This document contains an application for employment at Broome Park Nursing Home. It requests information such as personal details, education and qualifications, employment history, references, convictions, and equal opportunities monitoring. The applicant is asked to provide details of any criminal convictions due to the nature of the work. They also consent to a criminal records check being performed and for their information to be processed under data protection law.
This document contains an application for employment at Broome Park Nursing Home. It requests information such as personal details, education and qualifications, employment history, references, convictions, and equal opportunities monitoring. The applicant is asked to provide details of any criminal convictions due to the nature of the work. They also consent to a criminal records check being performed and for their information to be processed under data protection law.
This document contains an application for employment at Broome Park Nursing Home. It requests information such as personal details, education and qualifications, employment history, references, convictions, and equal opportunities monitoring. The applicant is asked to provide details of any criminal convictions due to the nature of the work. They also consent to a criminal records check being performed and for their information to be processed under data protection law.
This document contains an application for employment at Broome Park Nursing Home. It requests information such as personal details, education and qualifications, employment history, references, convictions, and equal opportunities monitoring. The applicant is asked to provide details of any criminal convictions due to the nature of the work. They also consent to a criminal records check being performed and for their information to be processed under data protection law.
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Application for Employment
Application for the post of:
Completed form must be returned to the Head of Care by: This form must be filled in the candidates own hand writing and all the questions must be completed in block capitals please.
Applicant Information Title: Mr/Mrs/Miss/Ms
DOB:
Surname:
Forenames:
Address: Postcode: Home Number:
Work Number:
Mobile: National Insurance Number:
E-Mail: Are you? :
Date when free if appointed:
a British passport holder
allowed indefinite leave to stay
Do you hold a full valid British/EC driving
license? Yes
a valid British work permit holder
No
a dependant of a British work permit holder
Do you own a car?
Yes
No
an EEC passport holder
a working holiday Visa holder
Driving licence number:
a Student Visa holder
General Education Educational Subject
Grade
Level
Year Obtained
Name of Establishment
Professional Qualifications Qualifications / Courses
NMC PIN Number:
Results
Training Establishment
Date Completed
Expiry Date:
Part(s) of NMC register:
Study Courses / Professional Development / PREP
Courses
Education Establishment
Date completed
Employment History (Last 10 years)
Position held
Name & Address of Employer
Date
Principal duties / reason for leaving
References Please state the Names and Addresses of two people from whom references may be obtained. You should include the details of your present employer or if not in employment, your last employer. Unless you request otherwise, your present or last employer will be approached for a reference. Name: Name: Address:
Address:
Relationship:
Relationship:
How did you hear about Broome Park Nursing Home:
Equal Opportunities To ensure Broome Park Nursing Homes Equal Opportunities Policy is effective, all candidates are asked to complete this section. All information that you provide will be treated as strictly confidential and used only to monitor fairness of our recruitment and selection process. Gender: Male Female
Marital Status:
Age:
Married Separated Widowed Divorced Co-habiting Single
26-35 36-45 46-55 56 and over
16-25
Ethnic Origin: I would describe my cultural origin as:
White UK
White Irish
White Other
Black UK
Black African
Black Other
Indian
Pakistani
Asian Other
Chinese
Any other group
Bangladeshi
Convictions Because of the nature of the work for which you are applying, this post is exempt from the provisions of section 4(2) of the Rehabilitation of Offenders Act 1974 by virtue of the Rehabilitation of Offenders Act 1974 (exceptions) order 1975. Applicants are, therefore, not entitled to withhold information about convictions which for other purposes are spent under the provisions of the act, and, in the event of employment, any failure to disclose such convictions could result in dismissal or disciplinary action. Any information given will be completely confidential and will be considered only in relation to an application for positions to which the order applies.
Please state any convictions, offences, cautions, reprimands or final warnings, including spent convictions in view of the nature of the work for which you are applying.
Disclosure The Criminal Records Bureau (CRB), an Executive Agency of the Home Office, provides wider access to criminal record information through its Checking service. This service enables organisations in the public, private and voluntary sectors to make safer recruitment decisions by identifying candidates who may be unsuitable for certain work, especially that involve children or vulnerable adults. The CRB was established under Part V of the Police Act 1997 and was launched in March 2002. As part of the employment process Broome Park Nursing Home will ask you to complete a CRB Disclosure form. You will be asked information about any previous names you may have had, addresses for the past 5 years and will be required to produce documentation such as your birth certificate, passport and driving license. The full cost of the disclosure is paid for by Broome Park Nursing Home.
Applicants are invited to add any comments in support of their application
(Include details of any relevant work experience, voluntary work, training not already covered, any special achievements, life achievements of which you are proud. You may also include your interests/hobbies/activities.) Please continue on a separate sheet(s) if necessary.
I certify that the information I have given in this form is correct to the best of my knowledge and without omission of any facts that could have a bearing on selection decisions. I understand that any appointment is conditional on this declaration. I consent to Broome Park Nursing Home checking any information that I am unable to verify personally, where an offer of employment is being considered. By signing this form I give my consent to Broome Park Nursing Home to process it under the Data Protection Act.
