 2

Education & Qualifications

Present Employment

Employment History

Requirements under the rehabilitation of offenders act 1974

Other Information

Safeguarding of Vulnerable Adults (SOVA)

Leisure Interests

Equal Opportunities

If you are invited for interview please bring the following (All documents must be originals)

Non EU citizens also bring

For nurses also bring

If you are offered a position we will require