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Job enquiry form

Job enquiry form
 
Job ref:
Position applying for:
Location applying for:
 
Preferred hours:
 

Personal details
 
Title:
First Name:
Last Name:
E-mail address:
Home address:
Telephone number:
 
Gender: Male Female Age:
 
Driving Licence: Yes No
 
Do you have a work permit? Yes No N/A
 
UK National Insurance number:
 

ISA Details & Date
 
 

Relevant qualifications
 
Qualification:Date Gained:
 

Qualified staff only
 
Qualification: Expiry date: UKCC PIN:
 

Previous employment
 
Job Title: Employer: Start Date: Finish Date: Leaving Salary:
 
Additional Information i.e. relevant experience:
 
 

References
 
Please include contact details for two people who can provide references - one of whom should be your current or most recent employer. Please tick the box provided if you do not wish a referree to be contacted until you have been offered a position.
 

1:

 
Contact name:
Position:
Company:
Address:
Telephone:
 
Tick this box if you do not wish us to contact this person until a job offer has been made
 

2:

 
Contact name:
Position:
Company:
Address:
Telephone:
 
Tick this box if you do not wish us to contact this person until a job offer has been made
 

Rehabilitation of Offenders Act
 
The position for which you are applying is exempt from the provision of Rehabilitation of Offenders Act 1974 (Exemptions) Order 1975. Applicants should be assured that the information they give will be kept confidential. The Data Protection Act requires that personal information is obtained and processed fairly and lawfully; is only disclosed in appropriate circumstances; is accurate, relevant and not held longer than necessary; and is kept securely. 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 or cautioned for a criminal offence? Yes No
 
Are you aware of any police enquiries undertaken following allegations made against you, which may have a bearing on your suitability for this post? Yes No
 
If yes, please give details:
 
 

Disability Discrimination Act 1995
 
Do you have a disability?
Yes No
 

Declaration
 
I confirm that the information I have given on this form is correct and complete and that misleading statements may be sufficient for cancelling any agreement made. I understand that, in the event of being shortlisted for interview I will be required to complete a confidential health check declaration in respect of my state of health. Because of the sensitive nature of the duties the postholder will be required to undertake I also understand that the declaration will include details of any criminal convictions, cautions, reprimands and final warnings and any other information that may have a bearing on my suitability for the post. I understand that an enhanced disclosure will be sought in the event of a successful application.
 
Please tick this box to confirm the above declaration
 
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