Employment Application Form

Position applied for:

Preferred location of work:

Dordon

Warton

Hartshill

Personal

Title

Preferred Pronouns

Surname

First Name(s)

Address

Post Code

Telephone Number

Date of Birth

Full Driving Licence?
Yes No

Endorsements?
Yes* No

*If yes please give further details, including dates

Are you involved in any actively which might limit your availability to work or your working hours e.g. local government?
Yes No

If yes, please give further details including dates

Are you subject to any restrictions or covenants which might restrict your working activities?
Yes No

If yes, please give full details

Are you willing to work overtime and weekends, if required?
Yes No

Please give details of any hours you would not wish to work

Have you any convictions (including spent convictions under the Rehabilitation of Offenders Act 1974)?
Yes No

If yes, please give full details

You may be required, if offered employment, as part of your Application to complete a Pre-Employment Medical Questionnaire. Are you prepared to undergo a medical examination prior to employment?
Yes No

Have you ever worked for this company before?
Yes No

If yes, please give full details

Have you applied for employment with this company before?
Yes No

Do you need a work permit to take up employment in the UK?
Yes No

How much notice are you required to give to your current employer?

Education

School atended since age 11

From

Examinations and Results

College or University

From

Courses and Results

Further Formal Training

From

Diploma/Qualification

Add additional Formal Training

Job Related Training Courses and name of organisation

Date

Subject

Add additional Job Related Training

Please give details of membership or any technical or professional associations:

Please list any foreign languages spoken and level of competence:

Employment Details

Please note at the interview you will be expected to provide full employment history details and reasons for changing employment.
Please give details of your previous employment, excluding your present or last employer, stating the most recent first.

Name and Address of Employer

Dates

Position Held/Main Duties

Reason for Leaving

Add additional Employer

Present or Last Employer

Are you currently employed?
Yes No

Name of present/last employer

Telephone

Nature of Business

Address

Job title

Length of service

From

Brief description of your duties

Medical Questionnaire

We will not contact your doctor without your prior written consent.

How many days' absence have you had from work in the last three years?

How many periords of absence have you had in the last three years?

Are you currently on medication or have you been prescribed medication (excluding contraceptives)?
Yes No

If yes, please give further details

Are you currently receiving treatment for any physical or mental condition?
Yes No

If yes, please give further details

Do you suffer from any injury, illness, medical condition or allergy that might affect your ability to perform your duties?
Yes No

If yes, please give further details

Do you consider yourself to have a disability?
Yes No

If yes, please give further details

Supplementary Information

Interests, Achievements and Leisure Activities (e.g. hobbies, sports, club memberships)

Please set out below any further information to support your application, e.g. past achievements, future aspirations, personal strengths.

Disclosures

Given the nature of the job applied for, in the event that I am offered the position, I understand that any offer of employment is subject to information on my criminal record being disclosed to the Company by the Disclosure and Barring Service (DBS, formerly known as the Criminal Records Bureau or CRB).

Declaration

I understand these details will be held in confidence by the Company, for the purposes of assessing this application, ongoing personnel administration and payroll administration (where applicable) in compliance with the Data Protection Act 1998.

I declare that the information given in this form is complete and accurate. I understand that any false information or deliberate omissions will disqualify me from employment or may render me liable to summary dismissal.

References - with your permission

I hereby give consent for Linden Care Homes Limited to apply for information regarding my employment history.

Signed (name)

Date (DD/MM/YYYY)

Please give the names of two people (one of which should be your present or most recent employer) whom we may approach for a reference with your consent.

Can we approach your current employer before an offer of employment is made?
Yes No

Reference 1

Name

Position

Address

Telephone

Reference 2

Name

Position

Address

Telephone

Source of Application

How did you hear of this Vacancy?

Take a look at our Care Homes

Types of care we offer at Linden Care Homes

Learn more about Linden Care Homes

Personal

Education

Employment Details

Present or Last Employer

Medical Questionnaire

Supplementary Information

Disclosures

Declaration

References - with your permission

Source of Application