EMAIL US:
info@birchwoodsw.co.uk

CALL US:
01823 213 600

Application Form

Complete our application form below, we aim to reply within 48 hours

Full Name

Date

Address

Date of birth

Home Phone

Mobile Phone

Email Address

Position Applied For

Date Available

National Insurance Number

Are you a citizen of the United Kingdom?

If no, are you authorised to work in the U.K.?

Do you hold a Full Driving License?

Any Driving Endorsements?

If Yes please detail:

Please give details of all previous employment since leaving education and account for any period of unemployment, to include periods of travelling, maternity leave. If more space is needed please continue on a separate sheet.

Name & Address of Employer

Dates From/To (MM/YY)

Job Role

Reason for Leaving

Name & Address of Employer

Dates From/To (MM/YY)

Job Role

Reason for Leaving

Name & Address of Employer

Dates From/To (MM/YY)

Job Role

Reason for Leaving

Name & Address of Employer

Dates From/To (MM/YY)

Job Role

Reason for Leaving

Name & Address of Employer

Dates From/To (MM/YY)

Job Role

Reason for Leaving

Exams Passed (Level) Qualifications & Memberships (Most Recent First)

Grade and Date Achieved*

Name of Educational Establishment and/or Professional or Awarding Body

Exams Passed (Level) Qualifications & Memberships (Most Recent First)

Grade and Date Achieved*

Name of Educational Establishment and/or Professional or Awarding Body

Exams Passed (Level) Qualifications & Memberships (Most Recent First)

Grade and Date Achieved*

Name of Educational Establishment and/or Professional or Awarding Body

Exams Passed (Level) Qualifications & Memberships (Most Recent First)

Grade and Date Achieved*

Name of Educational Establishment and/or Professional or Awarding Body

Exams Passed (Level) Qualifications & Memberships (Most Recent First)

Grade and Date Achieved*

Name of Educational Establishment and/or Professional or Awarding Body

Please give details of relevant training /development activities.

Training Course and Organiser or Development Activity

Time spent

Outcome - Grade Achieved (Where applicable)

Training Course and Organiser or Development Activity

Time spent

Outcome - Grade Achieved (Where applicable)

Training Course and Organiser or Development Activity

Time spent

Outcome - Grade Achieved (Where applicable)

Please give details of your reasons for applying for this post:

Referring to the person specification, please give details of your experiences, abilities and attributes that make you suitable for this post:

Please give names and addresses of two referees, including telephone numbers and email addresses. They will be asked to provide information about your ability to carry out the job. At least one should be your present employer, (last employer if unemployed, school or college, if a student).

Referee 1

Address

In what capacity do you know the above?

Referees current employer

Referees email address

Referees telephone number

May be contacted if offered interview?

Referee 2

Address

In what capacity do you know the above?

Referees current employer

Referees email address

Referees telephone number

May be contacted if offered interview?

Referee 3

Address

In what capacity do you know the above?

Referees current employer

Referees email address

Referees telephone number

May be contacted if offered interview?

Do you consider that you have a disability as defined by the Disability Discrimination Act 1995 which has a substantial and long term adverse effect on your ability to carry out normal day to day activities?

If yes please give brief details of the disability:

How many occasions and days have you had away from work in the past 12 months?

Do you have any medical issues that could impact on your ability to do the job?

If yes please give brief details

This post is exempt from the provisions of Section 4(2) of the Rehabilitation of Offenders Act 1974. Due to the nature of the establishment, your entitlement to withhold information which, for other purposes is ‘spent’ does not apply and should be declared unless otherwise “protected” from disclosure under the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (as amended in 2013). Please detail any convictions below. Failure to disclose convictions may lead to dismissal. Any disclosures will be treated in the strictest confidence and will be considered only in relation to this application.

Do you have any criminal convictions?

If yes please give details: These details will be checked with the police as the post involves working directly with children.

Have you ever been subject to a disciplinary procedure or gross misconduct within your past or current employment?

If yes please give details: These details will be checked with your previous employer as the post involves working directly with children. If yes, please give detail on an attached additional information sheet, place in a sealed envelope marked Confidential.

Any person who is offered employment with us will be required to complete a DBS Application Form before starting work and will be made aware of the DBS Code of Practice.

I declare that to the best of my knowledge the information given in this application is correct. I understand that any false or inaccurate information will invalidate my application and if I become employed may result in my dismissal. I understand that de novo care will approach any of your employers for a reference and/or verification of the reasons for period of employment ending.

Signature of Applicant

Date