Complete ALL sections clearly and fully in BLACK
ink. If you run out of space at any point please
continue by attaching an additional sheet.
Please DO NOT include your CV as we will not
consider it. If you require help completing this
form, please contact your Area Recruitment team
or visit your local job centre.
APPLICATION FORM – Cornwall, Devon and Plymouth
Position applied for: (job title and work base) Job Reference:
What hours do you want to work?
Full Time Part time Casual (bank) Internal
Miss /Ms / Mrs / Mr Home Tel:
Forenames: Mobile tel:
Surname: Email address:
Maiden Name : National insurance number :
Address (inc Postcode) Use of a car Yes No
Full driving license Yes No
Minibus license number Yes No
How did you hear about Brandon trust?
(Media / recommendation)
Are you related to someone we support or a
Current employee of Brandon Trust?
Yes No If recommended by an employee or bankworker, please
(Please provide full name / Workplace if applicable) state full name
Can you provide evidence of your entitlement to work in the UK? Yes No
(Please enclose a photocopy with your application – see enclosed guidance notes)
CURRENT / LAST EMPLOYER
Company name and full address (inc postcode )
Dates of employment
From: To: Salary:
Job title: Notice required:
Summary of duties & responsibilities : Reasons for leaving:
PREVIOUS EMPLOYMENT / EDUCATION
Please provide a full employment history (including temporary, work experience, voluntary work) and
education- detailing any gaps in employment e.g. periods of unemployment. Please list the most recent
first. If needed, please continue on a separate piece of A4 paper.
Job title (Brief Summary of Full name of Name and full address of From- Reasons for Leaving
Resp Responsibilities) Line Manager Company/College/School To
QUALIFICATIONS in date order – most recent first (Please include Math’s and English)
Subject Level Grade Date
If you are a registered nurse please provide you’re:
NMC Number : NMC Expiry date :
HEALTH & SAFETY TRAINING (MANDATORY) Please attach copies of certificates for training that are still
Subject Completed (Y/N) Date Completed Renewal period
Fire awareness 1 year
Manual Handling 1 year
First Aid (appointed 3 years
Person) or basic life
Food Hygiene 3 years
Managing abuse – 2 years
adults / children (SOVA)
Foundation Health and
safety Once only
You MUST provide the Names, addresses & contact details of 2 referees. Referees MUST be your
current and most recent line managers. If you have only worked in one place of employment, Please
contact the Area Office on 0120872142 to discuss an alternative reference.
Current / Last Employer: Current / Last Employer:
Referee’s full name (Line manager) Referee’s full name (Line manager)
Company name & address (inc postcode) Company name & address (inc postcode)
Tel number (inc area code) Tel number (inc area code)
Email address Email address
Contactable… After interview Contactable….. After interview
(please tick) After offer accepted (please tick) After offer accepted
Have you EVER received a caution, reprimand or final warning or been convicted of a criminal
offence (including motoring offences) or have any pending (this includes any ‘spent’
If YES, please enclose full details in a confidential envelope addressed to the Area
Director- This will not necessarily be a bar to working with us. Please refer to the attached
policy regarding rehabilitation of Offenders Act 1974.
The Trust meets the requirements in respect of exempted questions under the rehabilitation of
offenders Act 1974. If you are offered employment with us we are required to carry out a check
via The Criminal Record Bureau. This will include details of cautions, reprimands, final
warnings, convictions, plus any relevant non-conviction information such as police enquires
and pending prosecutions.
We are also required to check whether you are on the Department of Health’s list of people
considered unsuitable to work with vulnerable adults.
Any job offer is subject to the satisfactory outcome of these checks. It is a criminal offence to
apply for a ‘care’ role if you are on the list and could reasonably be expected to know you are
on the list.
In your current or any previous employment are you, or have you ever been, subject to any
form of complaint, grievance, disciplinary proceedings, dismissal or termination of
If YES, Please enclose full details in a confidential envelope addressed to the Area
SUPPORTING INFORMATION (Refer to the service profile, job description and person specification)
Please think carefully about how you complete this section. The information you provide here is used part of
the short listing process. Use this section to
explain how you meet each of the Brandon competencies listed on the person specification,
tell us why you want the position and
how your skills, experience (e.g. casual work / voluntary work / care of a relative) and qualifications make
you a suitable candidate for the job as outlined in the service profile and job description.
“I declare that, to the best of my knowledge, the information given is correct. If appointed I understand that
deliberate omissions, incorrect statements or canvassing of members of the Trust in connection with this
application could jeopardise my employment and may lead to dismissal. In addition, I am prepared to undergo
a medical examination if required and confirm that to the best of my knowledge there are no medical reasons
that would prevent me from undertaking the duties of the post.”
Please return this application to Administrator, Cornwall Area Office, The Brandon Trust, 19E & F Normandy
Way, Walker Lines industrial Estate, Bodmin, PL31 1 RB.
This information does not form part of the short listing process, and is provided for statistical purposes
Disability We have been granted the right to use the ‘positive about disabled people’ symbol in recognition of
Discrimination our positive and supportive approach to disabled applicants and employees.
As a member of the Focus on Disability scheme we guarantee to offer an interview to all candidates
with disabilities who meet the minimum short listing criteria.
Do you consider yourself to have a disability? YES / NO
Do you have a specific learning difficulty, such as
Dyslexia or dyspraxia? YES / NO
(If Yes please gives details of any additional support you may require at or during the recruitment
selection process or on appointment)
Gender: Date of Nationality
Ethnic White Asian Black / Black British
British Indian Caribbean
Irish Pakistani African
Other Bangladeshi Other
White & Black Caribbean Other
White & Black African
White & Asian
All information supplied is treated as strictly confidential. We will not collect or retain information without good
reason and you may access it at any time. We may pass on your details to a third party to confirm the
information (for example, to a referee) or if required by our regulators. However, we will not pass on any
information outside of the organisation for any other purposes unless you authorise us to.
Should you have a complaint that your application has been treated unfairly, please write to the Director of
Human Resources within 2 weeks of hearing the outcome of your initial application.