Pumpkin Patch Day Nurseries Ltd – Application Form

Position applied for and branch:
Title: Mrs/Miss/Ms/Mr /Other (please specify) …………………………………
Surname:
First Name:
Address:
Postcode:
Home tel no:
Mobile tel no:
E-mail address:

Previous Employment

Please indicate your last 5 years employment history and give details of any break in employment. Please continue on an additional piece of paper if necessary. Please note we must contact your last employer for a reference but will not do so until you have consented.

Name of Business and start date. / Position and main responsibilities. / Reason for leaving and end date. / Reference?
YES
Name:
Contact Details:
YES/NO
Name:
Contact Details:
YES/NO
Name:
Contact Details:
Qualifications and Training:
School Attended: Dates: to
Subjects taken and grades;
Relevant Training:
College Attended: Dates: to
Course Title: Result:

Other relevant Training:

Course / Date completed / Comments
Do you have the following?
  • Enhanced Disclosure Yes/No
  • Current First Aid Certificate Yes/No
  • Current driving licence Yes/No

Disability:
We welcome applications from people with disabilities. Is your ability to perform this particular job for which you are applying limited in any way?
Yes/no
If yes, how can we overcome this?
Asylum and Immigration Act 1996
National Insurance number:
If no National Insurance number available, do you have evidence of your entitlement to live and work in the UK?
Offer of Employment
Any offer of employment is conditional on satisfactory reference and an enhanced CRB check being received. All successful applicants will undertake a three month probationary period before being offered a permanent contract.
Please study the job description and give examples of attributes you have in relation to the job applied for.
Please comment on your motivation for working with children in this particular role.
Please give details of your hobbies and interests.
Rehabilitation of Offender Act/ Home office Circular 22/91
Because of the nature of the work, this employment is exempt from the provision of the Rehabilitation of Offenders Act 1974 and associated Order. Applicants are not, therefore, entitled to withhold details of any criminal convictions which for other purposes might be considered “spent”. Checks will made against police records in respect of those applicants selected for appointment in accordance with Home Office Joint Circular 86/44. Information given will be kept confidential and will only be used in relation to the application for the job.
Have you had any convictions or police cautions (including spent convictions?) Yes/No
Have you ever been subject to disciplinary procedures or child protection investigation?Yes/No
If yes please give details on a separate piece of paper.
When would you be available to start?
Office Use only
Job offered:
Position
Start date:
Salary:
Comments:

Suitability Questionnaire.

In order for Pumpkin Patch to ensure that we employ suitable staff it is imperative that these questions are answered honestly.

  1. Are you known to Social Services?
  1. Are you fit and healthy to work with children? Please notify us of any on going medical conditions you may have.
  1. Have you ever had any alcohol or drug related problems?
  1. Are you currently taking any medication? Does this impair your ability to work safely and effectively with young children?

If you are on medication, we hold the right to request medical advice and information regarding the mediation and any possible effect it may have on your ability to work with young children.

I……………………………………………………………… have answered these questions honestly. I understand that if I am employed at Pumpkin Patch this questionnaire will be regularly repeated throughout my employment.

Signed………………………………………………… Date………………………………………