JJ Recruiters

Personal Details

Surname *

Forename(s)*

Date of Birth *(DD-MM-YYYY)

Address *

Postcode *

Email Address *

Telephone Numbers Home *

Telephone Numbers Work *

Mobile Numbers*

Current driving licence? *

Yes No

Passport Number*

Date of expiry*

Are there any restrictions on you taking up work in the UK*

Other Training*

Registration/PIN Number (Nursing)*

Work Status – Self Employed/PAYE *

Qualification/Training

Place of study

Grade/Year obtained

Employment History

From -To

Name Address Employeee

job title & Duties

Salary on leaving

Reason For Leaving

Reference

References 1

References 2

Ref 1.Name *

Ref 2.Name*

Ref 1.Position *

Ref 2.Position *

Ref 2.Organisation*

Ref 1.Address *

Ref 2.Address *

Ref 1.Postcode *

Ref 2.Postcode *

Ref 1.Telephone Numbers*

Ref 2.Telephone Numbers*

Ref 1.Email *

Ref 2.Email *

May the company approach the above prior to interview?*

Yes No

May the company approach the above prior to interview?*

Yes No

General Comments

What are your reasons for applying for this position?*

What are your main achievements to date? *

What are the strengths you would bring to this post?*

Please detail how your knowledge, skills and experiences meet the requirements of this role *

Cautions, Rehabilitation AND Criminal Records

Because of the nature of the work for which you are applying, this post is exempt from the provisions of Section 4(2) of the Rehabilitation of Offenders Act 1974, by virtue of the Exceptions Order 1975 as amended by the Exceptions (Amendment) Order 1986, which means that convictions that are spent under the terms of the Rehabilitations of Offenders Act 1974 must be disclosed, and will be taken into account in deciding whether to make an appointment. Any information will be completely confidential and will be considered only in relation to this application. In addition you are required to submit to a Disclosure & Barring Service check/provide a PVG Scheme Record or Scheme Record Update. Any standard or enhanced disclosure made by the DBS/Disclosure Scotland will remain strictly confidential. Have you ever been convicted in a Court of Law and/or cautioned in respect of any offence? YES / NO (delete as required) If YES, please give details. *

Special Requirements (care Sector)

Because Of this position involves the care of vulnerable adults, employment is dependent on the following: 1 your written consent to obtaining a standard/ enhanced disclosure certificate from the Disclosure & Barring Service or an approved umbrella body or provider of a PVG Scheme Record/ Scheme Record Update. 2 Such disclosure being acceptable to us. 3 Proof of identity- Birth or marriage certificate (where appropriate) and passport (if available) 4 Two satisfactory written references, one being from your most recent employer. 5 That you will supply a photograph of yourself for retention in your records. 6 Is there anything we should know that could present difficulties in your carrying out the role described in the job description that you have applied for? *

DECLARATION (Please read this carefully before signing this application)

1. I confirm that the above information is complete and correct and that any untrue or misleading information will give my employer the right to terminate any employment contract offered. 2. Should we require further information and wish to contact your doctor with a view to obtaining a medical report, the law requires us to inform you of our intention and obtain your permission prior to contacting your doctor. I agree that the organisation reserves the right to require me to undergo a medical examination. In addition, I agree that this information will be retained in my personnel file during employment and for up to six years thereafter and understand that information will be processed in accordance with the Data Protection Act. 3. I agree that should I be successful in this application, I will, if required, apply to the Disclosure & Barring Service / Disclosure Scotland for a basic disclosure. I understand that should I fail to do so, or should the disclosure / PVG Scheme Record or Scheme Record Update not be to the satisfaction of the company any offer of employment may be withdrawn or employment terminated. *

Declaration Name *

Signature*

Yes No

Declaration Date *

Employee Application Form

Personal Details

Qualification/Training

Employment History

Reference

Medical History

General Comments

Cautions, Rehabilitation AND Criminal Records

Special Requirements (care Sector)

DECLARATION (Please read this carefully before signing this application)