1Personal Details 2Legal 3Availability 4Education and Training 5Employment History 6Questions 7References 8Equal Opportunities Elliots Hill will not pass your details onto third parties and only use the information supplied for the purposes of handling your application. Please refer to our privacy policy for further information about how we manage your data. Personal Details First name: Surname: Address: Tel No: Mobile No: Post Code: E-mail Address: Position Applied For: Are you registered with Social Care Wales? Yes No If yes, what is your registration number. Legal Ex-offenders will be considered on an individual basis and the nature of the offence will be taken into account in the recruitment decision. Have you ever been convicted of a criminal offence or recieved a police caution? Yes No If Yes, please provide details: Rehabilitation of Offenders Act 1974 (Exemptions) Order 1975 Because of the nature of the work for which you are applying, this post is exempt from the provisions of sector 4(2) of the Rehabilitation of Offenders Act 1974 (Exemptions) Order 1975. Applicants are therefore not entitled to withhold information about convictions which for other purposes are “spent” under the provision of the act. Is there any information you should give? Yes No If Yes, please provide details: Do you have a full UK driving license? Yes No Do you have any points on your licence? Yes No If Yes, please provide details: Availability Please supply dates you would be available to start: Are there any restrictions that you are aware of now, on your availability to work over the next 6 months? Yes No If Yes, please provide details: Please tick the hours you will be available to work Mornings Afternoons Evenings Waking Nights Sleepovers Please tick the days you will be available to work Monday Tuesday Wednesday Thursday Friday Saturday Sunday Education and Training Educational qualifications: Health care qualifications: Are you currently studying? Yes No If Yes, please provide details: Are you Welsh speaking? Yes No If Yes, please provide details: Employment History Please list your previous employment, starting with your most recent Please explain any gaps in employment, to include all employment post school. From: To: Name & address of employer: Position & responsibilities: Salary/Wage: Reason for leaving: Add More Questions 1. Tell us about an occasion when you had to communicate complex information. Why did you have to do this and how did you go about it? Did you achieve your desired result? 2. Tell us about a time when you were part of a team and there was a difference of opinion. What happened and what did you do? What was the outcome? 3. Describe a situation where you implemented change References Reference 1 Name: Position: Address: Post Code: Telephone Number: Email: In what capacity do you know this person? Reference 2 Name: Position: Address: Post Code: Telephone Number: Email: In what capacity do you know this person? When may your present employer be asked for a reference? Only after you are offered an interview Only after you are offered the post Where did you hear about this vacancy? Equal Opportunities We are committed to promoting equality and diversity. In particular, we seek to ensure that people are treated equitably regardless of their gender, race, colour, ethnic or national origins, age, disability, socio economic background, religion, marital status, family responsibility, sexual orientation or any other inappropriate distinction. In order to monitor the impact of this policy it is necessary to collect information from all employees and job applicants on key characteristics which relate to equality and diversity in employment. No information in this section is used to assist the recruitment decision. Gender Male Female Age: Do you consider yourself to have a disability under the Disability Discrimination Act? Yes No Ethnicity You are asked to classify yourself in the category below which you feel most nearly describes your origin. White British Irish Other Black/Black British African Caribbean Other Chinese/Oriental Chinese/Chinese British Oriental Other Mixed Background Asian & White Black African & White Black Caribbean & White Other Asian/Asian British Indian Pakistani Bangladeshi Other If you have ticked one of the “other” boxes, please specify your ethnic background. I consent to Elliots Hill using my information the purposes outlined above the form. BackNext
