Application Form – Weston Hospicecare

Application to work

Vacancy Details

Vacancy applying for?(Required)

Vacancy Ref.(Required)

Where did you find out about the vacancy?(Required)

Date you are available to start work with us(Required)

Can you work the hours / shifts detailed in the advertisement?(Required)

Yes

If no, please give details

Please tell us any dates you are not available for interview?(Required)

Salary Expectations

Personal Details

Name(Required)

Title Forename(s) Surname

National Insurance Number(Required)

Email(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City County Postcode Country

Education & Qualifications

Where a professional / academic qualification is an essential requirement of the job, we may seek to verify these with the relevant educational authorities. You may be asked to provide documentation at the job offer stage.

Education & Qualifications(Required)

Professional institution (e.g school, college, work based training course)

Level & subject (e.g GCSE Maths, Level 2 Health & Social Care, BSc in Palliative & End of Life Care

Type of qualification/grade or level achieved (e.g pass, merit, distinction)

Year in which your qualification was achieved

Current Study

Please detail any study you are currently undertaking.

Current Study(Required)

Professional institution (e.g school, college, work based training course)

Level & subject (e.g GCSE Maths, Level 2 Health & Social Care, BSc in Palliative & End of Life Care

Type of qualification/grade or level achieved (e.g pass, merit, distinction)

Year in which your qualification was achieved

Career History

Please start with your most recent employer. Continue on a separate sheet if you wish.

Name of organisation(Required)

Address of organisation(Required)

Street Address Address Line 2 City County Postcode Country

Date joined(Required)

Are you still employed there?(Required)

Yes

If no, date and reason for leaving(Required)

Are you / have you ever been subject to disciplinary poor performance proceedings whilst employed there?(Required)

Yes

Your job title(Required)

Current / leaving salary(Required)

Brief description of duties and responsibilities(Required)

Name of organisation(Required)

Position held(Required)

Address of organisation(Required)

Street Address Address Line 2 City County Postcode Country

Date joined(Required)

Date left(Required)

Reason for leaving(Required)

Brief description of duties and responsibilities(Required)

Name of organisation(Required)

Position held(Required)

Address of organisation(Required)

Street Address Address Line 2 City County Postcode Country

Date joined(Required)

Date left(Required)

Reason for leaving(Required)

Brief description of duties and responsibilities(Required)

Name of organisation(Required)

Position held(Required)

Address of organisation(Required)

Street Address Address Line 2 City County Postcode Country

Date joined(Required)

Date left(Required)

Reason for leaving(Required)

Brief description of duties and responsibilities(Required)

Please add additional employers / information on a separate sheet

Max. file size: 256 MB.

Employment/Education Gaps

If you have any gaps within your employment or education history, please state the reasons for the gaps below(Required)

Supporting Information

Please use this section to tell us in more detail about your skills and experience. This may have been gained whilst doing paid or unpaid work, apprenticeships, whilst at college or at any other time in your life. What you write here will be compared against the criteria detailed in the Job Description and Person Specification.

Please ensure you mention anything here that demonstrates that you fulfil the criteria. Don’t assume that we will know.(Required)

Further Information & Guidance for completing the Additional Information section:

If you are successful at interview and offered employment, your offer will be conditional upon us receiving satisfactory further information. The type of information that we will require from you at this stage will vary depending on the role that you are offered. It may include information on:

References - for all positions, you will be asked to provide the name, position and contact details of two referees. If you are, or have been employed, these should be your two most recent employers, your line manager or someone in a position of responsibility who can comment on your suitability for the post. If you are a student, you will need to provide contact details of a teacher at your school, college or university.
Your eligibility to work/remain in the UK
Your driving licence/record
Your fitness to practice, e.g. whether you are subject of a fitness to practice investigation or proceedings by a licensing or regulatory body in the UK or in any other country
Whether you have ever been removed from the register or have had conditions made on your registration by a fitness to practice committee or the licensing or regulatory body in the UK or in any other country
Criminal convictions, cautions, reprimands and similar criminal offence

Driving

Some roles require a current full driving licence. If you are unsure whether the post you are applying for requires this, please refer to the job advert, supporting recruitment information or Job Description/Person Specification. If this is not a requirement for your role, you are not required to complete the driving section below.

Disclosure & Barring Service (DBS)

If you are applying for a post involving access to persons in receipt of health services or supervising children, your offer of employment may be subject to a satisfactory disclosure from the Disclosure and Barring Service (DBS). Failure to reveal information relating to any convictions could lead to withdrawal of an offer of employment. If in doubt, please refer to the job advert, supporting recruitment information or Job Description/Person Specification. For more information or advice on any of the above, please contact the HR Team.

References

Please provide details of two referees below. Your referees should be your two most recent employers. References will not be taken up before an applicant has accepted an offer of employment. Please note; it is hospice policy to take up references via email, therefore email details are essential.

Type of reference(Required)

Referee Name(Required)

Position/Job Title(Required)

Relationship to you (e.g Line Mgr)(Required)

Organisation Name

Organisation Address(Required)

Street Address Address Line 2 City County Postcode Country

Contact email(Required)

Contact Number(Required)

I authorise Weston Hospicecare to obtain references from the employer (above)(Required)

Yes

Type of reference(Required)

Referee Name(Required)

Position/Job Title(Required)

Relationship to you (e.g Line Mgr)(Required)

Organisation Name

Organisation Address(Required)

Street Address Address Line 2 City County Postcode Country

Contact email(Required)

Contact Number(Required)

I authorise Weston Hospicecare to obtain references from the employer (above)(Required)

Yes

Additional Information

(see notes above)

Eligibility to Work in the UK

Are you eligible to work in the UK?(Required)

Yes

If so, do you have a valid work permit?(Required)

Yes

Do you require EU settled status?(Required)

Yes

Do you require EU settled status?(Required)

Yes

Driving

Do you hold a current, full, clean UK driving licence?

Yes

Are you able to travel to and between our various locations for work/training purposes?

Yes

Do you have access to a car you can use for work purposes?

Yes

Do you have any current endorsements?

Yes

Membership of Professional Bodies (e.g. NMC, GMC, HCPC)

Professional Body(Required)

Yes

Name of Professional Body

PIN/Registration No

Expiry Date

Have you ever been subject to investigation/regulatory proceedings in the UK or other country?

Yes

Privacy Statement and Declaration

In order to progress your application throughout the recruitment process, data contained within this form may be stored in both electronic and hard copy formats. Personal identifiable data will be held securely and only be accessed by authorised personnel within Weston Hospicecare.

If your application is successful we will retain your application form for the duration of your employment and up to 7 years after the end of your employment.

If your application is unsuccessful we will retain your application for up to 10 months; after this date it will be safely destroyed.

For more information, regarding data processing and storage please refer to our Privacy Statement shown on our website or by requesting our full suite of Information Governance policies from the HR Team.

I understand and agree that data contained in this application form will be used for
employment recruitment purposes and will be stored and retained as detailed above.
I understand that the appointment, if offered, will be subject to information given on this
form and I agree that any deliberate omission, false statements or misrepresentation in the
application form will be grounds for rejecting this application or subsequent dismissal of
employed by the Hospice

Signed(Required)

Dated(Required)

Please press submit to send your application

Application to work

Vacancy Details

Personal Details

Education & Qualifications

Current Study

Career History

Employment/Education Gaps

Supporting Information

Further Information & Guidance for completing the Additional Information section:

Driving

Disclosure & Barring Service (DBS)

References

Additional Information

Eligibility to Work in the UK

Driving

Membership of Professional Bodies (e.g. NMC, GMC, HCPC)

Privacy Statement and Declaration

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