Pathways Trained Call Handler / Health

Advisor [Work From Home] REF:11228

APPLICATION FOR EMPLOYMENT AND
EMPLOYEE SCREENING FORM
Connaught Resourcing

Job application form

Vacancy title: Pathways Trained Call Handler/Health Advisor REF:11921

Please tell us how you heard about this vacancy:

1. Personal details

First name
including any
Last name:
middle
names:

Address:
Postcode:
Move in date:

Old Address:
Postcode:
Move in date:

Old Address:
Postcode:
Move in date:

Home Telephone No. Daytime Contact No.

E-mail address:

National Insurance No.

Date of birth

Male Female

Nationality
 2. Preferred hours

Please tick

Full-time Part-time

We like our employees to be able to work flexibly across the week and need to know when other commitments mean
you could not be available to work:

Please tick when you are unavailable:

Mon Tues Weds Thurs Fri Sat Sun

Morning
Afternoon
Evening

3. Education/Qualifications

Qualification
School (11+) Study dates and Grade Date obtained

Qualification
College/University Study dates and Grade Date obtained

Ongoing Professional Qualification

Study dates and Grade Date obtained
Development
 4. Employment history

Previous employment: Please include any previous experience (paid or unpaid), starting with the most recent first.

Current or most recent employer

Name of employer:

Address:

Postcode:

Position held:

Date started: Leaving date:

Reason for leaving:

Salary on Contact name of line manager for

leaving this post: reference:

Brief description of duties:

Previous employer

Name of employer:

Address:

Postcode:

Position held:

Date started: Leaving date:

Reason for leaving:
 Salary on Contact name of line manager for
leaving this post: reference

Brief description of duties:

Previous employer

Name of employer:

Address:

Postcode:

Position held:

Date started: Leaving date:

Reason for leaving

Salary on Contact name of line manager for

leaving this post: reference

Brief description of duties:

Continue on separate sheet if necessary

 5. Information in support of your application

Skills, abilities and experience

Please use this section to demonstrate why you think you would be suitable for the post by reference to the job
description and person specification (and by giving examples and case studies). Please include all relevant information,
whether obtained through formal employment or voluntary/leisure activities. Attach and label any additional sheets
used. See guidance sheet for further information.

Continue on a separate sheet if necessary

 6. Convictions/ Disqualifications

Rescoures
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We would draw your attention to the following statement:-

“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
and the Rehabilitation of Offenders Act 1974 (Exceptions) (Amendment) Order 1986. Applicants are, therefore, not
entitled to withhold information about convictions which for other purposes are ‘spent’ under the provisions of the Act”.

Please provide details below if you have been convicted of a criminal offence or been the subject of a conditional
discharge or probation order. (Past criminal proceedings are not necessarily an obstacle to taking up a post. This occurs
only where the offence/s is/are deemed relevant. Any details will be discussed with you should you be the successful
candidate based on your supporting statement, interview and tests).

7. Reasonable adjustments/Arrangements for interview

Please contact us if you need the application form in an alternative format including large print.

Are you subject to any conditions relating to your employment in this country? YES/NO

If "yes" please use the space below to tell us what these are?

If you need us to make any adaptations for your interview to accommodate any disability you may have please tell us what
these should be?
If appointed when could you start? Give period of notice if applicable

References
Please give the detail of two references – see guidance sheet for further information.

Name of referee
and relationship to
you:

Address:

Postcode:
Email: Tel:

Name of referee
and relationship to
you:

Address:

Postcode:
Email: Tel:

Declaration

Statement to be signed by the applicant

Please complete the following declaration and sign it in the appropriate place below. If this declaration is not completed
and signed, your application will not be considered.

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information I have provided is later found to be false or misleading, any offer of employment may be withdrawn or
employment terminated.

Signed: Date: