Alba Childcare Agency
Application Form
Please complete all sections & Return to: OR
post to : Alba Childcare Agency, Coral Brae, Dunkeld Road, Bankfoot, Perthshire, PH1 4AJ.
If you have any difficulty completing this form please ask someone to help you. It may be completed at interview if you prefer.
In accordance with the data protection Act (1984) you are advised that you have the right of access to information from this application form.
Personal DetailsSurname / Title
Forename(s) in full / Previous Surnames
Address / Home Tel. No
Town / Mobile Tel No.
County / Date of Birth
Postcode / Nationality
Do you need a work Permit to work in the UK? YES / NO
Qualifications / National Insurance Number
E-Mail :
Name of Emergency Contact / Relationship to you
Work Tel No. / Home Tel No.
Education / Training
Name and Address of School/College/Other / Courses or subjects taken and (any) qualifications gained / From:
Month/Year / To:
Month/Year
Education & Training Cont.
Name and Address of School/College/Other / Courses or subjects taken and (any) qualifications gained / From:
Month/Year / To:
Month/Year
Employment
Present or most recent Employer and Address / Position Held / From:
Month/Year / To:
Month/Year
Previous Employer(s) and Address(es) / Position(s) Held / From:
Month/Year / To:
Month/Year
References
Please provide details of 2 referees who can provide information relating to your competence in childcare, one of whom should be your most recent employer.
Name / Position
Address / Organisation
Town / Telephone No
Postcode / E-Mail
Name / Position
Address / Organisation
Town / Telephone No
Postcode / E-Mail
Protection to Children / YES / NO
Have you ever been convicted of a criminal offence?
If Yes, Please give details on a separate sheet
DOH circular (88/9) Protection of Children requires us to carry out checks on police records for all workers who have substantial access to children.
Do you agree that such checks may be made concerning you as required by the registering authority?
Health / YES / NO
Do you suffer from any ailments or physical disabilities that will need to be taken into account whilst working for the Agency? If yes, please give details.
Declaration
I declare that the information given is true and I understand that any false of misleading information may result in my removal from Alba Childcare Agency register of workers.
Signed / Date