Application Form

Vancancy Application Form

Which role are you applying for?*

Title*

Forename*

Surname*

National Insurance*

Address line 1*

Address line 2*

Address line 3*

Postcode*

Telephone

Mobile*

Email*

Rehabilitation of Offenders Act 1974 and exception order 1975

Because of the nature of the work for which you are applying, you must provide information about any convictions. Our power to require this lies in the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975, which removes the normal operation of the Act in relation to specific occupations, including the provision of Home Care Services. In the event of being employed in connection with this application, any failure to disclose such convictions could result in dismissal or disciplinary action. Crossroads Care Rotherham follows a Code of Practice about the fair use of disclosure information, and a copy is available on request. If you do have any previous or outstanding convictions, details of the type of offence, date, sentence, fine etc. should be placed in a separate, sealed envelope which will subsequently be returned to you. It will only be opened if you are considered for the appointment. Such information will be completely confidential to the appointing panel. A criminal record will not necessarily be a bar to obtaining a position.

Do you have any criminal convictions, cautions, reprimands or final warnings?*

If yes, please provide additional information.

Do you have access to a vehicle?*

Do you hold a full driving licence?*

Education & Training

Please list your qualifications and the dates they were achieved.*

Professional Qualifications/Higher Education

Please list your qualifications and the dates they were achieved.

Previous Employment

Please start with your FIRST job and ensure that any gaps in employment history are explained.*

Present/Last Employer

Employer name

Employer address

Start date

End date

Job role

Salary

Period of notice, if applicable.

Reason for leaving

Primary responsibilities

Achievements

Employer Reference

Name of reference*

Contact number*

Address of reference

Further Information

Please tell us about yourself and why you would like to work for Crossroads Care Rotherham. What skills do you have to offer and why do you think these skills would support your application for the role.

Detail your successes in your previous roles

Declaration

I declare that the information on this application form is true and accurate, to the best of my knowledge. If untrue or inaccurate information is recorded, any employment contract may be invalidated and the employee subject to disciplinary action or dismissal.*

GDPR

Your details will be kept secure and we will never pass your details onto third parties. For full details, see our Privacy Policy below.

Please tick to consent to your data being stored in line with the guidelines set out in our Privacy Policy*

EQUALITY & DIVERSITY MONITORING

Crossroads Care Rotherham strives to operate a policy of equality and diversity and not discriminate against any person. The information you provide will be treated in the strictest confidence and is for monitoring purposes only and in no way forms any part of the selection process.

Where did you see the post advertised?

How would you describe your cultural or ethnic origin?

Gender

Age Group

Sexual Orientation

Marital status

Religious belief

Do you consider yourself to be disabled?

Crossroads Care Rotherham

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