Why Astley Grange
Life at Astley Grange
Facilities
Activities
Food
Request a Brochure
Careers
Careers
ASTLEY GRANGE HOMES LTD
APPLICATION FORM
DBS checks are part of recruitment process)
Position Applied For *
The following information will be treated in the strictest confidence.
Personal
(Please complete this section in BLOCK CAPITALS)
Surname*
First Name*
Address *
Postcode*
Home telephone number*
Mobile telephone number*
Pin no (Nurse only)*
Full Driving Licence*
Yes
No
Endorsements*
Yes
No
If YES, please give further details including dates:
Are you involved in any activity which might limit your availability to work or your working hours e.g., local government?
Yes
No
If YES, please give full details:
Are you subject to any restrictions or covenants which might restrict your working activities?
Yes
No
If YES, please give full details:
Are you willing to work overtime and weekends if required?
Yes
No
Please give details of any hours which you would not wish to work:
Are you aged over 18?
Yes
No
It is a criminal offence for barred individuals to apply to work in a regulated activity with children, young people or adults at risk. Are you on a barred list?
Yes
No
If offered employment, we are required to check your up to date DBS status before you are permitted to start work.
Do you have a DBS certificate?
Yes
No
If yes, are you a current member of the Update Service
Yes
No
If yes, do you consent to this Update Service check being made by the Company?
Yes
No
Do you have any convictions, cautions, reprimands or final warnings that are not "protected" as defined by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (as amended in 2013) by SI 2013 1198? (A copy of the Company's Equal Opportunities Policy and Disclosure and Disclosure Information Policy is available on request. These reflect the DBS Code of Practice).
Yes
No
If YES, please give full details
If offered employment, you will be required to complete a Medical Questionnaire. Are you prepared to undergo a medical examination before employment?
Yes
No
Have you ever worked for the Company before?
Yes
No
If YES, please give full details
Have you applied for employment with this Company before?
Yes
No
Do you need a work permit to take up employment in the U.K.?
Yes
No
How much notice are you required to give to your current employer?
Education
Schools attended since age 11
From
To
Examinations and Results
College or University
From
To
Courses and Results
Further Formal Training
From
To
Diploma/Qualification
Job related Training Courses Name of Organisation
Date
Subject
Please give details of membership of any technical or professional associations:
Please list languages spoken and the level of competence:
Employment Details
Please give details of your past employment, excluding your present or last employer, stating the most recent first.
Name and address of employer
Dates
Position held/Main duties
Reason for leaving
Present or Last Employer
Are you currently employed?
Yes
No
Name of present or last employer:
Address:
Telephone number:
Nature of business:
Job title & brief description of duties:
Reason for leaving:
Length of service:
From
To
Interests, Achievements, and Leisure Activities
(e.g. hobbies, sports, club memberships)
Supplementary Information
Please set out below any further information to support your application
(e.g. past achievements, future aspirations, personal strengths)
Declaration
I declare that the information given in this form is complete and accurate.I understand that any false information or deliberate omissions will disqualify me from employment or may render me liable to summary dismissal.I understand these details will be held in confidence by the Company, for the purposes of ongoing personnel administration and payroll administration in compliance with the Data Protection Act 1998. I undertake to notify the Company immediately of any changes to the above details.Given the nature of the job for which I have applied, I understand that any offer of employment will be subject to information on my criminal record being disclosed to the Company by the Disclosure Barring Service. (Please note that the amendments to the Exceptions Order 1975 (2013) provide that certain spent convictions and cautions are 'protected' and are not subject to disclosure to employers, and cannot be taken into account. Guidance and criteria on the filtering of these cautions and convictions can be found at the Disclosure and Barring Service website.) I have been given a copy of the Company's Equal Opportunities and Diversity Policy, which includes information relating to the recruitment of ex-offenders.
Signed :
PRINTED:
Date:
References
Please give the names of two people (one of which should be your present or most recent employer) whom we may approach for a reference.
Can we approach your current employer before an offer of employment is made?
Yes
No
Name:
Name:
Position:
Position:
Address:
Address:
Tel. No:
Tel. No:
Source of Application
How did you hear of this vacancy?