Job & Personal Details

Please note all fields are required on this page only.

Job Details

Job Title:

Personal Details
First Name:
Full Address:
Date of Birth:
Last Name:
Daytime Phone:
Cell Phone:
Email:
Expected Hourly Rate:
Present or Most Recent Employer/Employment
Business Name:
Full Address:
Period From (state month/year):
Period To (state month/year):
Contact Number:
Basic Salary:
Notice Period:

Nature of Business:
Position Held:
Nature of Responsibilities:
Reason for Leaving:


Education, Training & Development

Please tell us about your education; beginning with the most recent. You must complete this section if higher education is a requirement for the specific position you are applying for. You may also include relevant training courses.

Date From:
Date To:
Name of School, College, University or Training Provider:
Course Details, Qualifications Gained (specify grade/level):

Have more Education, Training or Development to list? Yes

Have even more Education, Training or Development to list? Yes

Membership of Professional Organizations
Date Joined
Institute / Organization
Grade of Membership (where required)


Previous Employment

Please state all employment (starting with the most recent - including voluntary work). Please account for any gaps in employment. Failure to do so may result in your application not being considered.

Name of Employer and Type of Business:
From:
To:
Job Title, Grade & Salary:
Brief summary of duties and reason for leaving (if applicable):
Previous Employment with Beatrice Loving Heart

Have you ever worked for Beatrice Loving Heart? YesNo

Position Held:
Reason for New Application:
Have you ever accepted Voluntary Severance, Early Voluntary Retirement or Discretionary Compensation from Beatrice Loving Heart?
YesNo


Essential and Desirable Skill Set


Reference Details

Please give the names and addresses of two people who would be willing to provide a reference concerning your application. One of the referees must be your current/last employer who will be asked specifically about your attendance record.

Reference 1

Reference Name:
Reference Full Address:
Reference Daytime Phone:
Reference Email:
Is this person your present or previous employer? YesNo

If you answered ‘no’ to the above question, in what capacity does the referee know you?

References might be contacted prior to your interview. Please indicate if your referee can be contacted at this stage.
YesNo

Reference 2

Reference Name:
Reference Full Address:
Reference Daytime Phone:
Reference Email:
Is this person your present or previous employer? YesNo

If you answered ‘no’ to the above question, in what capacity does the referee know you?

References might be contacted prior to interview. Please indicate if your referee can be contacted at this stage.
YesNo

Relationship to existing Agency Administrator or Employee of Beatrice Loving Heart

If you have any personal relationship to any Administrator at Beatrice Loving Heart, Board Member of the agency or employee of the Agency, please give their name and relationship. Any approach to Councillors or other employees to influence a selection decision will disqualify you. This does not stop a Councillor or employee from giving a reference.

Your availability

Please tell us when you are not available for an interview. This does not guarantee that we will be able to accommodate your needs, particularly after an interview date has already been indicated.


Additional Information

Guaranteed Interview Scheme

Beatrice Loving Heart supports individuals with a disability and is committed to their employment. The Agency’s policy is that any disabled applicant who meets the minimum (essential) criteria for the job will be interviewed.

Do you wish to apply under the Guaranteed Interview Scheme? YesNo

Driving or car ownership status

If the job for which you are applying requires you to drive or carries an essential car user allowance, please answer the following questions:

Are you a vehicle owner? YesNo

Do you hold a full clean current license? YesNo

If no, please give details of any penalties or endorsements:

Please state any other type of license you hold (e.g. HGV):

Declaration

I certify that the information provided in this application form is accurate and true. I give my consent to the processing, transfer and disclosure by Beatrice Loving Heart of all the information submitted by me during the recruitment process and throughout my subsequent periods of employment for pre-employment checks, equal opportunities monitoring, payroll operations, training and absence records (Data Protection Act 1988). (Deliberate falsification or withholding of information will lead to disciplinary proceedings and may result in dismissal.)

I understand that canvassing will automatically disqualify my application. YesNo

Benefits

Have you ever received or currently receiving any state or work-related benefits? YesNo

If yes, please specify:


Monitoring of Equality & Diversity

Beatrice Loving Heart aims to promote equality of opportunity for all with the right mix of talent, skills, and potential. We welcome applications from diverse candidates.

Why do I need to complete Equality & Diversity Questions?

The agency has a legal duty to promote equality. This duty applies to everything the agency does, both as an employer and a provider of services. In order to help us, please answer the following questions and complete the declaration at the bottom of the end page.

What happens to the Equality & Diversity information?

All data, in accordance with the Data Protection Act, will be confidentially retained and used only for the purpose of reporting to Committee and for the production of statistical reports. The Equality & Diversity data will only be recorded and maintained on the employee’s personal record on the Council’s Human Resources system and used for the purpose of statistical reports in relation to equality and performance indicators including recruitment.

Race & Ethnicity

What is your ethnic group? Please tick the relevant ethnic group. If you are in an ‘Any Other Background’ category please state what it is.

White: EnglishOther BritishIrishOther

Other:

Mixed: White & Black-CaribbeanWhite & Black-AfricanWhite & AsianOther

Other:

Asian or Asian-British: IndianPakistaniBangladeshiChineseOther

Other:

Black or Black-British: CaribbeanAfricanOther

Other:

Other Ethnic Group: ArabGypsy/Romany/Irish TravellerOther

Other:

Do not with to declare: Do not wish to declare

Country of Birth

What is your country of birth? United States of AmericaMexicoScotlandCanadaNorthern Ireland Republic of IrelandOther

Other:
Religion or Belief

What is your religion or belief? NoneChristianBuddhistHinduJewishMuslimSikhHumanistAtheistAgnosticPaganOtherDo not wish to declare

Other:
Nationality

What is your nationality? EnglishBritishFrenchSpanishOtherDo not with to declare

Other:
Language

Do you speak any other languages? SpanishFrenchRussianChineseOther

Other:
Disability

The agency takes a positive approach in the selection of people with disabilities, including interviewing all disabled persons who meet the essential selection criteria. The Disability Discrimination Act 1995, defines disability as “a physical or mental impairment which has substantial and long-term adverse effect on the ability to carry out normal day to day activities”.

Do you consider yourself to be a disabled person? NoYes

If ‘Yes’ please provide details of any adjustments we might need to make in order to better accommodate you.
Marriage/Civil Partnership

Are you currently married? YesNoDo not wish to declare

Or in a civil partnership? YesNoDo not wish to declare

Gender

What is your gender? MaleFemaleDo not wish to declare

Confirmation of Declaration

The details given by me are correct to my knowledge and belief. YesNo


Criminal Offenses

Safer Recruitment & Employment Policy Statement

“Beatrice Loving Heart is committed to safeguarding and promoting the welfare of children, young people and vulnerable adults. We expect all our employees and volunteers to share this commitment.”

Declaration of Criminal Offenses

Have you ever been convicted, or received a caution, warning or final reprimand, for an offense that will not be filtered from the background check? NoYes

If Yes please give details:
Confirmation of Declaration

The details given by me are correct to my knowledge and belief. I understand that my application may be rejected or my employment may be terminated for withholding relevant details or giving false information. YesNo