Personal Details
Place of Birth
Telephone Number
Mobile Number
How long have you had a licence?
Are you a United Kingdom(UK), European Community(EC),European Economic Area(EEA) National
Including Visa number
Are you related to any of our current members of staff or Service Users?
Equality Act 2010 - Under the Equality Act 2010, the definition of disability is if you have a physical or mental impairment that has a “substantial” and“ long-term adverse effect ”on your ability to carry out normal day-to-day activities. Further information regarding the definition of disability can be found at : www.gov.uk/definition-of-disability-under-equality-act-2010. For the purposes of this application and interview stage only, is there anything you would like us to be aware of so that we can make reasonable adjustments during the process?
Education* (All qualifications will be subject to a satisfactory check).
Training Courses attended or completing (evidence of attending courses is required)
Professional Memberships / Registrations
Employment History
Please record below the details of your full employment history beginning with your current or most recent first. Any gaps must be explained. Use a separate attached sheet if required; please sign the sheet(s)
Current / Most recent employer
Employment History (2)
Please provide at least two references from your past employments.
Reference (1)
Reference (2)
Safeguarding/Ex-Offernders Declaration: Please not this section will only be seen by those involved in the recruitment process and will be treated with the strictest confidence.
The Rehabilitation of Offenders Act 1974 aims to promote equality of opportunity and is committed to treating all applicants fairly regardless of ethnicity, disability, age, gender or gender re-assignment, religion or belief, sexual orientation, pregnancy or maternity and marriage or civil partnership. Genius Care Limited undertakes not to discriminate unfairly against applicants on the basis of a criminal conviction or other information declared.
Answering 'yes' to the question below will not necessarily prevent your employment. This will depend on the relevance of the information you provide in respect of the nature of the position and the particular circumstances.
Are you currently bound over or do you have any current UNSPENT convictions that has been issued by a Court or Court-Martial in the United Kingdom or inanyother country?
Do you have any current UNSPENT police cautions,reprimands or final warnings in the United Kingdom or in any other country?
We will only collect data for specified, explicit and legitimate use in relation to the recruitment process. By signing this application form, you consent to holding the information contained with in this application form. If successfully shortlisted, da ta will also include short listing scoring and interview records. We would like to keep this data until the vacancy is filled. (We can not estimate the exact time period, but we will consider this period over when a candidate accepts our job offer for the position for which we are considering you).When that period is over, we will either delete your data or in form you that we would like to keep it in our database for future roles.
Declearation
The information in this application form is true and complete. I accept that any willful omission, fabrication, or misre presentation in the application form will result in the rejection of this application or, if employed, the subsequent termination. Where applicable, Icon sent that can seek clarification regarding professional registration details.
