STRICTLY CONFIDENTIAL

APPLICATION FORM (CHIEF EXECUTIVE OFFICER)

Please type and where necessary continue on a separate sheet.

Please complete all sections and attach your CV and a covering letter.

Personal Details

Surname
Forenames
Address
Contact Telephone Number
Email Address
Do you hold a current driving licence and have access to a car for work use?YES NO 
CRIMINAL CONVICTIONS
An Enhanced DBS Check is a requirement for this post.
Have you ever been convicted of a criminal offence? At this stage only declare YES NO 
If YES, and you are shortlisted, please provide details in an envelope marked ‘Confidential’ to the HR Manager on the day of the interview
The Rehabilitation of Offenders Act (ROA) 1974 sets a scale of rehabilitation periods for people who have been convicted of criminal offences. After completing such a period without further conviction, the individual can regard any conviction as ‘spent’ (as if it had not occurred) when applying for jobs other than those that are ‘exempted’. The ROA 1974 (Exceptions) Order 1975 sets out a list of exempted occupations for which applicants are required to declare all criminal convictions. Certain posts within Suffolk Family Carers fall within these exempted occupations; this means that you may be required to declare all criminal convictions. However, having a criminal record will not necessarily bar an applicant from working with Suffolk Family Carers. We use the Disclosure and Barring Service (DBS) to assess the suitability of applicants who are offered employment and fully comply with the DBS Code of Practice.
HEALTH
The successful candidate may be required to attend an occupational health assessment.
How many days sickness absence have you taken in the past two years?
Over how many separate episodes were the days of sickness absence taken?
DISABILITY
Do you consider yourself to be disabled? YES NO 
Please let us know of any reasonable adjustments required to enable you to attend the interview if shortlisted

Education, Training and Qualifications

Please only include information that is relevant to your application

General Education
Further Education and Qualifications
Membership of Professional Bodies
Relevant training where no formal qualification has been gained

Employment History

Please include your employment history over the past 10 years

Current or Most Recent Employer

Employer Name, Address and Contact Details
Position held and brief description of role
Start Date
Finish Date and Reason for Leaving
Annual Salary / £

Career History

Please complete for each position held within the last 10 years (most recent first)

Employer Name, Address and Contact Details
Position held and brief description of role/key achievements
Start Date
Finish Date and Reason for Leaving
Employer Name, Address and Contact Details
Position held and brief description of role/key achievements
Start Date
Finish Date and Reason for Leaving
Employer Name, Address and Contact Details
Position held and brief description of role/key achievements
Start Date
Finish Date and Reason for Leaving

Copy and paste further boxes as required

Supporting Statement

Please evidence how you meet the Person Specification

References

We will only approach referees when considering a job offer.

Do you agree to us contacting your referees at this point?YES NO 

Please provide referees for your last 5 years of employment which must include your current or most recent employer. At least two referees must be provided which may include a Personal Referee if you do not have at least two employer referees. Please include Name, Status, Address, Email Address and Telephone Number for each referee

Referee 1
Current or Most Recent Employer
Referee 2
Referees from other employers within the last 5 years

Declaration

The information provided on this application form will remain confidential and only be used for the purpose of recruitment and selection. It will be stored and disposed of in compliance with the Data Protection Act. We may approach third parties to verify the information you have provided and by signing this form you consent to this.

Under the Immigration, Asylum and Nationality Act 2006, Suffolk Family Carers will carry out a document check to confirm the successful applicant has the right to work in the UK, before confirming appointment.

I declare that I am the person referred to on this Application Form and that the information I have given is accurate and true. I authorise Suffolk Family Carers to contact any current or former employers to verify the information. I understand that if I purposefully give false information this will lead to the withdrawal of any job offer or, if subsequently employed by Suffolk Family carers, will result in disciplinary proceedings which may lead to dismissal.

Signature of Applicant:

Date: