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CONFIDENTIAL APPLICATION FORM FOR EMPLOYMENT
Care Specialist Services Limited is committed to Equal Opportunities in all areas of our operations and welcomes all applicants irrespective of Sex, Sexual Orientation, Race, Age, Marital Status and Disability. The information which you provide on this application form will be used sorely to access your ability to carry out a particular role.
DSGselect one
Emergecy Contact Details
Additional Info
Do you hold a UK full driving licence?choose one
Do you have regular use of a(Tick appropriately)
Section 2
Eligibility / Right to work in the UK
Do you have the right to work in the UK?choose1
Do you have a valid Passport?choose one
Are you flexible to work?choose one
Work Preferenceschoose one!
Section 3
Education
Where applicable, please include details of examinations which have been or are about to be taken.
Education 2
Education 3
Education 4 (Optional)
Additional Info
Professional Qualifications
List your professional certificates, include : 1) Awarded By 2.) Qualification 3.) Grade/Class 4.) Date obtained
Section 4
Employment History
List your Employment History, include : 1) Organisation. 2.) From - To 3.) Position 4.) Reasons for leaving
Duties & Responsibilities
Additional Info
Section 5
References
Please supply the names and addresses of at least two people (not relatives) whom we may contact for references. One of these should be from your most recent employer and be from someone of a senior capacity.
Include : 1.) Employer / Character Reference 2.) Name 3.) Position 4.) Address 5.) Tel/Email
Section 6
Under the rehabilitation of Offenders Act 1974, certain previous convictions can be regarded as “spent” under certain circumstances, but this does not apply to persons seeking employment in Registered Care Homes. The information will be treated in confidence and only taken into account where, in the reasonable opinion of Care Specialist Services Limited, the offence is relevant to the post for which you are applying. Failure to declare a conviction may require us to exclude you from our register or terminate an assignment if the offence later comes to light.
Have you ever been convicted of ANY criminal offencechoose one!
I hereby give consent for you to liaise with other agencies for example, Police, Social Services, Probation Services
I declare that the details which I have given are true. I understand that providing misleading or false information to support my application will disqualify me from registration. I hereby declare that I have understood and complied with the requirements laid down in the previous paragraph and I agree that the information given on this form may be used for registered purposes under the Data Protection 1984.
Section 7
Health Declaration
Please give details of how many days sickness you have taken in the past year
Do you know yourself to be suffering from any illness or condition which might prevent you from accepting the appointment?
Have you been refused or dismissed from employment for health reasons?
Have you been registered as disabled?
Doctors Details
To the best of my knowledge and belief the information I have given above is correct. I understand that if I am appointed and this information is incorrect, I am liable to dismissal.
Section 8
Equal Opportunities Monitoring Form
Care Specialist Services Limited has an equal opportunities policy to ensure that all applicants are treated fairly and are appointed solely on their suitability for the post. All stages of recruitment process are monitored to ensure that unfair discrimination is not taking place.
Monitoring check list
For the sole purpose of monitoring our policy, as stated above, please complete the following:
Gengerchoose one!
Age Bandchoose one!
Do you consider yourself disabled?
Are you registered disabled?
Do you consider yourself to have a learning difficulty, e.g., dyslexia, dyspraxia or mental health issues?
(This information will only be used to support your staff development needs.)
Ethnicity
Ethnic Originchoose one!
Declaration
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