Contact Details:
Position Sought
Surname
First Names
Full Address
Post Code
Telephone (inc codes)
Mobile
(inc codes)
Fax (inc codes)
Email address
Date of Birth (dd/mm/yyyy)
Position Applied
for
Salary Expected
Publication in
which you s aw the
advertisement / source of Introduction
Have you previously worked for or
applied to join this company?
Expected Start
Date
In your own words, write briefly
why you feel you would be an ideal candidate for this /a
position, including details of any skills / experience which
you feel would especially suit the job you are applying for.
Employment
History:
Present / Last
Employer
Address
Job Title and
Responsibilities
Achievements
Type of Business
Starting Salary
Present /
Leaving Salary
Please give the
same details for your previous employment, beginning with the
most recent
Education:
Please give
details of your full time education since age 15
Names of
schools, dates of examination, subjects and results
Names of
Colleges, dates of examination, subjects and results
Please give details of any studies
undertaken since leaving full time education, including
training courses.
You will be required to produce
certificates/confirmation of examination results on commencing
employment.
Please give
details of memberships to professional or health related
bodies
Personal:
Health – Brief particulars of
illness and resulting absence from work over the past 3 years
Are you a
registered disabled person? If yes please give details
What adjustments
do you require to enable you to attend for interview or carry
out the duties of any given post?
Do you have a
clean driving licence? Please enter yes or no, if no please
give details
Have you ever been convicted of a
criminal offence other than a spent conviction under the
rehabilitation of offenders act 1974? (this does not include
minor traffic offences)
Please give brief details of
relevant pastimes, hobbies, sports, public duties
Please give details of two
contacts you would be happy for us to approach for references.
Where appropriate one of these
should be from your present or last employer. (References will
not be taken up unless you are offered and accept an
appointment)
Please provide any additional
information that you think may be useful in assessing your
application
Equal Opportunities Monitoring
Information:
Male
Female
Please indicate how you prefer to
describe your ethnic origin.
Bangladeshi
Black African
Black Caribbean
Black Other (please specify)
Chinese
Indian
Irish
Pakistani
White
Other (please specify)
For employment purposes, a
disabled person is defined as a person with a physical,
sensory or mental impairment that has a substantial and
long-term adverse effect on his or her ability to carry out
normal day-to-day activities.
For employment purposes are
you disabled (Yes / No)
Please state the nature of
your disability and your registered number:
By Completing and Submitting this
form you are agreeing to this Declaration:
I declare that the information
given in support of this application is correct to the best of
my knowledge and that if any statement is subsequently found
to be false or misleading, my employment with the company may
be terminated. I understand that any job offer is subject to
satisfactory employment references.
At Cliff House, we are always
actively seeking to recruit first and second level qualified nurses
together with auxiliary and domestic staff. NVQ qualifications are
preferred, however, Cliff House has as on-going National
Vocational Qualification training programme.