logo

Please return completed form to Human Resources Administrative Assistant,Baytree Care Ltd, 19 Reservoir Rd, London N14 4BB, or e-mail cm@Baytree.org.uk

Post details

 

Position applied for *:

Type of employment:

Permanent

Full time

Part time

Bank

Temporary

Availability from (date):

Personal Details

Name *:

Address *:

Postcode:

Telephone number:

Home:

Work:

Mobile:

Email address *:

Nationality:

NI Number:

Marital status:

Married

Single

Separated

Widowed

Divorced

Are you eligible to work in the UK:

Student

Working

Other(Give Details)

Type of Visa if not of British or EU Nationality

Yes

No

Do you have a current UK driving license:

Yes

No

Full

Provisional

Do you have any current endorsements on your driving license (if yes give details)

Yes

No

Do you have any health conditions that could potentially affect you in this job?

Yes(If yes please give details)

No

We at Baytree Care welcome all applications regardless of race, colour, nationality, religion, ethnic origin, sex, sexuality, age or social background, marital status or disability. We are positive about the abilities of disabled people and welcome applications. If you believe that you have a disability, and meet all the essential criteria for this post as detailed in the job description, please tick this box.

Next of Kin

Name:

Address if different to above:

Postcode:

Telephone number:

Home:

Work:

Mobile:

Email address:

Relationship:

General Education

Dates
From-to

Name and Address of School / College / University (secondary education only

Qualifications

From

To    

From

To    

From

To    

From

To    

From

To    

Professional Qualifications

Name of Institution

Qualification

Year Attaineds

Previous Employment

Employer Name:

Employer Address:

Postcode:

Job Title:

Responsibilities:

Relationship:

Date of commencement:

Date of Leaving:

Reason for Leaving?:

Starting Salary:

Final Salary:

Previous Employment

Employer Name:

Employer Address:

Postcode:

Job Title:

Responsibilities:

Relationship:

Date of commencement:

Date of Leaving:

Reason for Leaving?:

Starting Salary:

Final Salary:

Previous Employment

Employer Name:

Employer Address:

Postcode:

Job Title:

Responsibilities:

Relationship:

Date of commencement:

Date of Leaving:

Reason for Leaving?:

Starting Salary:

Final Salary:

Interests and Hobbies

Additional Information

Have you ever been convicted of a criminal offence? (Declaration subject to Rehabilitation of Offenders Act)

Yes

No

If offered the post will you continue to work in any other capacity? If yes please give details:

Yes

No

If offered this position, do you agree to work shifts as allocated by the company (applicable to care workers only)?

Yes

No

Why do you think you are suitable for this position?

Referees (not family members and should include your current / most recent employer)

Referee 1 (Professional)

Name:

Address:

Postcode:

Contact number:

Email:

Capacity in which you have known this person:

Referee 2 (Professional)

Name:

Address:

Postcode:

Contact number:

Email:

Capacity in which you have known this person:

Referee 3 (Professional)

Name:

Address:

Postcode:

Contact number:

Email:

Capacity in which you have known this person:

Equal Opportunities Monitoring Survey

Are you Male

Female

In which of these categories do you consider yourself to be?

White

British

Irish

European

Any other white background

(please specify)

Black or Black British

African

Pakistani

Bangladeshi

Any other black background

(please specify)

Asian or Asian British

Indian

Carribean

Any other black background

(please specify)

Mixed

White and Black African

White and Black Carribean

White and Asian

Any other black background

(please specify)

Other ethnic Groups

(please specify)

We are positive about the abilities of disabled people and welcome job applications from people with disabilities.

Do you consider yourself to be disabled?

Yes

No



Are you registered disabled?

Yes

No



If yes, what is your RDP number ? (you are not obliged to proved this information)

Disclosure and barring Records

Because of the sensitive nature of the duties the post holder will be expected to undertake, you are required to disclose details of any criminal record. Only relevant convictions and other information will be taken into account so disclosure need not necessarily be a bar to obtaining this position


Have you ever been convicted by the courts or cautioned, reprimanded or given a final warning by the Police? (Note that the post you have applied for is exempted from the rehabilitation of Offenders Act 1974, which means that all convictions, cautions, reprimands and final warnings on your criminal record need to be disclosed. This includes any convictions, which are spent.)

Yes

No


If yes, you must declare this now and please give details of offences, penalties and dates:

Are you aware of any police enquiries undertaken following allegations made against you which may have a bearing on your suitability for this position (Enhanced Disclosure only):

Yes

No


If yes you must declare these now and please give details:

I understand that it is a requirement of my employment to undergo a Criminal Records Disclosure and I confirm that I give permission for Baytree Care to apply for a Disclosure on my behalf. I also understand that it is a criminal offence to apply for a position working with children or vulnerable adults if I am aware that I am listed under the relevant DoH and/or DfES lists which indicate those that are banned from working with children and those considered unsuitable to work with vulnerable adults. I confirm that I am not listed on the relevant lists. Signature of applicant:


Date:

 

The information provided above will be used as laid down in the CRB code of conduct. A copy is available for you to view on request.

Declaration of Applicant

I confirm that to the best of my knowledge, the information entered onto this form is correct and understand that any misleading statement or deliberate omission may be sufficient grounds for cancelling any offer or terminating my employment. I agree that should I be offered and accept a position, I will undergo a medical examination if requested.


By signing this form I agree that the contents are correct and that Baytree Care may keep this information about me on their files. I understand that such information may be disclosed to, recorded and used by those persons as may be necessary for the purpose of them obtaining references relating to my employment record with Baytree Care. Including any potential employers, as well as assisting the DSS in their enquiries when requested..


Signature of Applicant:

Date: