Employment application form (enhanced DBS)

Please complete all sections and sign off electronically below.

It is the hospice’s policy to employ the best qualified personnel and provide equal opportunities for the advancement of employees including promotion and training, and not to discriminate against any person because of gender, age, religion or belief, marital status, race, nationality, ethnic origin, sexual orientation or disability.

You can save your application for 30 days and continue filling it in later by clicking ‘save and continue’ at the bottom of this page.
Position applied for*
Location*
Personal details
Title*
Forenames*
Surname*
Postcode Lookup

Address*
Street Address City County / State / Region ZIP / Postal Code Country
Phone number (preferred)*
Phone number (alternative)
Do you have an email address?*
Email*
Education & training
Please state your most recent qualifications first with the year and location of study. Include membership to professional bodies, if applicable.
Qualification(s) gained*
PIN number*
PIN number*
Expiry date*
DD slash MM slash YYYY
Current employment
Are you currently employed?*
Job title
Name of employer
Postcode Lookup

Address
Street Address City County / State / Region ZIP / Postal Code Country
Date joined
DD slash MM slash YYYY
Current working hours
Current salary/hourly pay rate
Details of duties and responsibilities
Reason for leaving
Notice period
Previous employment
Please give details of your employment for the last 10 years. Please also state your salary/hourly rate and NHS Band (if applicable).
Final salary/hourly rate*
Reason for leaving*
Date from*
DD slash MM slash YYYY
Date to*
DD slash MM slash YYYY
Employer’s name and nature of business*
Job title and summary of key responsibilities*
Do you have a second previous position to add?*
Final salary/hourly rate*
Reason for leaving*
Date from*
DD slash MM slash YYYY
Date to*
DD slash MM slash YYYY
Employer’s name and nature of business*
Job title and summary of key responsibilities*
Do you have a third previous position to add?*
Final salary/hourly rate*
Reason for leaving*
Date from*
DD slash MM slash YYYY
Date to*
DD slash MM slash YYYY
Employer’s name and nature of business*
Job title and summary of key responsibilities*
Do you have a fourth previous position to add?*
Final salary/hourly rate*
Reason for leaving*
Date from*
DD slash MM slash YYYY
Date to*
DD slash MM slash YYYY
Employer’s name and nature of business*
Job title and summary of key responsibilities*
Do you have a fifth previous position to add?*
Final salary/hourly rate*
Reason for leaving*
Date from*
DD slash MM slash YYYY
Date to*
DD slash MM slash YYYY
Employer’s name and nature of business*
Job title and summary of key responsibilities*
Do you have a sixth previous position to add?*
Final salary/hourly rate*
Reason for leaving*
Date from*
DD slash MM slash YYYY
Date to*
DD slash MM slash YYYY
Employer’s name and nature of business*
Job title and summary of key responsibilities*
Rehabilitation of Offenders Act 1974
The Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 provides that all convictions and offences of whatever nature (including motor offences) and whenever they were committed must be revealed when applying for employment at the hospice.

A DBS check (Disclosure and Barring Service formerly CRB) will be requested in the event of an individual being offered a post.
Do you have any such convictions?*
Please list ALL such convictions (including current driving endorsements).*
Are you currently being investigated by the police or any other regulatory body?*
Please give details*
Other details
Do you hold a full valid UK driving licence?*
Do you need a work permit for employment in the UK?*
In order to comply with the Asylum and Immigration Act 1996, any offer of employment will be subject to provision of documentation showing your entitlement to work in the UK (eg National Insurance Number).
Are you related to anyone employed by the hospice?*
Please tell us who this is?*
Do you speak a foreign langange?*
Please give details and degree of fluency?*
How did you hear about his vacancy?*
————————————————————————————————————————————————————————————————————————————————-
Are you aware of any reasonable adjustments to the workplace that will be necessary if you were to attend for interview?*
Please give us more details*
The hospice will consider making such adjustments as are reasonable in compliance with the Equality Act 2010. Note: A formal offer of employment cannot be made until a satisfactory medical report is received from the Occupational Health Providers who act as the hospice’s agents in this respect.
Experience
Please use the space below to explain what qualities you feel you could offer to the position and how you meet the requirements of the job. Outline the aspects of your experience and give particular achievements or distinctions which you consider relevant to this application.
*
References
Please give below the names and details of two persons (not members of your family) who can be contacted and asked for a reference. One should be your present or latest employer.
Note: Two satisfactory written references must be received before a formal offer of employment can be made.
First referee forename*
Surname*
Organisation (if applicable, if not please state N/A).*
Phone number*
Do you know their email address?*
Email*
Connection to you*
Work/character reference?*
Second referee forename*
Surname*
Organisation (if applicable, if not please state N/A).*
Phone number*
Do you know their email address?*
Email*
Connection to you*
Work/character reference?*
NB: The hospice may contact your referees at any time after receipt of application. If this is not acceptable please state your preference*
Declaration
I confirm that the details I have provided on this form are correct to the best of my knowledge and I understand that any contract of employment will be jeopardised if I have misrepresented or omitted any relevant information. I understand that a DBS Check will be sought in the event of a successful application. I understand that information divulged in application forms for employment will be kept on files (both manual and computer) for recruitment, monitoring and employment purposes. Information will be stored securely in line with Data Protection Act 2018 and the DBS Code of Practice.

I have read the Standard/Enhanced Check Privacy Policy for applicants www.gov.uk/government/publications/dbs-privacy-policies and I understand how DBS will process my personal data and the options available to me for submitting an application.

I have read and understand the Application Pack relating to this position.
Signature*
Date*
DD slash MM slash YYYY
Thank you for completing this form.

Save and Continue Later

Employment application form (enhanced DBS)

Please complete all sections and sign off electronically below.

It is the hospice’s policy to employ the best qualified personnel and provide equal opportunities for the advancement of employees including promotion and training, and not to discriminate against any person because of gender, age, religion or belief, marital status, race, nationality, ethnic origin, sexual orientation or disability.

You can save your application for 30 days and continue filling it in later by clicking ‘save and continue’ at the bottom of this page.

Position applied for*

Location*

Personal details
Title*

Forenames*

Surname*

Postcode Lookup

Address*
Street Address City County / State / Region ZIP / Postal Code Country

Phone number (preferred)*
Phone number (alternative)
Do you have an email address?*
Email*

Education & training
Please state your most recent qualifications first with the year and location of study. Include membership to professional bodies, if applicable.
Qualification(s) gained*
PIN number*
PIN number*

Expiry date*
DD slash MM slash YYYY

Current employment
Are you currently employed?*
Job title

Name of employer

Postcode Lookup

Address
Street Address City County / State / Region ZIP / Postal Code Country

Date joined
DD slash MM slash YYYY

Current working hours

Current salary/hourly pay rate

Details of duties and responsibilities
Reason for leaving

Notice period

Previous employment
Please give details of your employment for the last 10 years. Please also state your salary/hourly rate and NHS Band (if applicable).
Final salary/hourly rate*

Reason for leaving*

Date from*
DD slash MM slash YYYY

Date to*
DD slash MM slash YYYY

Employer’s name and nature of business*
Job title and summary of key responsibilities*
Do you have a second previous position to add?*
Final salary/hourly rate*

Reason for leaving*

Date from*
DD slash MM slash YYYY

Date to*
DD slash MM slash YYYY

Employer’s name and nature of business*
Job title and summary of key responsibilities*
Do you have a third previous position to add?*
Final salary/hourly rate*

Reason for leaving*

Date from*
DD slash MM slash YYYY

Date to*
DD slash MM slash YYYY

Employer’s name and nature of business*
Job title and summary of key responsibilities*
Do you have a fourth previous position to add?*
Final salary/hourly rate*

Reason for leaving*

Date from*
DD slash MM slash YYYY

Date to*
DD slash MM slash YYYY

Employer’s name and nature of business*
Job title and summary of key responsibilities*
Do you have a fifth previous position to add?*
Final salary/hourly rate*

Reason for leaving*

Date from*
DD slash MM slash YYYY

Date to*
DD slash MM slash YYYY

Employer’s name and nature of business*
Job title and summary of key responsibilities*
Do you have a sixth previous position to add?*
Final salary/hourly rate*

Reason for leaving*

Date from*
DD slash MM slash YYYY

Date to*
DD slash MM slash YYYY

Employer’s name and nature of business*
Job title and summary of key responsibilities*
Rehabilitation of Offenders Act 1974
The Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 provides that all convictions and offences of whatever nature (including motor offences) and whenever they were committed must be revealed when applying for employment at the hospice.

A DBS check (Disclosure and Barring Service formerly CRB) will be requested in the event of an individual being offered a post.
Do you have any such convictions?*
Please list ALL such convictions (including current driving endorsements).*
Are you currently being investigated by the police or any other regulatory body?*
Please give details*
Other details
Do you hold a full valid UK driving licence?*
Do you need a work permit for employment in the UK?*
In order to comply with the Asylum and Immigration Act 1996, any offer of employment will be subject to provision of documentation showing your entitlement to work in the UK (eg National Insurance Number).
Are you related to anyone employed by the hospice?*
Please tell us who this is?*

Do you speak a foreign langange?*
Please give details and degree of fluency?*

How did you hear about his vacancy?*
————————————————————————————————————————————————————————————————————————————————-
Are you aware of any reasonable adjustments to the workplace that will be necessary if you were to attend for interview?*
Please give us more details*
The hospice will consider making such adjustments as are reasonable in compliance with the Equality Act 2010. Note: A formal offer of employment cannot be made until a satisfactory medical report is received from the Occupational Health Providers who act as the hospice’s agents in this respect.
Experience
Please use the space below to explain what qualities you feel you could offer to the position and how you meet the requirements of the job. Outline the aspects of your experience and give particular achievements or distinctions which you consider relevant to this application.
*
References
Please give below the names and details of two persons (not members of your family) who can be contacted and asked for a reference. One should be your present or latest employer.
Note: Two satisfactory written references must be received before a formal offer of employment can be made.
First referee forename*

Surname*

Organisation (if applicable, if not please state N/A).*

Phone number*
Do you know their email address?*
Email*

Connection to you*

Work/character reference?*
Second referee forename*

Surname*

Organisation (if applicable, if not please state N/A).*

Phone number*
Do you know their email address?*
Email*

Connection to you*

Work/character reference?*
NB: The hospice may contact your referees at any time after receipt of application. If this is not acceptable please state your preference*

Declaration
I confirm that the details I have provided on this form are correct to the best of my knowledge and I understand that any contract of employment will be jeopardised if I have misrepresented or omitted any relevant information. I understand that a DBS Check will be sought in the event of a successful application. I understand that information divulged in application forms for employment will be kept on files (both manual and computer) for recruitment, monitoring and employment purposes. Information will be stored securely in line with Data Protection Act 2018 and the DBS Code of Practice.

I have read the Standard/Enhanced Check Privacy Policy for applicants www.gov.uk/government/publications/dbs-privacy-policies and I understand how DBS will process my personal data and the options available to me for submitting an application.

I have read and understand the Application Pack relating to this position.
Signature*
Date*
DD slash MM slash YYYY

Thank you for completing this form.

Save and Continue Later

Employment application form (enhanced DBS)

Personal details

Education & training

Current employment

Previous employment

Rehabilitation of Offenders Act 1974

Other details

Experience

References

Declaration

Employment application form (enhanced DBS)

Personal details

Education & training

Current employment

Previous employment

Rehabilitation of Offenders Act 1974

Other details

Experience

References

Declaration

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