General Information

    Length of time at address, if less than 5 years please provide address history to cover the last 5 years, with dates at each address(month and year from and month and year to).
    Please provide dates (month and year from and month and year to) when you lived at each previous address.
    Do you hold an NVQ/QCF level 3 in Children and Young Peoples Workforce?
    If no would you be willing to undertake it?
    Are you registered with the DBS Update Service?
    Do you hold a current driving licence?

    Emergency Contact Details

    Education, Training and Qualifications

    All Schools, Colleges and Universities attended should be listed, with dates of attendance, awards and qualications obtained and levels and grades achieved, commencing with the most recent. Please give details of examinations failed.

    School From – Month/Year To – Month/Year Subject/Course Studied Examination Result  
    -

    Full Employment History

    Please list details of all employment, including the names and addresses of employers, dates employed, positions held, full or part-time working and reasons for leaving, commencing with your current or last employment. All time since leaving full time education should be accounted for, and any time not spent in employment or education (listed previously) should be listed, including times spent in unemployment, voluntary work, raising a family or part-time work. Due to the nature of our business, the Company reserves the right to contact any previous employer for a reference.

    Employer including contact name and address Time Employed – From (Month & Year) Time Employed – To (Month & Year) Position Held Reason for Leaving Did this involve working with Children or Vulnerable Adults? YES/NO
    ADD +

    Please add your full employment history since you have finished school. Please press + to add new line

    Other Experience (Volunteering)

    Employer including contact name and address Time Employed – From (Month & Year) Time Employed – To (Month & Year) Position Held Reason for Leaving Did this involve working with Children or Vulnerable Adults? YES/NO

    Criminal Offences

    Rehabilitation of Offenders Act 1974. Because of the nature of the work for which you are apply, this post is exempt from the provision of the ACT. Applicants are therefore not entitled to withhold information about convictions/cautions, which for other purposes would be regarded as ‘spent’, and in the event of employment, any failure to disclose information about convictions or cautions, will result in dismissal. If you have been convicted of a criminal offence, please give details including all relevant dates in the space below. (Information given will be treated in the strictest confidence). If you have not been convicted/cautioned of a criminal offence, please indicate by stating ‘NONE’ in the box provided:

    Please note that this post is subject to the requirement for a Disclosure Application from the Disclosure and Barring Service

    References

    References To include job title, address and postcode of current employer, previous employer and one character reference, who you must have known for a minimum of 12 months. The capacity in which referees are writing should be stated, e.g. former employer, colleague etc. NB The referee listed under ‘current employer’ must be the principal person within your organisation. Please Note: We are unable to accept references from members of your immediate family. As required by legislation we verbally verify all references received.

    CURRENT EMPLOYER PREVIOUS EMPLOYER CHARACTER REFERENCE

    Monitoring Information

    Accalia Care Services has adopted an equal opportunities policy and is keen to ensure that it is working properly. As part of this policy, all job applicants are asked to complete this section.

    Please note that this section is primarily about colour and race and not naturalisation or citizenship.

    Ethnic Origins



    Are you a permanent UK resident?   

    Do you consider yourself to be disabled?

    Do you have any health issues that may affect your ability to work?
    In signing this application, candidates need to acknowledge that they are aware that:
    • Direct or indirect canvassing regarding their appointment will render them liable to disqualification.
    • The above information is correct.
    • Any false information or deliberate ommisions will disqualify them from employment or may render them liable for dismissal or criminal prosecution.
    • The information they provide is sublect to the Data Protection Act 1998. The company will process data principally for personnel, administration and payroll purposes.
    • I consent to Accalia Care Services Ltd to contact my named referees to obtain references in accordance with it’s normal policy.

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