Get documents about "APPLICATION FORM CFF SRC Extranet Mar 06
Document Sample
Private and Confidential
APPLICATION FOR EMPLOYMENT
CENTRAL FUNCTIONS AND FUNDRAISING
Further information about the work of Sue Ryder Care may be found on our web site
www.suerydercare.org
Reference No: Position Applied For (insert job title):
Job Code: [for office use only] Name of Applicant:
Private and Confidential
INFORMATION TO HELP YOU COMPLETE THIS DOCUMENT
Where did you see the
advertisement for this
position?
APPLICATION FORM
Please complete all sections unless otherwise indicated and sign the declaration at
the end of the form. Return it to the person at the address on the accompanying
correspondence or as indicated on the advertisement
PERSONAL DECLARATION FORM
Certain posts based at Care Centres or Hospices are exempt from the Rehabilitation
of Offenders Act 1974. This means that all convictions, cautions, reprimands and
final warnings must be disclosed. Only relevant convictions and other information
will be taken into account and disclosure will not necessarily be a bar to obtaining a
position.
Applicants for Care posts should tick the Yes box and complete the PERSONAL
DECLARATION – CRIMINAL CONVICTIONS FORM. It should then be returned to the
address as indicated on the form.
Personal Declaration Required: Yes No
( tick whichever is appropriate)
EMPLOYMENT MONITORING FORM
To help us monitor our Equal Opportunities Policy please complete the
EMPLOYMENT MONITORING FORM and return it as indicated at the end of the form.
PLEASE REMEMBER TO SEND:
EMPLOYMENT MONITORING FORM
PERSONAL DECLARATION FORM (if applicable)
to the address as indicated on the forms. They can be sent together if
preferred.
Private and Confidential
Personal Data
Do you have a relative
or friend working within
Yes If yes, please state relationship and work location:
Sue Ryder Care? No
Title: (Mr, Mrs, Miss, etc)
Surname Name/Family Name: Forenames:
Address: Telephone
Home:
Telephone
Work:
Mobile:
Post Code: Email
Address:
Have you ever been convicted of a motoring
Do you hold a current driving licence, which is
offence resulting in disqualification? (please tick)
valid in the UK? (Please tick)
If yes, please give details:
Yes
Yes
No
No
Eligibility to Work
All applicants will be asked to produce specified documentary evidence of their right to work in the United
Kingdom in accordance with the Asylum and Immigration Act 1996.
Work permits must be applied for as and when required.
Do you require a work permit to take up employment in the UK? (Please tick)
Yes
No
Education, Training and Qualifications
Please provide details of schools, colleges and any professional training completed and any qualifications
obtained which may be relevant to this vacancy, together with any other training.
Dates Attended Qualification Obtained or Place of Education or Training
Result/Grade
or Undertaken Training Completed or Examining Body or Location
March 2006
Private and Confidential
Employment History
Please summarise your previous jobs over the last ten years, starting with the most recent.
Identify any breaks and give reasons for them.
Current Role Notice Period Reason for leaving?
Employers Name, Location
Dates Employed Job Title & Summary of Main Duties
& Nature of Business
Continue on a separate sheet if necessary.
Membership of Professional Bodies/Associations
Please give details of membership of any professional body or association, including status of membership and
registration/membership number where appropriate.
Name of Association Membership Status Membership Number Expiry Date
March 2006
Private and Confidential
References
Please provide details of your last two employers who have knowledge of you in the working environment.
Your current employer will only be contacted with your permission. If you are a recent student, please give
details of appropriate school, college or university referees. All references must be on company headed paper
and personal references will not be accepted except in specific circumstances.
Name: Name:
Job Title: Job Title:
Address: Address:
Post Code: Post Code:
Telephone No: Telephone No:
Relationship to you: Relationship to you:
May we contact this referee? (please tick) May we contact this referee? (please tick)
Now Now
On acceptance of offer of employment On acceptance of offer of employment
The following question is asked in order to help Sue Ryder Care in making arrangements for interview and in
considering whether adjustments may need to be made
to meet the requirements of the Disability Discrimination Act.
Do you suffer from any disability or recurring
illness that could affect your ability to attend an Yes (Please give details)
interview or undertake the job for which you
have applied? (Please tick opposite) No
Declaration
I agree that any offer of employment with Sue Ryder Care is subject to what in the opinion of Sue Ryder Care
are satisfactory references, a medical assessment if required and a criminal record check under the Care
Standards Act where it is required. A criminal conviction will not necessarily be a bar to obtaining a position.
In accordance with the Data Protection Act, it is agreed that Sue Ryder Care may hold and use personal
information about me for personnel reasons and to enable Sue Ryder Care to keep in touch with me. This
information may be stored in both manual or computer files and will not be disclosed to anyone outside of
Sue Ryder Care without my prior consent.
I confirm that the information given on this form and any attachments is correct and complete. I understand
that any information later discovered to be incorrect may result in the termination of any agreements made.
Signature of Applicant: Date:
March 2006
Private and Confidential
Personal Motives
On this sheet please explain your motives for wishing to join Sue Ryder Care, the aspects of the work you
are most interested in and how your skills and experience meet the specification for the post applied for.
Continue on a separate sheet if necessary.
March 2006
Private and Confidential
PERSONAL DECLARATION - CRIMINAL CONVICTIONS
Name of Care Centre
Address of Care
Centre
Name of Applicant
Address of
Applicant
I understand the position I have applied for is exempt from the provisions of the
Rehabilitation of Offenders Act 1974 (Exemptions Order) 1975 and is subject to disclosure
under the Care Standards Act 2000.
I declare that I do not, nor have ever possessed a criminal record, nor have I been subject to
any conditional discharges, bindovers or cautions.
Signed: Date:
If you are unable to sign the above declaration, please list any convictions, conditional
discharges, bindovers and cautions:
Date Offence Sentence
I declare the above information to be true and I understand that providing false information
would lead to my employment being terminated immediately.
Signed: Date:
Print Name:
For office use only
CRB check initiated Yes No Date:
CRB Disclosure Received Yes No Date:
Employment Confirmed Yes No Date:
March 2006
Private and Confidential
EMPLOYMENT MONITORING FORM
Name: (Optional)
Position Applied For: Reference No:
(insert job title)
Department: Location/Region:
How did you hear about Web Site Advert (Where?)
this vacancy?
(please tick as appropriate) Job Centre Other (Where/Who?)
Status: (e.g. single, married, divorced, partner, etc.) Gender:
Date of Birth: Are you Disabled? Registration No: (if applicable)
(see note below)
The Disability Discrimination Act of 1995 defines a disabled person as a person with “a physical or mental
impairment, which has a substantial and long term adverse effect on his/her ability to carry out normal day to
day activities.”
Ethnic Origin
Ethnic origin describes a group sharing a common origin, culture or language. It is about colour and broad
ethnic group NOT place of birth or nationality – UK citizens can belong to any of the groups indicated.
(please tick the appropriate box below)
White Mixed
White and Black
English
Caribbean
White and Black
Scottish
African
Welsh White and Asian
Any other mixed
Irish
Background (please state)
Any other White
Background (please state)
Asian or Black or Chinese or
Asian British Black British Other ethnic group
Indian African Chinese
Any other
Pakistani Caribbean
(please state)
Bangladeshi Asian
Any other Asian Any other Black
background (please state) background (please state)
Please continue overleaf/.......
March 2006/CFF
Private and Confidential
Nationality: What is the religion/faith you most identify with, and/or practice:
Please indicate your age range (please tick)
18-24 25-34 35-44 45-54
55-64 65-74 75+
Thank you for completing the form
March 2006/CFF
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