Application Form Contact Details Title First Name Surname Address City County Post code Telephone Mobile Email Address * Position Position applied for How did you hear about the position? Are you applying for Full-time positionPart-time positionDay workNight workBank Driving Do you hold a full UK or European Economic Area (EEA) driving licence? YesNo If yes, has your driving licence been endorsed? YesNo If yes, please explain Do you have a vehicle you can use for business purposes if required? YesNo Education Do you have any experience in the health and social care sector? Please detail anything relevant below. Employment Please submit a copy of your CV If you do not have a copy of your CV to upload, please detail the last 5 years of your employment below. Include the following information: Employer, Job Title, Date of Employment and Reason for Leaving. Additional Skills Please use the space below to explain why you have applied for this vacancy. You should include details of your experience, skills and personal qualities that you can bring to this role. Please continue on a separate sheet if you need to (please put your name at the top of the sheet). You will need to refer to the enclosed job description and person specification when completing this section. Eligibility to work in the UK: Do you have the right to work in the UK? YesNo Please provide details of your visa and any restrictions in the space provided below (if applicable) Other Employment To allow us to monitor your working hours and comply with current legislation, please complete the following section: If you are successfully appointed to the post applied for at Peak15, do you intend to continue with other employment? YesNo Disclosure of criminal record information Due to 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 Rehabilitation of Offenders 1974 (Exceptions) Order 1975. This 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. Please read the above carefully and then answer the following questions: Have you ever been convicted of a criminal offence? YesNo Have you ever received any official cautions, reprimands or warnings? YesNo To your knowledge, are you currently the subject of any criminal proceedings or any police investigation? YesNo Data Protection: The Peak 15 Recruitment Privacy Statement is available here or a copy can be requested from the Human Resources Department. Please sign below to confirm you have accessed the Peak 15 Recruitment Privacy Statement and you have read, understood and agree to all the terms stated. Signature of Applicant Date Declaration: I declare that the information given in this application is to the best of my knowledge, complete and correct. I accept that should any statement made by me in connection with this application be found to be false, incomplete or misleading then the application shall be void and consequently, Ashcroft may terminate any contract arising at any time. Because of the sensitive nature of the duties the postholder will be expected to undertake, I understand that the declaration will include details of any criminal convictions, cautions, reprimands and final warnings that are not ‘protected’ as defined by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (2013) and any other information that may have a bearing on my suitability for the post. I also understand that the relevant level of DBS check will be sought in the event of a successful application. Signature of Applicant Date
