"*" indicates required fields

Step 1 of 5

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This field is for validation purposes and should be left unchanged.

The information you supply on this form will be treated in confidence.

SECTION 1 : Personal Details

Mr, Mrs, Miss, Ms, Other
Name*
Have you ever been known by any other names:*
Date of Birth:*
Are you aged 18 years or over:*
Are you eligible to work in the UK?*
Nationality:*
Right To Work (RTW) in the UK – Acceptable proof:*
Max. file size: 10 MB.
– British Passport – EU Passport / EU ID Card with proof of settlement
Disclosure and Barring Service (DBS) Certified:*
Type of Disclosure?*
MM slash DD slash YYYY
Are you on the Update Service?*
Do you have a current full driving license:*
Do you have your own transport:*
Address*

Proof of Address:

Please upload 2 (two) items stating your full name and current home address- Accepted Documents – A utility bill (gas, electric, satellite television, – Landline phone bill) issued within the last three months – Local authority council tax bill for the current council tax year – Bank, Building Society statement (last three months) – Original mortgage statement from a recognised lender issued for the last full year – HMRC correspondence within the current financial year (e.g. P45 / P60, self-assessment letter, tax demand, etc.)
Max. file size: 5 MB.
Max. file size: 5 MB.

SECTION 2 : Rehabilitation of Offenders Act

Have you ever been convicted of a criminal offence?*
Have you any prosecutions pending?*
(This information will be disclosed by the Criminal Records Bureau check which will be required if successful. Please note a criminal record will not necessarily be a bar to employment)

SECTION 3: Health

Are you registered disabled?*

SECTION 4: Education

Education and Training*
Please list your qualifications in reverse order, starting with the most recent first. Also, include any training that you have received which did not lead to a qualification but which you feel is relevant to the post. If short-listed for an interview, please be prepared to bring original copies of any certificates relating to post-school qualifications or vocational qualifications.
Date Obtained:
Place of study & address:
Examinations taken & grades:
 
Other Qualifications:*
Please give details of any other qualifications obtained or relevant courses attended.
Date Obtained:
Place of study & address:
Examinations taken & grades:
 

SECTION 5: Employment Record

Please list chronologically, starting with current or last employer*
Name of Employer:
Employer Address:
Length of Employment:
Salary:
 
DD slash MM slash YYYY
DD slash MM slash YYYY
(weeks)
5: List of Employer (Employment History): Note: Please click on the + sign to add more employment history.
Please give summary details of all your previous employment (most recent first for a minimum of 10 years if Applicable). Please ensure you include all part-time and temporary positions held, even those that are not relevant to your application. Please ensure you include any periods of unemployment or any other time that is not accounted for.
Name of Employer:
Employer Address:
Length of Employment:
Reason for leaving:
 

SECTION 6: Reference

(1) Referee:*
Please give the names and addresses of your two most recent employers (if applicable). If you are unable to do this, please clearly outline who your referees are.
Name of Referee:
Referee Job Title:
Email:
Telephone No:
Company Name:
Address:
May we contact your references prior to job offer:*
Referee 1:
(2) Referee*
The second referee can be your present employer or character reference (We will accept personal friends – No relatives.)
Name of Referee:
Referee Job Title:
Work Relationship:
Email:
Telephone No:
Organisation:
Address:
May we contact your reference prior to job offer:*
Referee 2:

SECTION 7: Emergency Contacts

Emergency Contacts/ Next of Kin:*
First Name :
Last Name:
Telephone Number:
Email:
Address:
 

SECTION 8: Personal Attributes

SECTION 9: Declaration

I confirm that the information provided in this application (and within my Curriculum Vitae if applicable) is both truthful and accurate. I have omitted no facts that could affect my employment. I understand that any false misleading statements could place any subsequent employment in jeopardy. I understand that any employment entered into is subject to documentary evidence of my right to work in the UK and satisfactory references. I expressly consent to personal data contained within this form being recorded for the purposes of assessing suitability for the post and may form the basis of any subsequent personnel file.
Enter Fullname as signature proof.
MM slash DD slash YYYY
Chipet Care and Services Ltd undertakes that it will treat any personal information that you provide to us, or that we obtain from you, in accordance with the requirements of the Data Protection Act 1998. After initial assessment, Chipet Care and Services Ltd may keep your details on file for opportunities that may arise in the future. Please tick if you do not wish us to hold your details.*
Accepted file types: pdf, doc, docx, jpg, Max. file size: 5 MB.
Filetypes: pdf, doc, docx, jpg

SECTION 10: Recruitment Monitoring Form

This sheet will be separated from your application form upon receipt and does not form part of the selection process. It will be retained by Human Resources purely for monitoring purposes.

Application for the post of:

To help us ensure that our Equal Opportunities Policy is fully and fairly implemented please COMPLETE THIS SECTION OF THE APPLICATION FORM.

What is your Ethnic Group?

Choose ONE section from A to E, and then tick the appropriate box to indicate your cultural background.
A: White
B: Black or Black British
C: Mixed
D: Chinese or other ethnic group
E: Asian or Asian British
F: I do not wish to provide this information

Section Break

Gender:
Are you registered disabled?*
Age Group:*
Please sate where you saw this advised.

Asylum and Immigration Act 1996:

It is now a requirement that before any offer of employment can be made, all candidates are to provide confirmation of their eligibility to work in the UK. Please bring one of the following original documents with you if invited to interview: a passport or an immigration and nationality directorate application registration card which evidence the right to work in the UK or a UK residence permit issued to an EEA national which confirms right of entry to or residence in the UK.