Application Form | Anglia Care Trust

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Recruitment

Application form for Employment - Strictly Confidential

Please complete the form below and upload your forms as requested:

Recruitment Application Form

All sections must be completed in full and not referred to in an accompanying CV
Additional information may be supplied
Anglia Care Trust operates a policy of Equality and Diversity. In pursuit of this policy applicants are requested to complete the Equality and Diversity Survey accompanying this form

Position applied for

Please tick as appropriate

Full time

Part Time

Job Share

If part time or job share, please indicate availability

Personal Details:

If invited for interview, you will be asked to produce evidence confirming your identity

Family Name

Forename/s

Address

Home telephone number

Email address

Mobile number

National Insurance number

Do you have a current driving licence

Yes

Type of licence held

Provisional

Standard

Other

Please give details of any penalties on your licence or convictions pending

Are you related to, or familiar with anyone who is currently employed - paid or voluntary – by Anglia Care Trust. If yes, please provide details.

Please let us know if you are aware of any adjustments that Anglia Care Trust could make to help you apply for, or carry out the position applied for.

Qualifications and Training

In the event of being offered employment you will be asked to provide evidence of qualifications obtained

Secondary Education

Subject

Qualification

Grade

Further/Higher/Professional Education

University or College

Dates (from>to)

Qualification (state if full or part-time)

Subject

Pass Level or Grade

Other Qualifications (eg Membership of Professional Bodies)

Details

Date

Relevant Training and Personal Development

Details

Date

Present Employment

Name of Employer

Address of employer

Reason for leaving

Position held

Salary and any benefits

Number of hours worked

Date started

Notice required

Main duties

Full employment history

This information should be in date order with the most recent employment first

Dates (from/to)

Name and address of employer

Position held

Reason for leaving

Do you require a work permit for the United Kingdom?

Yes

Referees

Please give the names and addresses of two referees (including your present or most recent employer), who have known you covering the last 5 years. All references will be followed up and you will be asked to explain any gaps in employment.

Name

Phone

Email address

Relationship to you

Address

Please tick box if you wish to be approached before this referee is contacted

Name

Phone

Email address

Relationship to you

Address

Please tick box if you wish to be approached before this referee is contacted

Disclosure of Criminal Convictions

Rehabilitation of Offenders Act 1974

In order to protect the public, the post you have applied for is exempt from certain provisions of the Rehabilitation of Offenders Act 1974. You are therefore required to disclose all and any past or pending cautions or convictions, whether spent or otherwise, unless it is either a “protected caution” or a “protected conviction” under the terms of the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975.

All information provided will be kept in the strictest confidence and only used for the purpose of assessing your suitability for the post you have applied for. Only relevant convictions and other information will be taken into account so disclosure need not necessarily be a bar to obtaining this position.

Please specify below details of all and any past or pending cautions or convictions, whether spent or otherwise, except for protected cautions or convictions. If you have no past or pending cautions or convictions, please specify “None”.

Information given in this section will be kept confidential. The Data Protection Act requires that personal information is obtained and processed fairly and lawfully; it will only be disclosed in appropriate circumstances; is accurate, relevant and not held longer than necessary and is kept securely.

Supporting Statement

It is important, in this section, to explain to us why you consider yourself to be the right person for the role. In considering your response, clearly make reference to the Supporting Information, Role Description and Person Specification.

Declaration

I confirm that the information given on my application form is correct and complete and that misleading statements may be sufficient for cancelling any agreements made with Anglia Care Trust.

I understand that:

In the event of being short-listed for interview, I will be expected to bring proof of identity that includes a photograph plus proof of address.
In the event of being offered the post, I will be required to complete a confidential declaration in respect of my state of health.
An enhanced DBS disclosure will be sought in the event of a successful application. I confirm I am not on any list of those disbarred from working with children and vulnerable adults, disqualified from working with children or subject to sanctions imposed by a regulatory body.
By signing below, I am giving my consent for you to collect and store my data as outlined in the Personnel Privacy Notice. I am aware that I can withdraw or change my consent at any time by contacting the Business Support Team.

Your Signature

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