Personal Details

Education:

Professional Education (Nursing Staff only):

Employment History:

The Criminal Justice and Court Services Act 2000, provision for the non-disclosure of criminal convictions do not apply to certain occupations. The position for which you are applying is included in the excepted type of employment under the above mentioned order. Therefore it is necessary to answer the question. Your answer should include any “spent convictions”. Failure to disclose a criminal offence could lead to your application being rejected or in dismissal, should it subsequently be discovered.

Have you ever been convicted of a criminal offence?

References

Please note here the names, addresses and telephone numbers of 2 persons from whom we may obtain both character and work experience references.

Your present/previous employer must be included. (Not family members)

Position One

Position Two

Have you ever been disciplined at work or had your employment terminated following disciplinary proceedings?

Health:

Do you feel you have a medical condition which will interfere with your duties in the post you are applying for?

How many times have you been off work due to ill health in the last twelve months and for how many days?

Declaration:

I confirm that the information I have given on this form is correct and complete, and that misleading statements may be sufficient for cancelling any agreement made. Because of the sensitive nature of the duties that the post holder will be expected to undertake, I also understand that the declaration will include details of any criminal convictions, cautions, reprimands and final warnings and any other information that may have a bearing on my suitability for the post. I understand too, that an Enhanced Disclosure will be sought in the event of a successful application.