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Thank you for your interest in applying for a job with us.

Please complete all of the fields listed below, fields marked with an * are required fields so you must fill these in before submitting the application.

You may find it useful to read our guidance notes before starting the application; they will open in a separate window and you can refer to them without closing your application.

The personal data you provide will be used, stored and deleted in accordance with our privacy notice.

Application Policies

Rehabilitation of Offenders Act 1974

Application Guidance

Equal Opportunities Monitoring

Information For Disabled Applicants

Guide To References

Authorization and Consent

Are you legally authorised to work in the UK?

Section One - Personal Details

Name:
Address:
Would you require a work permit or any other endorsements to work in the United Kingdom?
Do you have a current, full driving licence?
Do you have any penalty points?
Do you have access to a car for business use?
Have you applied for a position within St Cuthbert's Care before?

References

Please give names and addresses of two people who can comment on your suitability for this post. One of these must be your current or most recent employer and the other should be a professional person, at a business address.
Referee 1 Name:
Address:
May we contact this referee prior to an offer of employment?
Referee 2 Name:
Address:
May we contact this referee prior to an offer of employment?

Section Two - Career History

Current / Most recent employer's Address:
Employed from:
Do you have any additional employment which you would like to continue if appointed to this post?

Previous Employment

Please provide details of your previous employment history, starting with the most recent and accounting for any gaps. It is essential that we are able to account for all periods of applicants history due to safeguarding requirements. Please include voluntary, home-based, part-time, unemployment, college, university. St Cuthbert's Care reserves the right to contact any or all of your previous employers.
Employed from:
Employed to:
Employed from:
Employed to:
Add previous employer 3?
Employed from:
Employed to:
Add previous employer 4?
Employed from:
Employed to:
Add previous employer 5?
Employed from:
Employed to:

Section Three - Education and Qualifications

Include membership of professional bodies, giving details and level of membership
Include short training courses and seminars, giving details and dates

Section Four - Health and other relevant information

Do you smoke?
If there are any health concerns in respect of your application or subsequent employment, a medical examination or information may be required. Successful candidates will be required to complete a pre-employment health questionnaire.
Have you ever been involved in disciplinary action?
Please declare any other issues that have been raised in respect of your working practice

Section Five - Supporting Statement

This section must be completed.
In the event of a successful application a DBS certificate may be requested from the Disclosure and Barring Services. Having a criminal record will not necessarily exclude you from consideration; this will depend on the nature of the position you have applied for and the circumstances and background of your offences.

Section Six - Declaration

have completed this form and that the information I have provided is correct. I understand that supplying false or misleading information may lead to automatic disqualification from appointment or dismissal.
Date:

Rehabilitation of Offenders Act 1974

The nature of this work for which you are applying, is exempt from the provisions of the Rehabilitation of Offenders Act 1974, by virtue of the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975. Applicants are not entitled to withhold information about criminal records, which for other purposes are 'spent' under the Provisions Act, and in the event of employment any failure to disclose such criminal records could result in dismissal or disciplinary action. All information supplied will be treated in the strictest confidence and will be considered only in relation to the application for the position to which the order applies.
Do you have any convictions, cautions, reprimands or final warnings which would not be filtered in line with current guidance?
Should you have any queries about how to respond to this question, guidance is available on the website www.gov.uk/DBS or telephone NACRO helpline on 0300123 1999
Are you aware of any police enquiries undertaken following allegations made against you which may have a bearing on this post?

Information for disabled applicants

The Disability Discrimination Act (1995) says that employers, as providers of goods and services, must make 'reasonable adjustments' to work places and services to make sure disabled people are treated fairly. We are committed to equal opportunities and increasing employment opportunities for disabled people. The Disability Discrimination Act 1995 defines a disabled person as 'a person with a physical or mental impairment which has a substantial and long term adverse effect on his/her ability to carry out normal day to day activities.' If you require assistance whilst attending an interview or selection test, please provide details and include with your application form. Alternatively contact us by phone on (0191) 228 0111.