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NICKI'S DAY NURSERY

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									Nicki Day Nursery
NICKI DAY NURSERY STAFF APPLICATION FORM POSITION APPLIED FOR: __________________________

PERSONAL DETAILS TITLE: _______ NAME(s): _________________________________ Date of Birth: _____________________ age: __________ PET NAME: (if any) ___________________________ ADDRESS: ____________________________________ ______________________________________________ ______________________________________________

DAYTIME TELEPHONE NUMBER: ___________________________________ Mobile: ___________________________________ NATIONAL INSURANCE NUMBER: _________________________ Nationality: _______________________________________________ Religion: ________________________________________________ Emergency contact information Name, address and telephone number of your next of kin (eg. parent, spouse or partner) ______________________ _________________________________ ________________________________________________________

HEALTH Please circle: yes or no for the following DO YOU HAVE ANY MEDICAL CONDITION THAT WE SHOULD KNOW ABOUT? Yes / no Do you consider yourself to be in good health? Yes / No Do you have any known allergies? Yes / No Do you have any disabilities? Yes / no

Nicki Day Nursery 190 Southampton Way London SE5 7EU

Email:info@nickidaynursery.co.uk Tele: 0207 7082738 Company Registration # 5264857

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Nicki Day Nursery
Are you a qualified nursery nurse? Yes/ no If yes, how many years experience do you have? ___________________ What age children have you worked with? __________________________ Do you have an up to date first –aid certificate? Yes/ no _____
DO YOU HAVE A DRIVING LICENCE? YES/NO If yes have you got any points on the Licence __________ IF YES HOW LONG? __________________________

Education and Qualifications: Secondary To include qualifications gained both at school and later in life eg NVQ, GCSE and any further qualification currently being taken.

COURSE

from

Date received

Qualification certificate received

EMPLOYMENT HISTORY EMPLOYER FROM TO DUTIES REASONS FOR LEAVING

Nicki Day Nursery 190 Southampton Way London SE5 7EU

Email:info@nickidaynursery.co.uk Tele: 0207 7082738 Company Registration # 5264857

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Nicki Day Nursery

NOTICE PERIOD REQUIRED IN CURRENT POST INTEREST PLEASE TELL US ABOUT YOUR HOBBIES, LEISURE ACTIVITIES AND ANY CLUBS OR SOCIETIES TO WHICH YOU MAY BELONG AND SAY POSITION OF RESPONSIBILITIES HELD.

SUPPORTING STATEMENT

PLEASE USE THIS SPACE TO TELL US WHY YOU HAVE APPLIED FOR THIS POSITION AND WHYYOU BELIEVE YOU ARE SUITABLE FOR IT. PLEASE ALSO INCLUDE ANY FURTHER INFORMATION YOU BELIVE IS IMPORTANT TO CONSIDER WHEN ASSESSING YOUR APPLICATION.

Nicki Day Nursery 190 Southampton Way London SE5 7EU

Email:info@nickidaynursery.co.uk Tele: 0207 7082738 Company Registration # 5264857

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Nicki Day Nursery

Please note that the Employment Law only allows us to employ non-European Community residents who has permission to work in this country. Any candidate call for interview will be asked to provide documentary proof of permission to be inor work in- the United Kingdom.

Are you required to have a work visa/permit? If so do you have valid visa/ permit?

yes/no Yes/no

Have you ever been convicted of a criminal offence in a court of Law? Do you have any offence pending

Yes / no yes /no

Date

Conviction

Signed__________________________________________ Dated________________________ Please signed above, whether you have answered yes or no DO YOU HOLD A CURRENT CRIMINAL RECORD BUREAU CHECK (CRB)? EQUAL OPPORTUNITY MONITORING How would you describe your ethnic origin? Nicki Day Nursery 190 Southampton Way London SE5 7EU Email:info@nickidaynursery.co.uk Tele: 0207 7082738 Company Registration # 5264857 yes/ no

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Nicki Day Nursery
White / UK White / Irish White Scottish White European White Other Black /UK Black West Indian Black African Black / mixed Black/ Other Asian / UK Asian/ Indian Asian/ Pakistani Asian/ Bangladeshi Asian/ Sri Lankan Other (please specify) Asian / West Indian Asian/ Chinese Asian Vietnamese Asian / Other Cypriot / U.K Cypriot/Greek Cypriot / Turkish

Are you registered as a disabled person for employment purposes? Reg no: _________________________________ Nature of disability_____________________________________________

Yes/ No

HAVE YOU EVER ENTERED PLEA OF GULILTY OR BEING FOUND GULITY BY A CRIMINAL, CIVIL OR MILITARY COURT OR PUBLIC AUTHORITY FOR ANY OFFENCE OTHER THAN MINOR MOTORING OFFENCE? YES/NO

IF YES, PLEASE GIVE DETAILS

PLEASE PROVIDE THE NAMES, ADDRESSES AND CONTACT NUMBERS OF TWO REFEREES. (From whom we may obtain character and work references.)

Reference Name & Job Title Business Name & address:

Reference name & Job title Business Name & address:

Telephone No: Telephone No: Contact prior to interview: yes/no contact prior to interview yes/no Thank you for completing this form and enabling us to monitor the effectiveness of our equal opportunities policy.

CONSENT AND DELCLARATION Nicki Day Nursery 190 Southampton Way London SE5 7EU Email:info@nickidaynursery.co.uk Tele: 0207 7082738 Company Registration # 5264857

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We request a reference from your most recent employer if you are offer a position with us. If you agree to this please sign below. Signature ____________________________ Date: ___________________

Due to the nature of our business, all members of staff are police checked before they start working with us. If you consent to this, please sign below. Signature _____________________________ Date: ____________________

Declaration (please read this carefully before signing this application) 1. I confirm that the above information is complete and correct and that any untrue or misleading information will give my employer the right to terminate any employment contract offered. 2. Should we require future information and wish to contact your doctor with a view to obtain a medical report, the law requires us to inform you of our intention and obtain your permission prior to contacting your doctor. 3. I agree that the organisation reserves the right to require me to undergo a medical examination.

FOR OFFICAL USE ONLY

First Interview date and notes:

Second Interview date and notes:

Offer Letter

Y/N

Rejection Letter Y/N

Acceptation

Y/N

Reference

Y/N

PASS TO MANAGEMENT

DEAD FILE/NEW FILE

Nicki Day Nursery 190 Southampton Way London SE5 7EU

Email:info@nickidaynursery.co.uk Tele: 0207 7082738 Company Registration # 5264857

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