Job Application Form

Name of position you wish to apply for.(Required)

Hours

Name(Required)

Mr/Miss/Mrs/Ms/Dr First Last

Email(Required)

Enter Email Confirm Email

Address(Required)

Street Address City County Post code

Home Phone

Mobile

Work Number

Is it ok to contact you on this number?

Yes, you can contact me at work

Do you have a full UK driving licence?(Required)

Yes

No

Do you have use of a vehicle during work hours(Required)

Yes

No

General Education(Required)

Please provide full details in the sections below. Click on the plus icon to create additional spaces.

From

To

School/College/University

Subject(s) Taken

Level

Grade

Professional/technical/specialised training and qualifications (held or being studied)

From

To

Institute/Professional Body

Qualification/Training details

Grade (if applicable)

Professional Registration

Membership of

Renewal date(s)

Registration Number

Current Employment/most recent employment (reference always required)(Required)

Name of company

Employer's Address

Street Address City County Postcode

Position Held(Required)

Salary

Date Appointed(Required)

Date Left (if applicable)

Employer's Business

Give a description of current duties and responsibilities(Required)

Reason for leaving

Period of Notice

Previous employment

Name of company

Employer's Address

Street Address City County Postcode

Position Held

Salary

Date Appointed

Date Left (if applicable)

Employer's Business

Give a description of current duties and responsibilities

Reason for leaving

Employment History

Please list with most recent first, and account for any breaks

Name and Address of Employer

Position Held

From

To

Supporting Information(Required)

In the space below please tell us how you match the requirements of the person specification for the job (you can view a person specification for this vacancy on our website). This should include relevant skills, knowledge, experience, voluntary activities and training etc. If relevant to the post for which you are applying you should include details about research experience, publications or poster presentation, clinical care (knowledge and skills) and clinical audits.

Have you any criminal convictions or bind overs, or any cautions, warnings or reprimands?(spent, current or pending)(Required)

Policy statement for the Recruitment of Ex-offenders applies.

Yes (If yes please give details below)

No

Please give details

Your offer of employment will be subject to a satisfactory disclosure from the Disclosure and Barring Service. Failure to reveal information relating to any convictions could lead to withdrawal of an offer of employment.

Professional Body Action - Are you aware of any investigations or actions pending, or have any ever been taken, against you by a professional body?(Required)

Yes (If yes please give details below)

No

Please give details

Please give two referees who have consented to be approached for a reference on your behalf. One must be your current line manager or HR Department. Relatives are not acceptable as referees.

Name(Required)

First Last

Occupation

Address(Required)

Street Address City County Postcode

Phone Number

Email Address

May we contact this referee before interview?(Required)

Yes

No

May we contact this referee if successful?(Required)

Yes

No

Capacity in which referee knows you:(Required)

Name(Required)

First Last

Occupation

Address(Required)

Street Address City County Postcode

Phone Number

Email Address

May we contact this referee before interview?(Required)

Yes

No

May we contact this referee if successful?(Required)

Yes

No

Capacity in which referee knows you:(Required)

Declaration: I confirm that the information provided in my application is correct and understand that misleading statements, deliberation omissions or inclusion of incorrect details may be sufficient to disqualify me from appointment.(Required)

Yes, I confirm

Declaration: I understand that any appointment will be subject to relevant pre-employment checks which meet with regulatory requirements and the hospice’s satisfaction. If I am successfully appointed I give my consent for the hospice to contact the referees provided to obtain a reference.(Required)

Yes, I confirm

The information given in your application will be held securely, in accordance with the Data Protection Act 1998, not shared with any other individuals or organisations, and will only be used for the purpose of processing your application for employment. In line with our procedures if you are unsuccessful in your application we will delete all your data after 6 months.

Unfortunately St. John’s Hospice is unable to respond to all applicants individually. If you have not had a response to your application within three weeks of the closing date please assume that on this occasion your application has been unsuccessful.

Once you complete our monitoring form you will receive a confirmation to say we have received your application form.

Name

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Application for Employment

Welcome

I Need Help Now

I need palliative care for a relative, friend, myself or a patient.

Myself a friend or relative has been referred to St John’s for care and I need to know more.

I am currently experiencing a bereavement and I need help.

Where does St John’s Hospice offer its services?

I have a fundraising or event enquiry.

I would like to donate to St John’s Hospice.

Contact Information