Mentaur - caring with commitment

Referred By: Personal Details: Address Details: Contact Numbers: (please include code): Current Driving Licence?:

YesNo

Expiry Date:

Car Owner:

YesNo

Details of Endorsement: Are there any restrictions on you taking up work in the UK? (If yes please provide details)

Yes
No

How did you hear about us: Education Details - Schools: Education Details - University: Other Training:

Employment History

(Please complete in full starting with your most recent employment and give reasons for any gaps in employment)

Company Name & Address Details: Job Title & Duties:

Start Date:

End Date:

Salary On Leaving: Reason For Leaving:

References

Please provide details of two referees who can provide information relating to your competency in a caring role, one of whom must be your present or most recent employer (referees for qualified Nurses must be professionals). If you are a student, please give an academic referee. If you are applying for a post which requires unsupervised access to children/vulnerable adults, the company reserves the right to approach any past employer for a reference.

Reference 01: May the company approach the above prior to interview?:

Yes
No

Reference 02: May the company approach the above prior to interview?:

Yes
No

Cautions, Rehabilitation And Criminal Records

Because of the nature of the work for which you are applying, this post is exempt from the provisions of Section 4(2) of the Rehabilitation of Offenders Act 1974, by virtue of the Exceptions Order 1975 as amended by the Exceptions (Amendment) Order 1986, which means that convictions that are spent under the terms of the Rehabilitation of Offenders Act 1974 must be disclosed, and will be taken into account in deciding whether to make an appointment. Any information will be completely confidential and will be considered only in relation to this application.

In addition you are required to submit to a Disclosure and Barring Service check. Any standard or enhanced disclosure made by the DBS/SCRO will remain strictly confidential.

Have you ever been convicted in a Court of Law and/or cautioned in respect of any offence?

If YES, please give details

Special Requirements (Care Sector)

Because this position involves the care of children and/or vulnerable adults employment is dependent on the following:

Your written consent to obtaining a standard/enhanced disclosure certificate from the Disclosure and Barring Service or an approved umbrella body.
Such disclosure being acceptable to the company.
Proof of identity – birth or marriage certificate (where appropriate) and passport (if available).
Two satisfactory written references.
That you will supply a photograph of yourself for retention in your records.
Evidence of physical or mental suitability for your work.

Please note: Personal information held within this document will be made available to be audited by the CQC, commissioners or immigration officers when requested.

Declaration (Please read carefully before approving this application)

I confirm that the above information is complete and correct and that any untrue or misleading information will give my employer the right to terminate any employment contract offered.
Should we require further information and wish to contact your doctor with a view to obtaining a medical report, the law requires us to inform you of our intention and obtain your permission prior to contracting your doctor. I agree that the organisation reserves the right to require me to undergo a medical examination. In addition, I agree that this information will be retained in my personnel file during employment and for up to six years thereafter and understand that information will be processed in accordance with the Data Protection Act.
I agree that should I be successful in this application, I will, if required, apply to the Disclosure and Barring Service/Disclosure Scotland for a standard or enhanced (as appropriate) disclosure/PVG Scheme Record or Scheme Record Update. I also agree that the company may apply to my previous employers for references. I understand that should I fail to do so, or should the disclosure or reference not be the satisfaction of the company, any offer of employment may be withdrawn or my employment terminated.

I agree to the terms and conditions and confirm that the above information is complete and correct.

Date:

Policy Statement

Application for employment

Because this position involves the care of children and/or vulnerable adults employment is dependent on the following: