Form Builder

Title

Name

Address

Postcode

Tel No Home

Mobile

Do you have the right to work in the U.K

If you are not, please attach the relevant documentation stating your eligibility for employment.

EMPLOYMENT HISTORY

1: Job Details

Name, Address & Tel No of Employer

Job Title

Title of Supervisor/Manager

Details of Duties/Responsibilities

Start Date

End Date

Rate of Pay

Reason for Leaving

2: Job Details

Name, Address & Tel No of Employer

Job Title

Title of Supervisor/Manager

Details of Duties/Responsibilities

Start Date

End Date

Rate of Pay

Reason for Leaving

3: Job Details

Name, Address & Tel No of Employer

Job Title

Title of Supervisor/Manager

Details of Duties/Responsibilities

Start Date

End Date

Rate of Pay

Reason for Leaving

Have you ever worked for Community Care Choice?

Have you ever been dismissed, disciplined, or asked to resign by your employer?

If YES, please give details:

Are you related/associated with any employee of Community Care Choice?

If YES, please give details:

The position you are applying for may require you to travel from one service user to another. What form of transport would you use?

Other – please specify:

Do you hold a current Driving Licence?

If YES, do you have any endorsements?

If YES, please give details:

CCC is committed to a family friendly policy with regard to working hours. Please detail the hours, times and days that you would be available to work:

References

Reference 1

Name

Position

Work/Relationship:

Organisation:

Address

Telephone No:

Length of time known:

Reference 2

Name

Position

Work/Relationship:

Organisation:

Address

Telephone No:

Length of time known:

Reference 3

Name

Position

Work/Relationship:

Organisation:

Address

Telephone No:

Length of time known:

CRIMINAL CONVICTIONS

This post is excluded/exempted from provisions of the Rehabilitation of Offenders Act 1974 and therefore information on both spent and pending convictions should be provided.

All offers of employment will be subject to an acceptable Enhanced Disclosure Scotland criminal record check. The cost for which will be met by applicant.

Do you have any criminal convictions either pending or spent?

If YES, please give details:

GENERAL AVAILABILITY

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Are there any days of the week/hours you absolutely cannot work?

Notes/Future adjustments

DECLARATION

It is understood and agreed that any misrepresentation by me on this application form will give cause for cancellation of this application and/or termination from employer’s service.

All information provided in this application form will be held within the requirements of the Data Protection Act.

To conform with the requirements of the Data Protection Act I give the employer the right to investigate all of the references supplied in this application form and to secure additional information on me, if job related. I hereby release from liability the employer and its representative, information and all other persons, corporations or organisations for furnishing such.

Please note – if you do not hear from us within 28 days, please consider your application to be unsuccessful.

I Agree
I Disagree