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Job Application

Personal Details

Address
Post Code
City
Country

Ethnicity

What is your ethnic group?
Which of the following best describes your White background?
Which of the following best describes your Mixed or Multiple ethnic groups background?
Which of the following best describes your Asian or Asian British background?
Which of the following best describes your Black, African, Caribbean or Black British background?
Which of the following best describes your background?
Are you applying for a Clinical or Administrative Role?

Membership of Professional Bodies

Include in this section any relevant professional registrations or memberships. If you are registered then please enter the relevant details below. All information disclosed on this application will be subject to verification.
Have you ever been removed from the register or have conditions or undertakings been made on your registration by a fitness to practise committee or the licensing or regulatory body in the UK or in any other country?

Employment History

Current or Most Recent Role:
Employment History (most recent first) Please complete the full employment history, together with a satisfactory written explanation of any gaps in employment.

Previous Role 1
(Where a person has been previously employed in a position whose duties involved work with children or vulnerable adults this info is mandatory)
Previous Role 2
(Where a person has been previously employed in a position whose duties involved work with children or vulnerable adults this info is mandatory)

Education & Training

Please tell us why you applied for this job and why you think you are the best person for the job.
If ‘yes’, please give brief details of the effects of your disability on your day-to-day activities, and any other information that you feel would help us to accommodate your needs and thus meet our obligations under the Disability Discrimination Act 1995
If you have a disability, please tell us if there are any reasonable adjustments we can make to help you in your application or with our recruitment process.
If so please give details of any unspent convictions. Spent convictions do not have to be declared as the job is not one covered by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975. [As this post is one covered by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 both spent and unspent convictions must be declared.]

References

Please provide the names and full contact details of the people who have agreed to supply references. Please note we can’t accept personal email addresses or mobile numbers unless for Character references. Character references are only accepted in exceptional circumstances such as when there isn’t sufficient Employment history. References must include at least two positions with separate employers, one of which must be of the most recent employer. This may be your line/department manager, or someone in a position of responsibility for any work experience or placement undertaken. Please note that all reference requests will be followed up and verified through the organisation’s human resources department post interview.
Reference 1
Declaration

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