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Job Application Form

Please complete this form using capital letters. Proof of identity (Passport, Driving Licence or Birth Certificate) and a recent photograph will be required at interview.


Contact Details


Position


Education & Qualifications










Most Recent Employer



Previous Employment

Please list all employment since leaving education.

If there have been any gaps in your employment history since you left full-time education, when you were not in either paid or voluntary employment, can you please tell us about them below.


References

Please supply details of two references, one of these should be your current or most recent employer ot an academic reference if this is your first job. References will only be contacted if your application has been successful.

Reference 1

Reference 2


General Information

Are you eligible to work in the UK:

YesNo

i) Have you ever been convicted of a criminal offence:

YesNo

ii) Have you ever recieved any police cautions, repimands or warnings:

YesNo

iii) Have you ever been subject to disciplinary action and/or dismissed from previous employment:

YesNo

If you answered Yes to any of the 3 previous questions, please provide details:

If your application is successful, when would you be able to start work:

Do you have a current, full driving license:

YesNo

Do you have access to a car?:

YesNo

Qualified Nurses

How did you hear about us?

Family Member or FriendWebsiteFacebookRadioNewspaper

If referred under Recommend A Friend scheme


Equality & Diversity Monitoring

Please fill in the gaps or tick the most appropriate answer. All sections are optional.

Sex:

MaleFemaleOther

Age:

11-1819-2424-3940-5455-6465-8485-99

Ethnic Group:

White (English / Welsh / Scottish / Northern Irish / British)White IrishWhite Gypsy or Irish TravallerWhite & Black CaribbeanWhite & Black AfricanWhite & AsianIndianPakistaniBangladeshiChineseAfricanCaribbeanArabOther

Would you consider yourself to have a disability which makes it difficult for you to carry out normal day to day activities? The disability could be physical, sensory, a learning disability or of a mental health nature:

YesNo

If you answered 'Yes' to having a disability, how would you describe your impairment?:

Physical ImpairmentVisual Impairmentlearning DisabilityHearing Impairment / DeafMental Health / Mental DiseasesLong term limiting illness

Please indicate your highest level of qualifications::

GCSEsA LevelsFirst DegreeMastersMPhil / PHD

Data Protection & Declaration

The information detailed in this application form will be used for the purpose of administration and legitimate issues relating to employment in line with our Employment Privacy Policy available on our website or on request.

I confirm the information given on this form is correct and complete, and that misleading statements may be sufficient for cancelling any agreements made. I also understand that an enhanced CRB disclosure may be sought in the event of a successful application.
Signed

Date


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