application

Application

Preferred working days and times

Regulatory Board Membership Details e.g SSSC

Personal and Social information

Name & address of next of kin to be contacted in an emergency

PENSION

REFERENCE 1

Please provide the names of at least two people, one of whom MUST be your present or last employer, who may be asked for a reference. All applications for references will be made in the strictest confidence after first having obtained your permission.

REFERENCE 2

DETAILS OF SKILLS/EXPERIENCE/QUALITIES

Please state the reason why you are applying for this post and give details of any experience/training/skills/qualities that you have which you think are relevant together with any other information in support of your application, including details of your present post. (Use additional A4 sheets if needed)

Decleration

I confirm that I have read and understood this document.

  • I understand that the completion of this form does not guarantee employment.
  • I certify that all the information given on this form is true and accept that any mis-statement or suppression of material may mean the cancellation of any appointment, and the termination of any employment.
  • I understand that any offer of employment made is subject to the receipt of satisfactory references and an Enhanced Criminal Records Bureau Check.
  • I understand that Potters Health Care is an Equal opportunities employer and that an offending record is not necessarily a bar to employment.
  • I understand that Disclosure Scotland/ PVG scheme membership checks or regulatory body registration checks will be carried out.
  • As this post is exempt from the provisions of the Rehabilitation of Offenders Act 1974 (Exemptions) Order 1975, I hereby undertake to advise Potters Health Care of any criminal offence which I may be convicted of during my employment with Potters Health Care.

Data Protection Information

The information which you have supplied on this form will be processed and may be held on file as per our Data Protection Policy, and will be held on your personal records file if you are appointed. The information will also be used for equality monitoring and statistical purposes. By signing this application, you will be deemed to have given your consent to this, including information which may be considered to be sensitive and personal.

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