Application Form

We are committed to equal opportunities and welcome applications from all sections of the community.

PLEASE COMPLETE THE APPLICATION FORM IN FULL

1. PERSONAL DETAILS

2. PRESENT/MOST RECENT EMPLOYMENT

3. Previous Employment

Starting with most recent, please ensure you include all employment since leaving school or full time education and explain all gaps in your employment history.

Employer’s Name Position Held/Reason for leaving From date To date

4. EDUCATION/QUALIFICATIONS

Give details of all secondary schools/colleges attended. You will be required to provide evidence of qualifications gained.

Name of Secondary School/College/University From date To date Qualification Grade attained

Please give details of the name of the association, membership grade/level and membership number

5. RELEVANT TRAINING AND NON QUALIFICATION COURSE

Provide details of any training that may be relevant to your application including dates/duration.

Training Course Date

6. SUPPORTING INFORMATION

7. REFERENCES

Please provide the names and full contact details (including e-mail addresses) of two referees. One should be your present or most recent employer. Your references must cover a minimum period of three years employment and/or academic training. Please detail the reasons for any gaps within this 3 year period.

Referees will be required to comment on your competence, personal qualities and suitability for the post. If you are not able to provide employment or academic references to cover this period then you can provide a character reference from a person of standing within your community. (Family members are not accepted for character references)

YOU MUST SEEK PERMISSION FOR ALL REFERENCES BEFORE SUBMITTING THEIR DETAILS.

References will only be taken up and considered after selection and an offer of employment has been made.

1. Referee

2. Referee

8. RELATIONSHIPS

9. CRIMINAL RECORD BUREAU/INDEPENDENT SAFEGUARDING AUTHORITY CHECKS

Offers of employment to regulated/controlled and exempt posts will be subject to a satisfactory enhanced disclosure via the Disclosure and Barring Service.

The Safeguarding Vulnerable Groups Act

In 2012 the new Disclosure and Barring Service (DBS) was launched. All applicants for posts that are defined as a ‘regulated’ or ‘controlled’ activity within the Company will be subject to an Enhanced Disclosure via the Disclosure and Barring Service.

Rehabilitation of Offenders Act

The Rehabilitation of Offenders Act allows for a person who has been convicted of a criminal offence involving a sentence of not more than 2 years imprisonment and who has since lived trouble free for a specified period of time (related to the severity of the offence) to be treated as if the offence, conviction or sentence had never occurred. This is known as a spent conviction.

The job for which you are applying is one of those to which the provisions of the above Act in relation to spent convictions, do not apply. You must, therefore, disclose whether you have any previous convictions, whether or not they are spent.

Should you identify that you have a criminal conviction, this will be discussed in confidence at interview. However you should you not disclose any conviction you have it could lead to your application being rejected, or, if you are appointed, may later lead to your dismissal.

People who have convictions will be treated fairly and given every opportunity to establish their suitability for the job. Any information that you give will be kept in strict confidence and will be used only in respect of your application for this job.

Only convictions that are relevant to the job in question will be taken into account.

10. DECLARATION

To the best of knowledge and belief all the particulars I have given are true. I acknowledge that providing incorrect information or deliberately concealing any relevant facts may result in disqualification from the selection process or where the discovery is made after an appointment in termination of contract. I also understand that no offer of employment made to me will be binding unless confirmed in writing. *
Date *
ASC Healthcare is committed to protecting your privacy by making sure that your personal information is held securely. We limit access to the personal information contained within your application to certain organisations who have statutory or regulatory responsibilities and to trusted, non-commercial organisations to enable research about recruitment in the Health and Social Care Sector.

When you submit this declaration, you will be providing your consent to the use of your personal information, as defined by the Data Protection Act 1998, by ASC Healthcare. *

Date *

11. Equal Opportunities

How would you describe your ethnic origin?
This question is not about nationality or citizenship: It is about colour and broad ethnic group.
UK Citizens can belong to any of the groups listed. Please select appropriate answer.

The Equal Opportunities information is to develop our equal opportunities policy and is used only for monitoring purposes.

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