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Title

Gender

First Name *

Surname *

Any Previous names(if applicable):

Address*

Contact Number*

Preferred contact method

Place of Birth *

Nationality*

Are you a citizen of the United Kingdom?*

If no, are you authorized to work in UK?*

Visa Type*

Do you hold a current UK Driving Licence?*

Do you have access to a car during work hours?*

Do you have business insurance?*

Maximum Hours available to work?*

Next of Kin Name and address*

Next of Kin Contact

Relationship to you*

Secondary School*

Date from*

Date to*

Subjects and Grades*

College*

Date from*

Date To*

Qualifications Gained*

Do you have any NVQ or Diplomma equivalent in Health and Social care?

Course Name and Date Completed*

Level Achieved

Position Appplied for*

Current Employer*

Address*

Reason for leaving*

Job Title

Start Date*

Brief Description of Duties Undertaken

Notice Required in Current Job*

Previous Employment-All gaps in employment must be accounted for

Have you ever dismissed or requested to resign from any previous employment? if yes please provide details below.

Name and Address of Previous Employers/ Date

Type of Employment

Reason for Dismissal/Request to Resign

Have you ever been the subject of formal disciplinary action in any previous employment? if yes please provide details below:

Details of Formal disciplinary Action

Name and Address of Previous Employers/ Date

Type of Employment

Are you registered with DBS online update service?*

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REHABILITATION OF OFFENDERS ACT 1974 AND CRIMINAL RECORDS*

The post for which you are applying does not entitle you to rely on the provisions of the Rehabilitation of offenders Act 1974. All previous convictions must be disclosed.

If you disclose that you have a criminal conviction,and your application is successful, this will be discussed in confidence at interview.

If you do not disclose any convictions you have then this may result in your apllication being rejected, or any conditional job offer you have received being withdrawn. if you are appointed, this non-disclosure may later lead to your dismissal.

Any applicants who discles convictions will be treated fairly,and will be provided with the opportunity to evidence their suitability for the post for which they are applying.

Any information provided will be kept cofidential, and will only be used in relation to your application. Only convictions relevant to the post for which you are applying will be taken into account.

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By checking, I declare that to the best of my knowledge and beleif all the information i have provide in this application form is true and correct.

I understand that providing incorrect information or deliberately concealing any relevant information, may result in disqualification from selection process, or any conditional job offer you receive being withdrawn. If you are appointed, this may later lead to your dismissal.

Sunlite Healthcare Application Form version...1.1