Job Application Form

Step 1 of 8

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1. Job Details
Post applied for:*

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2. Personal Details
First Name:*
Surname:*
Address:*
Town/City:*
Postcode:*
Home or mobile telephone:*
Alternative telephone:
Email*

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3. Further Details
Do any reasonable adjustments need to be made to accommodate you through the recruitment process?*
If yes, please give details of the adjustments that need to be made:
Where did you hear about this vacancy?
Did a Bryn Melyn Care employee tell you about this vacancy?*
If yes, please give the employee name:
Do you currently or have you previously worked for Bryn Melyn Care?*
Do you have the right to work in the UK?*
What is your National Insurance number?*
Do you hold a full manual driving licence?*
Do you have your own transport?*
Please give details here of any driving convictions, cautions or endorsements:

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4. Current Employer
Name of current employer:*
Address:*
Postcode:*
Telephone:*
Job title:*
Start date:*
End date (leave blank if currently employed):
Manager/HR Contact:*
Telephone:
Email:
Present salary:
Notice required:

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5. Who have you worked for in the past?

Please list all employers (paid and voluntary) since leaving full time education, starting with your most recent. Please include all care related roles (either paid or voluntary) with contact details to support out vetting process.

If we offer you a job, we will need to carry out background checks. Please provide accurate information below.
Job 1
Employer name:
Address:
Postcode:
Telephone:
Job title:
Start date:
End date:
Manager/HR Contact:
Telephone:
Email:
Reason for leaving:
Job 2
Employer name:
Address:
Postcode:
Telephone:
Job title:
Start date:
End date:
Manager/HR Contact:
Telephone:
Email:
Reason for leaving:
Job 3
Employer name:
Address:
Postcode:
Telephone:
Job title:
Start date:
End date:
Manager/HR Contact:
Telephone:
Email:
Reason for leaving:
Gaps in employment
Have you had any gaps in employment of more than one month since leaving school?*
If yes, please give details: (all gaps in employment of one month or more must be explained in full)
Conduct
Have you ever been subject to disciplinary action in the workplace or been dismissed for any reason other than redundancy?*
If yes, please give details below:

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6. Qualifications and Experience
Please give details of any relevant qualifications: (Add extra rows by clicking the '+' icon)
Qualification gained (with grade if known) Subject Date gained
What attracts you to this job?
Please tell us why you are interested in this job and why you believe you have the right qualities to do it well. Please refer to the job description wherever possible.*
Do you know anyone else who might like to work for BMC?
Please tell us about any friends, family or colleagues that may be interested in career opportunities with Bryn Melyn Care. We run an attractive employee referral scheme; details can be requested from the Recruitment Team or HR.
Name:
Telephone:
Email:

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6. Criminal Convictions

Because of the nature of the work for which you are applying, this post is exempt from the provisions of section 4(2) of the Rehabilitation of Offenders Act 1974 (Exceptions order 1975). Applicants are, therefore, NOT entitled to withhold information about convictions which for other purposes are considered ‘spent’ under the provisions of the Act. Please respond fully and honestly to the following question and note that a criminal conviction is not necessarily a bar to working with us.
Have you ever been cautioned or convicted by any court, be it criminal, civil or military, of any offence when either a juvenile or adult or do you have any allegations against you outstanding?*
If the answer is yes, please detail below the offense, the dates and the court which sentenced you and any other information you feel is relevant. Please continue on a separate sheet if necessary.
Disqualification from Caring for Children Regulations 1991
Please tick where the statement is accurate:
- No child of whom I am parent has been made the subject of a care order.
- No child has been prevented from living with me or removed from my care by a court order other than custody or residence order in favour of the child’s other parent.
- I have not carried on, been concerned in the management of, or had any financial interest in a private or voluntary children’s home which has been refused registration or which has had its registration cancelled.
- I have not been prohibited from being a private foster parent and have not been refused registration in respect of nurseries, day care or childminding.
- I have not had a prohibition order issued by the National College for Teach and Leadership against me.
- I have not been barred from taking part in the management of an independent school.
If you are unable to tick any of the above, please give circumstances and dates as appropriate here:

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7. Declaration
I have read the job description and other information issued relating to the vacancy and can comply with the fundamental requirements of this role. I confirm that all the information given above is correct and complete. Incorrect, incomplete or misleading information may result in my dismissal without notice or pay in lieu of notice. I agree to an Enhanced Disclosure being sought in the event of a successful application. I give permission for a Police Check to be carried out and understand that any spent convictions will be disclosed. I give my permission for the Company to check all details I have given above. I consent to all referees being contacted. I accept that any offer will be subject to receipt of satisfactory references by the Company, satisfactory DBS clearance, evidence of qualification, or identify and of work status.*
Signed:*
Date:*
Comments
This field is for validation purposes and should be left unchanged.

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Qualification gained (with grade if known)	Subject	Date gained

Job Application Form

Step 1 of 8

1. Job Details

2. Personal Details

3. Further Details

4. Current Employer

5. Who have you worked for in the past?

Job 1

Job 2

Job 3

Gaps in employment

Conduct

6. Qualifications and Experience

What attracts you to this job?

Do you know anyone else who might like to work for BMC?

6. Criminal Convictions

Disqualification from Caring for Children Regulations 1991

7. Declaration