Application Form

Thank you for your interest in job opportunities with Choices Homes. Please complete all sections of the application.

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Personal Details

Please complete all sections

Surname

Phone

First Names

Mobile

Address

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Previous * address: (If current address less than 5 years)

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Postcode

Drivers Licence

Length of time at address

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National Insurance No

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Date of Birth

Do any members(s) of your immediate family currently work at Theracare?

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Give details of Work Permits, VISAs, Leave to Remain etc that allow you to work legally in the UK – include expiry dates

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View

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Upload CV

Education & Training

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School Attended

From

Exams Passed-Sub

Grades

Year

@endforeach

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University/College

From

Exams Passed-Sub

Grades

Year

@endforeach

Relevant NVQ’s Obtained inc Dates

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Other relevant qualifications obtained

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Employment History

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Organisation name

Job Role

Date Commenced

Date Ended

Reason for leaving

Salary

@endforeach

About You

Why would you like to work for Theracare?

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How can you make a positive impact to our residents’ lives?

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Can you tell us what related experience You have i.e. Previous roles either paid or unpaid, qualifications or training you may have?In detail

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Do you understand the term? ‘Safeguarding’ and what this entails?

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What assets will you bring to the role you are applying for?

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Please tell us about any sickness or absence from work you have had in the previous two years?

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Are you aware of the term ‘Whistleblowing’?

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Further Information

Please complete all sections

Are you facing any criminal prosecutions?

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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)?

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Have you ever been subject to any safeguarding concerns / or enquiries in ANY roles previous to applying for this post?

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Have you ever been dismissed from any employment? Please explain the reasons

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Have you ever been or are you currently going through any investigation or disciplinary action?

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Are you currently able to conduct the jobyou are applying for?

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Can we make any reasonable adjustments to avoid you being at a disadvantage in the work place?

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Referees

Current/Most Recent Employer

Company

Name

Position

Address

Telephone

Fax

Previous Employer

Company

Name

Position

Address

Telephone

Fax

Personal Reference

Company

Name

Position

Address

Telephone

Fax

Reason that these Referees are being used:

Ref 1

Ref 2

Please provide the names and addresses of three referees, one of whom should be your current or most recent employer and one other previous employer. The other should be a personal referee, someone who knows you well.Please do not give the name of a relative as a referee. If you are known to your referee by a former name, please supply the name by which you were known. We cannot process your application unless you provide this information.

In line with Children’s Home Regulation we require a FULL WORK HISTORY including any voluntary or unpaid roles, any time off work you may have had due to sickness, ill health or maternity. All work history should include month and year of roles and reasons for leaving going back to full time education. Any gaps in employment require explanation and contact details for someone who can support reasons for this.

Any application that does not hold this information will be returned to sender and not reviewed until completed.

Declaration

I confirm that the information provided on this application form is true and complete, and that I am legally entitled to work in the UK.

I understand that any false statements or deliberate misrepresentations will be regarded as grounds for disciplinary action and/or termination of my employment.

I understand that any offer of employment is subject to satisfactory references and DBS checks, and I authorise Theracare Homes to obtain references to support this application once an offer has been made and accepted.

I understand that any information given in relation to my application will be held by the Company and falls within the provisions of the Data Protection Act 1998. I also give my consent for my personal information being retained and used to process my application for employment.

Print name

Signed @if(isset($form->signature) && !empty($form->signature))

@endif

Date