The Flowers Care Home Application for Employment

For office use only
Form……………………………………………………………………………………………………………………………………………………
Questionaire……………………………………………………………………………………………………………………………………..………………………………………………………………………………………………………………………………………………………………Availabilty of hours ……………………………………………………………………………………………………………………………..
Holidays……………………………………………………………………………………………………………………………………………...
Availability ………………………………………………………………………………………………………………………………………….
Criminal record …………………………………………………………………………………………………………………………………..
Minimum hours required ……………………………………………………………………………………………………………………
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Pease carefully read this form and answer all the applicable questions honestly and truthfully. Afterwards read the declaration and Consent under the Data Protection Act at the end of the form and sign and date it.
Return the completed for to: The Flowers Care Home, 3 Snape Drive, Horton Bank Top, Bradford, BD7 4LZ
Post applied for:      ………………………………………………………………………..                     

Applicant’s details

Full name:…………………………………………………………………………………………..

Home address and postcode.
……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….  

Home telephone number: ……………………………………………………………..

Mobile telephone number:…………………………………………………………….
National Insurance Number:…………………………………………………………..
Date of Birth: …………………………………………..

Driving licence

Do you have a driving licence: Yes/No       Private car/Commercial

If Commercial, give class of vehicle:

Do you have any penalty points on your driving licence: Yes/No

If “Yes”, please give details: ………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………… 

Criminal convictions
Do you have criminal convictions?
Yes/No

If “Yes” give details:
…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………… 

Have you at any time been convicted of a crime that has resulted in a prison sentence? Yes/No

If “Yes” give details:
……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………  

Eligibility to work in the UK

Are you legally eligible to live and work in the UK in accordance with the Asylum and Immigration Act 1996?: Yes/No

NOTE: Before any contract of employment can be offered to anyone subject to immigration control we are required to check and copy certain documents under Section 8 of the Asylum and Immigration Act 1996 as amended.

Availability for work
If currently employed, how much notice will you have to give you current employer?: 
…………………………………………………………………………………

Is there any other reason why you would not be able to start work immediately if you were offered the job you have applied for?: Yes/No

If “Yes” give details:
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Education, Skills and Qualifications

Please give details of any skills and qualifications and/or experience relevant to the job for which you have applied: 
…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………… 

Education: Please give brief details of your education and examination results:
………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………                               

Employment History
 Are you currently employed: Yes/No

If “No” please state why not:
……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………… 

Have you ever been dismissed by an employer?: Yes/No

If “Yes” give details, including the reasons given for your dismissal: 
……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
                   
Your current or last employer:
Name of company: ………………………………………………………………………………..
Address:………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

Telephone number: ……………………………………………………..
Job title:…………………………………………………………
Describe your main duties and responsibilities:
……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………..
Rate of pay:…………………………………………………..

Reason for leaving or wanting to leave:
……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………… 

Other information relevant to your employment history: 
……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………… 

Do you have any part time or evening jobs which you intend to continue: 
Yes/No
If “Yes” give details:
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References

Please give details of two people we can contact who are willing to give you a reference and who are not related to you:
Please provide two full names and postcodes for your referees please note without these your application will not be processed.

(1) Name:…………………………………………………………………………………………………..
Address:…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

Telephone number:……………………………………………………………
Occupation:……………………………………………………………………….

(2) Name: ……………………………………………………………………………
Address: ………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
Telephone number: 
Occupation: 

The job you have applied for:
Please state what attracted you to the job you have applied for and why you think you are a suitable person to do it: 
…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

Declaration

I declare that the information I have given on this form is correct and that any misrepresentation by me may be sufficient grounds for my dismissal if I am employed. I give my permission for my previous employer(s) and any references given to be contacted.

Signed by Applicant:

Date:

Consent under the Data Protection Act 1998 - the information given to [Name of employer] in this form will be processed only by [Name of employer] for the purpose of considering your application for employment. If you are successful in your application this form and the information in it will be retained in your HR file for such time as you are an employee of [Name of employer] and for up to 6 years after the end of your employment. Otherwise this form will only be retained by [Name of employer] for so long as it is required in connection with your application. By signing this consent you give us your express consent to retain and process all the information contained in this form and to transfer it to countries outside the European Economic area if required.

Signed by Applicant:

Date: