Heycroft Care Agency,

Job Application

Title

First Name

Last Name

Have you ever been known by any other name? (If yes please include details)

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Length of time at address

Previous * address: (If current address less than 5 years)

Address Line 1

Address Line 2

City

State

Zip Code

Country

National Insurance No.

Date of Birth

Drivers Licence

Give details of Work Permits, VISAs, Leave to Remain etc that allow you to work legally in the UK – include expiry dates.

What position are you applying for?

Preferred Shifts

How did you hear about the vacancy?

If there are any gaps in your employment, please insert details below including dates. (MM/YYYY)

Please include below, Name of School / College / University Employer/Agency, Postal & Email Address (Employer/Agency), Date Started (Month and Year), Date Finished (Month and Year), Subject Studied or Job Title, Qualification Achieved or Reasons for Leaving Employment/Agency Work.

If there are any gaps in your employment, please insert details below including dates. (MM/YYYY)

Why are you applying for this job?

What skills and special experience do you have that will help you care for our residents?

What will the young people like about you?

Reference 1

Please include, Company, Name, Position, Address, Telephone, Fax, Email

Reference 2

Please include, Company, Name, Position, Address, Telephone, Fax, Email

Reference 3

Please include, Company, Name, Position, Address, Telephone, Fax, Email

Please do not contact until confirmed.

OFSTED regulations mean that we must obtain references from everywhere you have worked with children and vulnerable adults. In addition to this, we will obtain a minimum of 2 references covering at least 5 years.

Are you facing any criminal prosecutions?

If Yes – give details

Do you have any spent/unspent convictions or cautions under The Rehabilitation of Offenders Act 1974?

If Yes – give details

Have you been dismissed from any employment?

If Yes – give details

Have you ever been or are you currently going through any investigation or disciplinary action?

If Yes – give details

Have you ever had a LADO referral made wether this was substantiated and unsubstantiated?

If Yes – give details

What period of sickness and/or unauthorised absence have you had in the last two years?

If Yes – give details

Additional Information

Declaration
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 any offer of employment is subject to satisfactory references and DBS, and I authorise Heycroft Care to obtain references to support this application once an offer 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 2018. I also give my consent for my personal information being retained and used to process my application for employment.

Sign

First Name

Last Name

Date

Heycroft Care Agency,

Job Application

Services

Company

Heycroft Care Ltd