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ESSENCE TELFORD EMPLOYEE APPLICATION FORM
Section 1: Personal Details
TitleTitle
First NameFirst Name
SurnameSurname
AddressAddress
Address 2Address
Postal CodePostal Code
Forenames (in full)Forenames (in full)
Previous Surname(s) (if any)Previous Surname(s) (if any)
Position Applied ForPosition Applied For
Fileupload
Upload Official ID
Home Tel :Phone Home
Mobile NoPhone Mobile
Date Moved to Current AddressDate Moved to Current Address
Date Moved to Current AddressDate Moved to Current Address
National Insurance NumberNational Insurance Number
Do you hold a current UK driving license?
Do you own a car?
Section 2: Education and Training

Please list your educational qualifications and training in chronological order with the most recent first. Feel free to continue on a separate sheet if necessary but Please ensure you attach any additional sheets securely.

School or OrganisationSchool or Organisation
0 /
From Dateof appointment
To Dateof appointment
Qualification or TrainingQualification or Training
0 /
Grade or Passmore details
0 /
School or OrganisationSchool or Organisation
0 /
From Dateof appointment
To Dateof appointment
Qualification or TrainingQualification or Training
0 /
Grade or PassGrade or Pass
0 /
School or OrganisationSchool or Organisation
0 /
From Dateof appointment
To Dateof appointment
Qualification or TrainingQualification or Training
0 /
Grade or PassGrade or Pass
0 /
Section 3: Employment History

Please list below a complete record of other employments and include, if you wish, any voluntary activities either paid or unpaid. These should be in date order, starting with the most recent. Please explain any gaps in employment.

Name of Organisation, nature of business and addressName of Organisation, nature of business and address
0 /
From Dateof appointment
To Dateof appointment
Job title and brief summary of duties and responsibilitiesmore details
0 /
Reason for leavingmore details
0 /
Name of Organisation, nature of business and addressmore details
0 /
From Dateof appointment
To Dateof appointment
Job title and brief summary of duties and responsibilitiesmore details
0 /
Reason for leavingmore details
0 /
Name of Organisation, nature of business and addressmore details
0 /
From Dateof appointment
To Dateof appointment
Job title and brief summary of duties and responsibilitiesmore details
0 /
Reason for leavingmore details
0 /

(Continue on separate sheet if required)

How many sick days have you had in the last 3 years?your full name
Please list the reasons for such sick days.more details
0 /

Do you have any commitments that prevent you from working certain hours/days? if so, please state below:

Reasons for not wanting to work certain hours.more details
0 /
Are you currently working?
If so, how much notice must you provide to your current employer?more details
0 /
Section 4: Why would you like to work at Essence?

Please write a brief paragraph about why you want to work for Essence Telford Limited, why you want to work within the care industry and the qualities that you have that would make you the ideal candidate. 

Why you want to work for Essence Telford.more details
0 /

(Continue on a separate sheet if necessary)

Section 5: Further Information
Criminal convictions

As defined by the Rehabilitation of Offenders Act 1974 and subsequent regulations, under section 4.2 you do not need to declare convictions which are 'spent'.

However, by virtue of the Rehabilitation of Offenders (Exceptions/Amendments) Order 1986 those provisions do not apply if you are applying for a job supervising, caring for or otherwise connected with people from the following list, you must always declare any convictions and/or cautions for criminal offences, even where they are'spent'.  For these purposes, this includes working with children, young and older people, those who are dependent on alcohol or drugs, and those with mental or physical disabilities, illness,injury or deformity, including people who are blind, deaf or without speech.

*Criminal conviction (Please state NONE if appropriate)
0 /

* Please note if you have any cautions orconvictions that you do not declare on this form then we will not be able tooffer you a position. Please list all cautions and convictions

References

PLEASE PROVIDE TWO PROFESSIONAL REFERENCES, ONE MUST BE YOUR CURRENT/LAST EMPLOYER

Referee 1
First Nameyour full name
Last Nameyour full name
Company Nameyour full name
Addressyour full name
Phone Work
Phone Mobileyour full name
Referee 2
First Nameyour full name
Last Nameyour full name
Company Nameyour full name
Addressyour full name
Phone Workyour full name
Phone Mobileyour full name
Declaration

The information that I have provided is to the best of my knowledge. I understand that giving false information or omitting relevant information could disqualify my application and, if I am appointed,could lead to my dismissal.


Signedyour full name
Dateof appointment
Essence Equal Opportunity Policy

We regularly review and improve our recruitment process; therefore we ask that you complete the following form to assist us with such improvements.

Information you provide in this form will not be used in selecting or not selecting you for an employment position, and is used to monitor our equal opportunities policy. This information is confidential and you will not be identified by any information you provide in this form. Completed forms will be detached from your application upon receipt and will not be held in employment files. This form is not part of your application.

Job Title Applied for:
Surnameyour full name
Genderyour full name
Forename(s)your full name
Marital Statusyour full name

Ethnic Origin (The following categories are recommended by the Commission for Racial Equality.  If you feel the choices do not provide a suitable option, please write down how you would describe your ethnic origin)

A White
D Black or Black British
3 White other (please specify)your full name
13 Any other black background (please specify)your full name
B Mixed
E Chinese or other ethnic group
15 Any other (please specify)your full name
6 Any other mixed background (please specify)your full name
C Asian or Asian British
10 Any other (please specify)your full name
Essence Next of Kin and Doctors
Emergency Contact Details

Can you please fill in this section so we have apoint of contact for you as an emergency contact number.

Your Nameyour full name
Next of Kin Nameyour full name
Relationshipyour full name
Phoneyour full name
Addressyour full name
Next of Kin Nameyour full name
Relationshipyour full name
Phoneyour full name
Addressyour full name
Next of Kin Nameyour full name
Relationshipyour full name
Phoneyour full name
Addressyour full name
Doctor Details (if any)
Nameyour full name
Surgeryyour full name
Contact Numberyour full name

If these details change, can you please ensure the office is made aware. These contacts will only be used in an emergency.

Holidays Booked
Full Nameyour full name
Date Completedof appointment
Do you have any holidays booked within the next year?
If so, please specify datesmore details
0 /
Notice:
Essence Telford Ltd requires certain information prior to candidates commencing employment, to ensure performance requirements for the position are met and a reliable service is provided. This information is to ensure compliance with relevant Health and Safety regulations. The information is also required in order to establish whether any reasonable adjustments may need to be made to assist you in performing your duties, in accordance with the Disability Discrimination Act 1995. All information provided is kept confidential and used only for the purposes detailed above in compliance with the Data Protection Act 1998.
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