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0333 034 8411
Email:
info@heart-link.co.uk
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Application Form - SPR26
Please ensure that you complete the application form in full as we cannot accept CVs. Please complete with black ink and block capitals. This form will be kept in confidence. Please note that no applicant will be unfairly discriminated against. This includes discrimination on account of age, cultural, religious, political beliefs, disability, ethnicity, gender, race, relationship status, sexual orientation, and / or Trade Union membership or stewardship. At the application stage of recruitment, we will not require you to give information about the characteristics listed above. However, where confirmation of gender is a requirement for the role, you will be expected to provide this information. If you have any special requirements to support you to complete this form (e.g. the need for large print or additional time) please contact the Registered Manager on .
Position Applied For:
Work Preference:
Please select
Full time
Part Time
Bank
I understand this role may include: Shift work, Unsociable Hours, Lone working involved.
Please select
Yes
No
Location:
Hours Requested:
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First Names
Middle Name
Surname
Previous Names:
Telephone number:
Mobile number:
Gender
NI number:
Email address
Address
Are you a Driver:
Yes
No
Own Transport
Please select
Yes
No
How long have you had a licence?
Please select
Yes
No
Any Endorsements:
Please select
Yes
No
Are you a United Kingdom (UK) National
Please select
Yes
No
Are you related to any of our current members of staff or Service Users?
Please select
Yes
No
*If no, Please detail your current immigration status and the relevant visa currently held (including Visa number)
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Equality Act 2010 Under the Equality Act 2010 the definition of disability is if you have a physical or mental impairment that has a “substantial” & “long-term adverse effect” on your ability to carry out normal day-to-day activities. Further information regarding the definition of disability can be found at:
www.gov.uk/definition-of-disability-under-equality-act-2010
.
For the purposes of this application & interview stage only, is there anything you would like us to be aware of so that we can make reasonable adjustments during the process?
Please select
Yes
No
Education *(All qualifications will be subject to a satisfactory check).
School / College / University
School / College / University
School / College / University
Date From:
Date From:
Date From:
Date To:
Date To:
Date To:
Examinations, Qualifications*
Examinations, Qualifications*
Examinations, Qualifications*
Training Courses attended or completing (evidence of attending courses is required)
Subject
Location
Date
Details
Professional Memberships / Registrations
Name of Organisation
Registration Number
Renewal Date
Details
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Please record below the details of your full employment history beginning with your current or most recent first. Any gaps must be explained. Use a separate attached sheet if required; please sign the sheet(s)
Current / Most recent employer
`start Date
End Date
Salary
Reason for Leaving:
Telephone:
Contact Name:
Address:
Post Code
Email address
Reason for Leaving:
Telephone:
Untitled
Contact Name:
Address:
Post Code
Email address
Explanation of Gaps Use this section to detail any gaps in employment and why
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References: Please provide names, addresses and telephone numbers for referees below who we may approach for a reference. In line with Care Inspectorate requirements, we require references (or other satisfactory evidence as the employer may determine) from all previous employers concerned with the provision of services relating to health or social care, or children or vulnerable adults which should include details of why their employment came to an end (note that this is not time limited). If your previous employment does not concern the provision of services relating to health or social care, or children or vulnerable adults, you must provide references from your two most recent employers. Please provide two character references if you are unable to obtain two professional references, e.g. in the case of an applicant who has been raising children for ten years. All will be contacted, therefore please inform the referees of the fact that you have used their name. If you are unable to provide the required references, please discuss the matter with us.
Referee 1
Contact Name:
Business Name:
Address:
Postcode:
Telephone:
Email address
Capacity in which known
Referee 2
Contact Name:
Business Name:
Address:
Postcode:
Telephone:
Email address
Capacity in which known
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Adult Support and Protection / Ex-Offenders Declaration: Please note this section will only be seen by those involved in the recruitment process and will be treated with the strictest confidence.
The Rehabilitation of Offenders Act 1974 aims to promote equality of opportunity and is committed to treating all applicants fairly regardless of ethnicity, disability, age, gender or gender re-assignment, religion or belief, sexual orientation, pregnancy or maternity and marriage or civil partnership. undertakes not to discriminate unfairly against applicants on the basis of a criminal conviction or other information declared. Answering 'yes' to the question below will not necessarily prevent your employment. This will depend on the relevance of the information you provide in respect of the nature of the position and the particular circumstances.
Are you currently bound over or do you have any current UNSPENT convictions that have been issued by a Court or Court-Martial in the United Kingdom or in any other country?
Please select
Yes
No
Do you have any current UNSPENT police cautions, reprimands or final warnings in the United Kingdom or in any other country?
Please select
Yes
No
Have you ever been dismissed from a position of employment, or do you have any outstanding disciplinary investigations?
Please select
Yes
No
Privacy Statement
We will only collect data for specified, explicit and legitimate use in relation to the recruitment process. By signing this application form, you consent to holding the information contained within this application form. If successfully shortlisted, data will also include shortlisting scoring and interview records. We would like to keep this data until the vacancy is filled. (We cannot estimate the exact time period, but we will consider this period over when a candidate accepts our job offer for the position for which we are considering you). When that period is over, we will either delete your data or inform you that we would like to keep it in our database for future roles. We have privacy policies that you can request for further information. Please be assured that your data will be securely stored by the Registered Manager and only used for the purposes of recruiting for this vacant post. You have a right for your data to be forgotten, to rectify or access data, to restrict processing, to withdraw consent and to be kept informed about the processing of your data. If you would like to discuss this further or withdraw your consent at any time, please contact the Registered Manager to discuss.
The information in this application form is true and complete. I agree that any deliberate omission, falsification or misrepresentation in the application form will be grounds for rejecting this application or subsequent dismissal if employed. Where applicable, I consent that can seek clarification regarding professional registration details.
Print Full Name:
Signature
Date
If I was a Service User, I would like:
I believe that the Service User’s family and Relatives would like the following:
I believe that I can support a Service User because:
As a member of the team, I would feel valued when:
I believe that a good relationship between me and the Service User depends upon:
I believe that I learn best when:
I believe that a good working team is made by:
I believe that my role in relation to the Service User is:
My other beliefs and values relevant to my job role are:
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