Application for Employment

    Note: Because of the nature of the work for which you are applying, this post is exempt from the provisions of section (2) of the Rehabilitation of Offender Act, 1974 by virtue of the rehabilitation of offenders Act 1974 (exemptions) order, 1975 Applicants are, therefore not entitled to withhold information about convictions which for other purposes are ‘spent’ under the provision of the Act, and in the event of employment, any failure to disclose such convictions could result in dismissal or disciplinary action by the Company. Any information given will be completely confidential and will be considered only in relation to an application for positions for completely confidential and will be considered only in relation to an application for positions for which the order applies.

     

    Personal Details

    Position applied for

    Title

    Forename

    Middle name(s)

    Surname

    Address

    Postcode

    Email

    Mobile Telephone

    Landline Telephone

    Marital Status

    Gender

    National Insurance No.

    Do you have the ‘Right to Work’ in the UK? (Sponsorship not available currently with Optima)
    Note: If yes, all documentation will be required if application successful!

     

    Availability

    All work is based over 7 days and 24 hours per day, therefore you will be expected to work any time.
    Please indicate your availability below and the number of hours you would prefer to work within the range of hours set out below.

    Due to the nature of the service we provide, occasionally we require people to work at short notice.
    Would you be willing to respond at short notice?

    Do you hold a valid license to drive a motor vehicle? (UK or International)

    Details of any endorsements

    Is your Driving Licence for a ‘Manual’ gearbox?

    Do you at present own a car

     

    Education History

    List any schools, colleges or university attended including the month and year, also any qualifications gained during the period. Please list all education accessed and enclose a photocopy of certificates of training courses.
    Add more by clicking the + button below

    Date From

    and to

    Name and address of provision

    Qualifications

     

    Skills and Qualifications

    List any special training, skills, licenses, certificates and/or characteristics of yourself that may qualify you as being able to perform job related functions for the position for which you are applying.
    Please enclose a photocopy of certificates of training courses (Please include any Diploma’s/NVQ’s completed)
    Add more by clicking the + button below

    Date From

    and to

    Qualifications/course details

    Certificate

     

    Employment History

    Give details of FULL employment history starting with the most recent.
    Please give exact dates of employment including month and year. If there are gaps in your employment history please give full dates and reason. Ensure you complete address and contact details of all employers.
    Add more by clicking the + button below

    Date employed from

    and to

    Job Title

    Employer Name, Address, Contact Details

    Reason for leaving

    Summary of roles and responsibilities.

    Salary on leaving

     

    Voluntary Information

    In order to monitor the effectiveness of our commitment to equal opportunities it would be helpful if you could complete this section of the form. Completion is not compulsory, but should you give details below the information will be used for no other purposes that that as stated in this paragraph

    Ethnic Origin

    If Other please specify below

    Languages
    Do you speak fluent English?

    Are you fluent in any other language, if so, please state

    How did you hear of our company/the job vacancy?

     

    References

    List name, address, telephone number and email address of 3 referees who are able to comment on your work practice and reliability, etc. Two must be previous employers, one of which must be your last employer. The referees must not be related to you.
    Please ensure you complete ALL boxes.

    Reference 1 – Current/Last Employer (Professional)

    Date worked from

    Date worked to

    Name of Company

    Address

    Name of Referee

    Position

    Telephone number

    Email address

    Reference 2 - (Professional)

    Date worked from

    Date worked to

    Name of Company

    Address

    Name of Referee

    Position

    Telephone number

    Email address

    Reference 3 - (Character or Personal)

    Known from

    Known to

    Name of Referee

    Relationship

    Address

    Telephone number

    Email address

     

    DBS Requirements

    Have you any Cautions, Convictions or Reprimands
    If YES, please give details below

     

    Consent to request References

    If successful following Interview, Optima Health & Social Care Ltd. are required to request references, prior to start of employment in line with GDPR, CQC Guidelines & Optima H&SC Safer Recruitment Policy.Do you consent for Optima to request these following a successful job offer?

    If there is a requirement for Optima Health & Social Care Ltd. to request references prior to offer of employment, are you happy for us to do so?

     

    I, the undersigned, being a candidate for the before-named appointment, do hereby declare that the particulars entered by me are, to the best of my knowledge and belief, a true and complete record. I understand that the terms of the Contract of Employment Act 1972 (as amended) apply to the post.

    Signature

    Date

    For more information call 0161 441 4630 or email admin@optimahsc.com