Vacancy Application Form

Which role are you applying for? *

Title *

Name *

First

Last

National Insurance Number *

Address Line 1 *

Address Line 2

Address Line 3

Postcode *

Telephone *

Email *

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

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.

If yes, please provide additional information

Do you have access to a vehicle? *

Do you have 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 Name

Present/Last Employer Address

Present/Last Employer Start Date

Present/Last Employer End Date

Present/Last Employer Job Role

Present/Last Employer Salary

Present/Last Employer Period of Notice, if applicable

Present/Last Employer Reason for Leaving

Present/Last Employer Primary responsibilities

Present/Last Employer Achievements

Employer Reference: Name of Reference

Employer Reference: Contact Number

Employer Reference: Address of Reference

Further Information - Detail your successes in your previous roles

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.

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

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

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