Position applied for: (job title and work base)

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					                                                                              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
valid.


 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
 support.
 Food Hygiene                                                                   3 years


 Managing abuse –                                                               2 years
 safeguarding vulnerable
 adults / children (SOVA)
 Foundation Health and
 safety                                                                         Once only




OTHER TRAINING
REFERENCES

 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




CRIMINAL CONVICTIONS
                                                                                                     Yes
 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’
 convictions)?
                                                                                                     No


 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.
DISCIPLINARY HISTORY


                                                                                                      Yes
 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
                                                                                                      No
 employment?


 If YES, Please enclose full details in a confidential envelope addressed to the Area
 Director.
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.




DECLARATION


 “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.

SIGNED:                                                      DATE:
         This information does not form part of the short listing process, and is provided for statistical purposes
         only.
         FULL NAME:



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.
Act (1995)
                   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
                                                Birth


Ethnic           White                          Asian                          Black / Black British
Origin
                   British                          Indian                          Caribbean
                   Irish                            Pakistani                       African
                   Other                            Bangladeshi                     Other
                                                    Other
                 Mixed                                                              Chinese

                   White & Black Caribbean                                          Other
                   White & Black African
                   White & Asian
                   Other



DATA PROTECTION
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.

COMPLAINTS
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.

				
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posted:10/5/2012
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