Suite 4, 62 Portman Road, Reading, Berkshire. RG30 1EA

Email: [email protected] Tel: 0118 3913542

JOB APPLICATION FORM

This form can be supplied in large print please contact us. (Please see Guidance notes on the last page)

Vacancy title

Please tell us how you heard about this vacancy

1. PERSONAL DETAILS

First Name *

Last Name *

Address *

City *

State *

Postal code *

Country *

Daytime Contact No. *

Email *

Are you subject to any conditions relating to your employment in this country? (Visa Restrictions) *

Yes- I have restrictions

If "yes" please use the space below to tell us what these are?

2. PREFERRED HOURS

We like our workers to be willing to work flexibly across the week and need to know when other commitments mean you could not be available to work *

Full-time

Part-time

Availability: We like our workers to be willing to work flexibly across the week and need to know when other commitments mean you could not be available to work: Please type morning, afternoon or evening on the day you are available. *

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

3. EDUCATION/QUALIFICATIONS

School 11+

School Name

Study Dates

Qualification and Grade

Date Obtained

College/University

College/University Name

Study Dates

Qualification and Grades

Date Obtained

ONGOING PROFESSIONAL DEVELOPMENT

Ongoing Professional Development

Study Dates

Qualification and Grade

Date Obtained

TRAINING AND DEVELOPMENT

Please use the space below to give details of any training or non-qualification based development which is relevant to the post and supports your application.

Training Course

Course Details

CURRENT MEMBERSHIP OF ANY PROFESSIONAL BODY/ORGANISATION

4. EMPLOYMENT HISTORY

Previous Employment: Please include any previous experience (paid or unpaid), starting with the most recent first.

CURRENT OR MOST RECENT EMPLOYER

Name of Employer

Address

Postal Code

Position Held

Date Started

Leaving Date

Reason for Leaving

Salary on Leaving this Post

Contact Name of Line Manager for reference:

Brief description of duties:

PREVIOUS EMPLOYER

Previous employer Name of Employer

Previous employer Address

Previous employer Postal Code

Previous employer Position Held

Previous employer Date Started

Previous employer Leaving Date

Previous employer Reason for Leaving

Previous employer Salary on Leaving this Post

Previous employer Contact Name of Line Manager for reference

Previous employer Brief description of duties

5. INFORMATION IN SUPPORT OF YOUR APPLICATION

Skills, abilities and experience Please use this section to demonstrate why you think you would be suitable for the post by reference to the job description and person specification (and by giving examples and case studies). Please include all relevant information, whether obtained through formal employment or voluntary/leisure activities. Attach and label any additional sheets used. See guidance sheet for further information.

6. CONVICATIONS/DISQUALIFICATIONS

To ensure the safety of our clients/members a CRB check must be completed for all positions. A criminal record will not necessarily be a bar to obtaining a position at Apex Healthcare Services. If a check is returned and reveals any information, this will be discussed with the applicant. The Chief Executive will make a decision as to whether the offer of employment should be withdrawn.

Rehabilitation of Offenders Act 1974 (Exceptions)(Amendment) Order 1986

We would draw your attention to the following statement:-

“Because of the nature of the work for which you are applying, this post is exempt from the provisions of Section 4(2) of the Rehabilitation of Offenders Act, 1974, by virtue of the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 and the Rehabilitation of Offenders Act 1974 (Exceptions) (Amendment) Order 1986. Applicants are, therefore, not entitled to withhold information about convictions which for other purposes are ‘spent’ under the provisions of the Act”.

Do you have any pending or confirmed convictions we should be aware of? Or anything that may be reflected on you DBS.

Yes

Please provide details below if you have been convicted of a criminal offence or been the subject of a conditional discharge or probation order. (Past criminal proceedings are not necessarily an obstacle to taking up a post. This occurs only where the offence/s is/are deemed relevant. Any details will be discussed with you should you be the successful candidate based on your supporting statement, interview and tests).

7. REASONABLE ADJUSTMENTS/ARRANGEMENTS FOR INTERVIEW

Please contact us if you need the application form in an alternative format.

If you need us to make any adaptations for your interview to accommodate any disability you may have please tell us what these should be?

Are you related or know anyone within the organisation?

Yes

If yes, please state the name of the staff nature of this relationship below:

If appointed when could you start? Give period of notice if applicable

DECLARATION

Privacy notice

We process personal data relating to those who apply for job vacancies with us or who send speculative job applications to us. We do this for employment purposes, to assist us in the selection of candidates for employment, and to assist in the running of the business. The personal data may include identifiers such as name, date of birth, personal characteristics such as gender, qualifications and previous employment history.
We will not share any identifiable information about you with third parties without your consent unless the law allows or requires us to do so. The personal data provided during an application process will be retained for a period of at least six months or, if required by law, for as long as is required.

This privacy notice does not form part of an employment offer or contract between us. If we make an employment offer to you, we will provide further information about our handling of your personal information in an employment context separately.

If you would like to find out more about our data retention policy and how we use your personal data, you want to see a copy of the information about you that we hold or have any questions or issues regarding data protection, please email us with the Subject “Data Protection Request”.

Statement to be Signed by the Applicant

Please complete the following declaration and sign it in the appropriate place below. If this declaration is

not completed and signed, your application will not be considered.

I agree that Apex Healthcare Services can create and maintain computer and paper records of my personal data and that this will be processed and stored in accordance with the General Data Protection Regulation 2016.

I agree

I confirm that all the information given by me on this form is correct and accurate and I understand if any of the information I have provided is later found to be false or misleading, any offer of employment may be withdrawn/terminated

Decline

Signature

Clear

Date