Alternatively if you would prefer to submit a paper application please click here, print off and complete the form. Then send it to:
Recruitment,
Orchard Head Office,
2150 Century Way,
Thorpe Park,
Leeds, LS15 8ZB |
| |
Personal Details |
First Name*
Address 1*
|
Surname*
Town/City*
|
Contact Number*
County*
|
Email*
Postcode*
|
| | |
| |
Give details of Work Permits, Visas, Leave to Remain etc that allow you to work legally in the UK –
include expiry dates |
|
| | | | |
The Job you are applying for |
| Please list the home(s) you are interested in working at and the position(s) you are applying for |
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
|
|
Preferred Shift
|
|
|
| |
|
|
|
Hours
|
|
|
| If applying for a bank position please tick here.
|
|
| |
|
|
|
How did you hear about the vacancy?*
|
|
If other please specify
|
|
If referred by a friend please provide their full name
|
|
| |
Education and Training |
| Please tick the qualifications that you have: |
|
NVQ L2 in Care |
NVQ L4 in Care
NVQ in Cleaning & Support Services |
|
NVQ L3 in Care |
RMA or LMCS
Food Hygiene Certificate |
| Please list any other qualifications that are relevant to the job you are applying for |
|
| Please give us details of any professional bodies that you are a member of |
|
If you are a nurse please also let us have your pin number and expiry date |
|
|
|
|
|
About You |
| Why are you applying for this job? |
|
| What skills and/or special experience do you have that make you suitable for this role? |
|
| What are your strengths? |
|
|
|
|
|
Employment History |
|
|
|
|
Current or Most Recent Employer |
Company
From
|
|
Address
To
Position
|
Telephone
Reason for Leaving
|
Email
|
| |
|
|
|
Previous Employer |
Company
From
|
Address
To
Position
|
Telephone
Reason for Leaving
|
Email
|
| |
Additional employment information |
If you have not been in employment over the past five years please provide a brief summary of your
activities over this period |
|
|
References |
| Please provide a minimum of two references. Unfortunately we cannot accept your relative as a referee. |
|
|
|
|
Current/Most Recent
Previous Employer
Reference 3 |
Company
|
Contact Name
|
Position
|
Address
|
Telephone
|
Email
|
|
|
|
|
Medical Questions Have you suffered any of the following |
Heart Trouble
Lung Trouble
Stomach Trouble
|
Eye Trouble
Ear Trouble
Back Trouble
|
Nerve Trouble
Diabetes
High Blood Pressure
|
Asthma
Cough (frequent)
Rheumatic Fever
|
| Arthritis
Epilepsy/fits
Shortness of Breath
|
Skin rashes
Anaemia
Headaches
|
Fainting or Dizziness
Hay Fever
Jaundice
|
Swelling of legs/ankles
Period/Prostate Problem
Varicose veins
|
Head injuries
Do you take medicine
Any other ailments
|
| |
|
|
|
|
|
|
Do you have any impairment that has a substantial long term adverse effect on your ability to carry out day-to-day activities?
|
Have any health related reasons in the last two years kept you away from work?
|
Can we make any reasonable ajustments to avoid you being at a disadvantage at work?
|
Have you ever been dismissed from employment because of health related reasons?
|
Do you have a current illness?
|
|
|
|
|
| If you have answered yes to any of the above questions please provide further details |
|
|
|
|
|
Further Information |
| |
If you answer 'yes' to any of the following questions
please provide further details below |
| Are you facing any criminal prosecutions |
|
| Do you have any spent/unspent convictions, cautions or reprimands under the Rehabilitation of Offenders Act 1974? |
|
| Have you ever been dismissed from any employment? |
|
| Have you ever been on or are you currently going through any investigation or disciplinary action? |
|
| What period of sickness and/or authorised absence have you had in the last two years? |
|
| |
I confirm that the information provided on this application form is true and complete, and that I am legally entitled to work in the UK.
I understand that any false statements or deliberate misrepresentations will be regarded as grounds for disciplinary action and/or termination of my employment.
I understand that an offer of employment is subject to satisfactory references and CRB/POVA checks, and I authorise Orchard Care Homes to obtain references to support this application once an offer of emplyment has been made and accepted.
I understand that any information given in relation to my application will be held by the company and falls within the provisions of the Data Protection Act 1998. I also give my consent for my personal information being retained and used to process my application for employment. |
|
|
|
|
If you agree to the above statements please type your name and tick this box
|
|
|
|
|
| If you do not want us to keep your details on file for six months for future job opportunities please tick here:
|
|
|
|
|
| * = mandatory field |
|
|
|
|
|
|
| | |
