PASSPORT DETAILS
NEXT OF KIN
REFERENCE
Please give the name and contact details of two referees. One should be your previous Employer.
Reference 1
Reference 2
EQUAL OPPORTUNITY MONITORING FORM
The information in this form will be used in total confidence and accordance with current data protection legislation. It will help to ensure that the company properly monitors and confirms with its policies relating to equality of opportunity. Information will be used for monitoring only. Our commitment aims to allow our staff to develop their skills and realize their maximum potential as individuals without any wish on the part of the company to limit their opportunity.
Please tick the relevant box.
16-20 21-25 26-30 31-35 36-40 41-45 46-50 51-55 56-60
Yes No
PROTECTION OF CHILDREN AND VULNERABLE ADULTS DECLARATION
Has any Social Service Department or Has any Social Service Department or Police Service ever Conducted an equiry or investigation into any allegations or that you may pose an actual or potential risk to children or vulnerable adults?
Yes No
Yes No
Yes No
REHABILITATION OF OFFENDERS
Because of 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 Act 1974(Exemptions) Order 1975. Applicants are therefore not entitled to withhold information about convictions, which for other purposes are spent under the provisions of act and in the event of employment any failure to disclose such convictions could result in dismissal or disciplinary action by the employer. All Successfull candidates will be required to obtain an enhanced disclosure report from the Disclosure and Barring Service.Have you ever been convicted of a criminal offence, or been subject to any confidential discharge, bind overs or caution.
Yes No
Any information contained in this will be treated in confidence. Failure to disclose any relevant information or providing false or inaccurate information may be regarded as a breach of any subsequent contract of employment, resulting in disciplinary action and/or dismissal.
NOTES :
DOCUMENT UPLOADED :
DECLARATION
I hereby declare that all the above mentioned details of mine are true to the best of my knowledge and belief. In case of any discrepancies Excellent Care Ltd. can take any actions on me.