Application for Employment

LWC-82 Version 2 | Reg: 5872994

Confidential and secure

Initial Questions

Do we need to make any disability-related adjustments to allow you to take part in the recruitment process? We're committed to making reasonable adjustments for all candidates

Are you entitled to enter or remain in the UK and undertake the work in question? * This is a mandatory requirement

Personal Information

Title

Forename(s) *

Surname *

Home Address *

Postcode *

Home Telephone

Mobile *

Email *

Education

School, College, etc.

Dates

Qualifications

Employment History

Please provide full employment history and explain any gaps between employment.

Name & Address of Employer

Dates

Job Title or Duties

Reason for Leaving

Driving Information

Current driving licence?

Type of licence

Any current endorsements?

Endorsement details

Any motoring prosecutions pending?

Prosecution details

Additional Information

Please detail any further information you wish to put forward in support of your application.

Health Information

Question asked under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

Do you have any physical or mental health conditions which are relevant to your capability, after reasonable adjustments are made, to properly perform the tasks which are intrinsic to this employment?

Give details:

References

I hereby authorise you to contact the references below to obtain any information which, in your opinion, will attest to my suitability, qualifications and work history. *

Work Reference

Name *

Address *

Post Code *

Email *

Telephone *

Work Reference

Name *

Address *

Post Code *

Email *

Telephone *

Declaration under the Protection of Freedoms Act 2012

Important: The post for which you are applying is a 'regulated activity' within the meaning of Part 5 Chapter 1 of the Protection of Freedoms Act 2012 and it is a criminal offence for a 'barred person' to apply to work in a regulated activity. If you are a barred person you must not proceed with this job application.

Are you a barred person? *

Yes

This is a mandatory declaration

Do you have any outstanding safeguarding investigations or suspensions, criminal prosecutions or convictions that might lead to your being barred from working on child-orientated premises (e.g. schools), with children or with protected adults? *

Yes

Give full details:

This is a mandatory declaration

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

Yes

Give full details:

This is a mandatory declaration

If you have previously had any other surname(s) or forename(s), you must declare all of them below and state the date of each change and the reason.

Digital Signature & Declaration

Digital Signature Required: Please sign below using your mouse, finger, or stylus. Your signature confirms the accuracy of all information provided and serves as your legal signature on this application.

Draw your signature

Please sign above to complete your application

Date *

Your signature is securely processed and will be attached to your application. By signing, you confirm that this is your legal signature and that all information provided is accurate.

Privacy Policy

We process personal data relating to those who apply for job vacancies with us or who send speculative job applications to us. We do this for employment purposes, to assist us in the selection of candidates for employment, and to assist in the running of the business. The personal data may include identifiers such as name, date of birth, personal characteristics such as gender, qualifications and previous employment history.

We will not share any identifiable information about you with third parties without your consent unless the law allows or requires us to do so. The personal data provided during an application process will be retained for a period of at least six months or, if required by law, for as long as is required.

This privacy notice does not form part of an employment offer or contract between us. If we make an employment offer to you, we will provide further information about our handling of your personal information in an employment context separately.

If you would like to find out more about our data retention policy and how we use your personal data, you want to see a copy of the information about you that we hold or have any questions or issues regarding data protection, please email us with the Subject "Data Protection Request".

Statement on the recruitment of ex-offenders

Introduction

As an organisation using the Disclosure and Barring Service's (DBS) checking service to assess applicants' suitability for positions of trust, we comply fully with the Code of Practice and undertake to treat all applicants for positions fairly. We undertake not to discriminate unfairly against any subject of a DBS check on the basis of a conviction or other information revealed.

We are committed to the fair treatment of our employees, potential employees and users of our services, regardless of their offending background.

Policy

We actively promote equality of opportunity for all with the right mix of talent, skills and potential and welcome applications from a wide range of candidates, including those with criminal records. We select all candidates for interview based on their skills, qualifications and experience.

A DBS check is only requested after a thorough risk assessment has indicated that one is both proportionate and relevant to the position concerned. For those positions where a DBS check is required, all application forms, job adverts and recruitment briefs will contain a statement that a DBS check will be requested in the event of the individual being offered the position.

Where a DBS check is to form part of the recruitment process, we encourage all applicants called for interview to provide details of their criminal record at an early stage in the application process. We request that this information is sent under separate, confidential cover, to a designated person within the organisation and we guarantee that this information will only be seen by those who need to see it as part of the recruitment process.

Unless the nature of the position allows us to ask questions about your entire criminal record, we only ask about 'unspent' convictions as defined in the Rehabilitation of Offenders Act 1974.

We ensure that all those who are involved in the recruitment process have been suitably trained to identify and assess the relevance and circumstances of offences. We also ensure that they have received appropriate guidance and training in the relevant legislation relating to the employment of ex-offenders, e.g. the Rehabilitation of Offenders Act 1974, and in the secure handling of "sensitive personal data", e.g. DBS checks.

At interview, or in a separate discussion, we ensure that an open and measured discussion takes place on the subject of any offences or other matter that might be relevant to the position. Failure to reveal information that is directly relevant to the position sought could lead to withdrawal of an offer of employment.

This policy document is made available to all DBS applicants at the outset of the recruitment process and we make every subject of a DBS check aware of the existence of the Code of Practice and make a copy available on request.

We undertake to discuss any matter revealed in a DBS check with the person seeking the position before withdrawing a conditional offer of employment.

I agree to the above documents. Both the Privacy Notice and Statement on the recruitment of ex-offenders *

The above information is true. I understand that any job offer made on the basis of untrue or misleading information may be withdrawn or my employment terminated. *