Stonehaven Care Group EMPLOYMENTAPPLICATION FORM Note:Please;Sign,PrintNameDateatbottomof eachpage

FormREVISED:23.10.17EW

POSITIONAPPLIED FOR:

PERSONAL

Thefollowinginformationwillbetreatedinthestrictestconfidence.

(PleasecompletethissectioninBLOCKCAPITALS)

Surname: / FirstName(s):
Address:

ContactTel.No: MobileTel.No:

FullDriving Licence: / YES/NO / Endorsements: / *YES/NO
*If YES,please givefurtherdetailsincludingdates.
Areyouinvolvedinanyactivitywhichmightlimityouravailabilitytowork oryourworkinghours e.g.,localgovernment? / YES/NO
IfYES, pleasegivefulldetails.
Areyousubjecttoanyrestrictionsorcovenantswhichmightrestrictyourworkingactivities? / YES/NO
IfYES, pleasegivefulldetails
Areyouwillingto work overtimeand weekends ifrequired? / YES/NO
Pleasegivedetailsof anyhours which youwouldnotwishtowork:
Haveyouanyconvictions(otherthanspentconvictionsundertheRehabilitationofOffenders
Act1974)? / YES/NO
IfYES, pleasegivefulldetails
If offered employment, you will be required to complete a Pre-Employment Medical
Questionnaire.Areyoupreparedto undergoamedicalexaminationbeforeemployment? / YES/NO
Haveyouever worked forthisbusinessbefore? / YES/NO
IfYES, pleasegivefulldetails / YES/NO
Haveyouappliedforemploymentwiththisbusiness before? / YES/NO
Doyouneed a work permittotakeup employmentinthe U.K.? / YES/NO
Howmuchnoticeareyourequiredto givetoyour currentemployer?

Applicant’ssignature: Printname: Date:

Schoolsattendedsinceage 11 / From / To / Examinationsand Results
Collegeor University / From / To / Coursesand Results
FurtherFormalTraining / From / To / Diploma/Qualification
JobrelatedTrainingCourses
NameofOrganisation / Date / Subject

Pleasegivedetailsofmembershipof anytechnicalorprofessionalassociations:

Pleaselistanylanguagesspoken and thelevelof competence:

Applicant’ssignature: Printname: Date:

EMPLOYMENTDETAILS

Pleasegivedetailsofyourpastemployment,excludingyourpresentorlastemployer,statingthemost recentfirst.

PRESENTORLASTEMPLOYER

Areyoucurrentlyemployed? YES/NO Current pay (or last pay if now unemployed)

£

Nameof presentorlastemployer:

Address:

TelephoneNo:

Natureofbusiness:

Jobtitleand a briefdescriptionof yourduties:
ReasonforLeaving:

LengthofService: From: To:

Applicant’ssignature: Printname: Date:

INTERESTS,ACHIEVEMENTS,LEISUREACTIVITIES(e.g.,hobbies,sports,clubmemberships)

REHABILITATION OFOFFENDERSAct 1974 (Exceptions)Order 1975

Duetothenatureofthework,thisemploymentisexemptfromtheaboveAct,soapplicantsarenotentitledto withholdinformationaboutanyconvictions,whetherpast(‘spent’)orpresent. Therefore,pleasegivedetailsand dates ifyou haveEVER been convictedofan offence bya courtoflaw orhavebeen subjecttoany conditional discharges,bind-oversorcautions.

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………………………………………………………………………………………………………………………………………… Ifyou havenotthenpleasewritehere“NoConvictions”:……………………………………………………………………… Anyinformationgivenwillbeconfidentialandconsideredonly inrelationtothisApplication. Intheeventof

employment,aDisclosurewillberequiredandifitbringstolightsomethingthathasnotbeendisclosed

above then the Commission for Social Care Inspection require your employment to be terminated immediately. Havingacriminalrecordwillnotnecessarilybarsomeonefromworkingwithus. Thiswill dependonthenatureofthepositionand thecircumstancesandbackgroundofanyoffences.

NOTE-POVA &CriminalRecordsBureauChecks – COSTS–

ThecompanywillpayforthecostoftheCRBDisclosure.However,ifyouleavethecompanywithina period of12 monthstheCompanyreserves therighttodeductthecostoftheCRBDisclosurefromyourfinalpay.

Pleasegivedetailsifyouwillcontinuetoworkinanyothercapacityifofferedthis position (Pleasenotethatwewillnotemployanypersonwhoeithercontinuesto,orlatercommences, workinthecare industryforanotheremployerwhilsttheyareundercontracted employmentwith thiscompany.)

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Applicant’ssignature: Printname: Date:

Pleasegiveyouranswersto thefollowingquestions….

(i)‘Whatexpectationsdoyou haveforyourself?Whatgoalshaveyou setyourself?Wheredoyou wantto be in1year, 3years and5yearstime?’

(ii) ‘How areyouplanningto achievethosegoals?’

(iii) ‘Whatisitthatattractsyou to acareerin StonehavenHealthcareLtd?’

(iv) ‘When doyougetthemostsatisfactionfrom yourwork?

(v)‘Canyoudescribeatimewhen youhavetakenactiontofixaproblem/help apersonin work withouthavingbeeninstructedtodo sobyamanager’.

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Applicant’ssignature: Printname: Date:

DECLARATION

Ideclarethatthe informationgiven inthis formiscompleteandaccurate. Iunderstandthatanyfalse informationordeliberateomissions will disqualifymefrom employmentormay rendermeliableto summarydismissal

IunderstandthesedetailswillbeheldinconfidencebytheCompany, forthepurposesofassessingthis application,ongoingpersonneladministrationandpayrolladministration(whereapplicable) incompliance withtheDataProtectionAct1998.

Signature: Date:

REFERENCES

Pleasegivethenamesoftwopeople(oneofwhichshouldbeyourpresentormostrecentemployer)

whomwemayapproachfora reference.

Can weapproachyourcurrentemployerbeforean offer ofemploymentismade? YES/NO

Name: / Name:
Position: / Position:
Address: / Address:
Tel.No: / Tel.No:

SOURCE OFAPPLICATION

Howdidyouhearofthisvacancy?

Applicant’sname: Printname: Date:

COMPANY USE ONLY(remember totakecopies)

Proofof I.D. satisfactory Yes/No

Proofof Qualificationssatisfactory Yes/No

Applicant’ssignature: Printname: Date: