Job Application form - DOC by 7xS3ef

VIEWS: 65 PAGES: 5

									Affinity care Partnership – Job Application Form


Job Application form

Please complete the application form along with the ethnic monitoring form and return to
Shelly Marsh at shelly@affinitycarepartnership.uk.com

All applications are treated as confidential.

Post Applied For;

Full / Part Time / Both;


Personal Details

Name:

Date of Birth;                                       Age;

Address;



Telephone;

Mobile;

National Insurance No;




Health Details

Please list any disorders, diseases or allergies from which you suffer or have suffered
in the past;




                                                                                           1
Affinity care Partnership – Job Application Form




Please detail any medicine, drugs or treatment that you are currently and/or regularly
receive;




Please list all absences from work over the past 12 months along with reasons for
them;




Would you be prepared to have a medical examination if required? Y / N


Criminal Convictions

Please list any criminal convictions except those “spent” under the Rehabilitation of
Offenders Act 1974. If none, state “None”.




Education*

Schools / Colleges / Universities          Qualifications Gained;
attended with dates;




                                                                                         2
Affinity care Partnership – Job Application Form




Employment History*

 Dates        Name & Address       Job Title & Description   Rate of     Reason for
Employed        of Employer               of Duties           Pay         Leaving




*Please use additional sheets if required.
Personal Statement

Please use the space provided to tell me why you think that you should be considered
for this position. Include any specific skills and/or qualities that you offer;




                                                                                       3
Affinity care Partnership – Job Application Form




Interests & Hobbies

Please state your leisure interests and any other pastimes.




                                                              4
Affinity care Partnership – Job Application Form




                                           References

   Please give the names and addresses of two people to whom we can apply for a
   reference. If you do not want us to contact them unless we offer you a position, please
   tick the box below


Reference 1;                                  Reference 2;

Name;                                         Name;
Position;                                     Position;
Address;                                      Address;




Telephone;                                    Telephone;

Relationship                                  Relationship

Declaration

   I confirm that the information provided on this form is accurate and correct. I
   understand that any untrue or misleading information will give my employer the
   right to terminate any employment contract offered.


Print Name;


Signed;                                              Date;




                                                                                             5

								
To top