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Contact Details

Prefix

First Name *

Last Name *

Street Address *

City

ZIP / Postal Code

Country

Phone *

Email Address *

Position

Position applied for *

How did you hear about the position? *

Driving

Do you hold a full UK or European Economic Area (EEA) driving licence? *YesNo

If yes, has your driving licence been endorsed? *YesNo

Do you have a vehicle you can use for business purposes if required? *YesNo

If yes, please explain *

Full Employment History

Please list below your complete and full employment history, explaining all employment gaps, starting with your most recent employer, working backwards to when you left full-time education (continue on a separate sheet if necessary). Please also attach a full CV (if possible).

Full CV

No file chosen

Employer 1

Employer's name

Reference Details

Street Address

Phone

Email Address

Job title and main duties

Position

Salary

Start Date

End Date

Start Date End Date Notice period

Reason for leaving

Employer 2

Employer's name

Reference Details

Street Address

Phone

Email Address

Job title and main duties

Position

Salary

Start Date

End Date

Notice period

Reason for leaving

Employer 3

Employer's name

Reference Details

Street Address

Phone

Email Address

Job title and main duties

Position

Salary

Start Date

End Date

Reason for leaving

Education

Secondary School (name and address)

Qualifications gained

Start Date

End Date

Further Education

Further Education e.g. college / university

Qualifications gained

Start Date

End Date

Qualifications and Training

Please give details of any professional qualifications gained

Are you undertaking any course of study at present?YesNo

Character References

Please provide details of two people who can be contacted for a reference if you have not provided a full 5 year work history. The referee must be able to comment on your suitability and character for the post you have applied for (e.g. fellow work colleague or course tutor). Relatives and/or Partners should not act as referees. Referees will not be contacted without your consent.

Reference 1

Contact Name

Job Title

Street Address

Phone

Email Address

Relationship to you

Number of years known

Reference 2

Contact Name

Job Title

Street Address

Phone

Email Address

Relationship to you

Number of years known

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.

Please submit a copy of your resume

No file chosen

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 Vitality Healthcare, 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 Vitality Healthcare Privacy Statement is available on our website (www.vitalityhealthcare.net) or a copy can be requested from the Human Resources Department. Please confirm you have accessed the Vitality Healthcare Privacy Statement and you have read, understood and agree to all the terms stated.

I confirm that i have understood the private policy

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, Vitality Healthcare may terminate any contract arising at any time.

I confirm that i have understood the private policy

Date

Contact Details

Position

Driving