Form Test – Assisted Lives | Personalised Care & Support

Are you currently employed?*
- Yes
- No
What position are you applying for?*
When can you start?*
Date Format: MM slash DD slash YYYY
What's your Title?*
- Mr
- Mrs
- Miss
- Dr
- Ms
Name*
First Last
Date of Birth*
Mobile Number*
Email*
Do you have a UK driving Licence?*
- Yes
- No
Do you have a vehicle?*
- Yes
- No
Are you eligible to work in the UK?*
- Yes
- No
Address*
Street Address City County Post Code
Language Skills*
Please indicate which languages (other than English) you speak / understand
Non-availability*
Please indicate the times you are NOT available for work

EMPLOYMENT HISTORY
Provide complete information for your past 2 employers. Start with your present or most recent job.
EMPLOYMENT HISTORY > EMPLOYER 1*
Address*
Street Address City County Post Code
Job Title*
Salary*
Responsibilities*
Be specific. Describe your major job duties and responsibilities
Dates of Employment*
Previous Employment
Employer Namer Position Start and End Date Reason for Leaving
Employment Gaps*
You must provide a full employment history covering the last 10 years. If there are any gaps on your CV in your employment history provide an explanation here

EDUCATION AND TRAINING
Please list details of all qualifications you have obtained as well as any relevant training, including where and when you obtained them, in order of date received starting with the most recent.
Qualifications and Training*
Please list details of all qualifications you have obtained as well as any relevant training, including where and when you obtained them, in order of date received starting with the most recent.

REFERENCES
Please give names and addresses of two referees who know you well enough to comment on your suitability for the post. One of them must be your present or most recent employer. If you have not been previously employed, give the name of a responsible person who knows you well. Your referees must not be a relative or a member of your household. Please state in which capacity you know each referee.
REFERENCES > NAME OF REFEREE 1*
First Last
Company & Job Title*
Phone Number*
Email*
How long have you known this person?*
In what capacity do you know this person?*
Can we approach this referee before your interview?*
- Yes
- No
REFERENCES > NAME OF REFEREE 2*
First Last
Company & Job Title*
Phone Number*
Email*
How long have you known this person?*
In what capacity do you know this person?*
Can we approach this referee before your interview?*
- Yes
- No

SUPPORTING INFORMATION
SUPPORTING INFORMATION > Please use the space below to tell us why you think you are a good candidate for this post. Please include relevant aspects of your non-paid work experience, voluntary activities or time spent in caring for family members at home.
This is your opportunity to tell us about yourself and why you are applying for this position. Take care to explain what you have done outside of work as well as in the workplace and explain how it is relevant to this position.

EQUALITY, DIVERSITY & INCLUSION
Assisted Lives aims to seek a workforce which reflects the community we serve. We welcome applications from those groups which are under-represented on our staff. Applications for vacancies are based purely on their skills and suitability for the vacancy. To ensure this policy is carried out effectively, we ask all applicants to provide the information requested on this page. It will be used only for administrative and monitoring purposes and will be confidential and not used to discriminate in favour or against any individual applicant.
Ethnic Classification*
Gender*

DISCLOSURE & CONVICTIONS
As part of Assisted Lives’ Safe Recruitment Processes you will be asked to make a Disclosure Application so that the information you provide can be checked. For the purposes of the Rehabilitation of Offenders Act (1974), the group of people you will be working with are classed as a vulnerable group and this means that you are exempt from the Act. Therefore you can be asked and MUST declare any previous criminal record INCLUDING any spent convictions. Having a criminal record will NOT NECESSARILY mean that you will not be able to work in the Health & Social Care Sector. Please tick the appropriate answer below:
Have you been convicted of any criminal offences, or received a police caution or warning?*
- Yes
- No
Please Specify*
Acknowledgement and Sending the application
Acknowledgement*
- I certify that the information contained in this application is true and complete.
- I authorize investigation of all statements contained in this application for employment as may be necessary for arriving at an employment decision.
- In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge.
Signature*

EMPLOYMENT HISTORY

Employer Namer	Position	Start and End Date	Reason for Leaving