We are committed to equal opportunities and welcome applications from all sections of the community.
PLEASE COMPLETE THE APPLICATION FORM IN FULL
Post Applied For *
Job Reference No
Email address *
Telephone Number (Home)
Telephone Number (Work)
Telephone Number (Mobile) *
Can we contact you at work? *YesNo
Do you have an entitlement to work in the United Kingdom? *YesNo
If yes, is your entitlement time limited? YesNo
Entitlement Expiry Date:
National Insurance Number: *
Do you have a driving licence? *YesNo
If yes, please indicate type:
Do you have any live endorsements/penalty points? *YesNo
If yes, please provide details:
Do you have business insurance? *YesNo
Job title *
Employer name *
Employer address *
Current salary/hourly rate
Notice required *
Employment start date
Employment end date
Brief Outline Of Job Role & Responsibilities
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.
Give details of all secondary schools/colleges attended. You will be required to provide evidence of qualifications gained.
Membership of Professional Associations
Please give details of the name of the association, membership grade/level and membership number
Provide details of any training that may be relevant to your application including dates/duration.
Use this section of the application form to explain why you are applying for the job, concentrating on how your skills, knowledge and personal qualities match the requirements of the person specification.*
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.
Company Name *
Telephone Number *
Are you related to any Employee or Client of ASC Healthcare? *YesNo
If yes, please provide Name:
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.
Do you have any spent criminal convictions? *YesNo
If yes, please give details:
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.
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.
Your ethnicity *WhiteBlack – CaribbeanBlack – AfricanBlack – OtherIndianPakistaniBangladeshiChineseOther
What is your nationality?
Are you: *MaleFemale
Are you: *MarriedSingleOther
Please select your age group: *18-2526-3536-4546-5555+
Are you registered disabled? *YesNo
The Equal Opportunities information is to develop our equal opportunities policy and is used only for monitoring purposes.