The Lakes Care Centre | Job Application: Registered General Nurse | Residential Care | Nursing Care

Fields marked with an asterisk (*) must be filled out before submitting.

Personal Details

Name *
Surname *
Email Address *

Contact Details

Address
City
Post code
Country
Telephone
Mobile phone

Formal Education and Qualifications

Secondary Education

Name of School/College
Location
List subjects studied at GCE/GCSE and results obtained. Place the highest grade obtained against each subject.

Further/Higher Education Number 1

Name of School/College/University
Location
Course of Study/Qualification(s) gained e.g. GCSE’s, “A” levels, NVQ, Degree etc
Year qualification obtained

Further/Higher Education Number 2

Name of School/College/University
Location
Course of Study/Qualification(s) gained e.g. GCSE’s, “A” levels, NVQ, Degree etc
Year qualification obtained

Further/Higher Education Number 3

Name of School/College/University
Location
Course of Study/Qualification(s) gained e.g. GCSE’s, “A” levels, NVQ, Degree etc
Year qualification obtained

Full Employment History

Current Employer

Name of Employer
Location
Dates of Employment
Position Held
Reason for leaving/Last salary or wage

Previous Employer Number 1

Name of Employer
Location
Dates of Employment
Position Held
Reason for leaving/Last salary or wage

Previous Employer Number 2

Name of Employer
Location
Dates of Employment
Position Held
Reason for leaving/Last salary or wage

Previous Employer Number 3

Name of Employer
Location
Dates of Employment
Position Held
Reason for leaving/Last salary or wage

Driver’s Licence

Do you hold a valid and current British Driver’s Licence?	Yes No
If Yes, what type? (E.g. Provisional, Full, LGV, PCV)
Do you have any endorsements?	Yes No
If Yes, please give details

Additional Information

Give details of any additional information which you would like to include in support of your application. Such information, for example, may include skills and/or achievements which you think may be of interest, and/or a summary of why you believe that you have the qualities we are looking for. Please provide details of any relatives employed by the Company and their relationship to you.
Details
Do you have to give notice to any present Employer?	Yes No
If Yes, how much notice do you have to give?

Referees

References are normally taken up for candidates selected for interview. Give details of the names/addresses of two work-related Referees. One of the Referees should be your current employer, or if presently unemployed or self-employed, your last employer

Referee Number 1

Name
Address
Relationship to you
May we contact the above person now?	Yes No

Referee Number 2

Name
Address
Relationship to you
May we contact the above person now?	Yes No

Rehabilitation of Offenders Act

As a general rule, no-one need answer questions about spent convictions. However this general rule does not apply to specified professions, employments and occupations. By virtue of the Rehabilitation of Offenders Act 1974 (Exceptions) (Amendment) Orders, the exemption rule does not apply to: any employment or other work which is concerned with the provision of health services and which is of such a kind as to enable the holder of that employment or the person engaged in that work to have access to persons in receipt of such services in the course of his normal duties, or any employment or other work which is concerned with the provision of care services to vulnerable adults and which is of such a kind as to enable the holder of that employment or the person engaged in that work to have access to vulnerable adults in receipt of such services in the course of his normal duties One or both of the above apply to work at the Home, and covers all occupations. You are therefore requested to provide details of all convictions, including those which would otherwise be considered as “spent”. All employment applications will be considered carefully, and the disclosure of a conviction does not imply that this employment application will be rejected. Records will be checked via the Criminal Records Bureau procedures.
Do you have a criminal conviction	Yes No
If yes please give details here

As a general rule, no-one need answer questions about spent convictions. However this general rule does not apply to specified professions, employments and occupations. By virtue of the Rehabilitation of Offenders Act 1974 (Exceptions) (Amendment) Orders, the exemption rule does not apply to:

any employment or other work which is concerned with the provision of health services and which is of such a kind as to enable the holder of that employment or the person engaged in that work to have access to persons in receipt of such services in the course of his normal duties, or
any employment or other work which is concerned with the provision of care services to vulnerable adults and which is of such a kind as to enable the holder of that employment or the person engaged in that work to have access to vulnerable adults in receipt of such services in the course of his normal duties

One or both of the above apply to work at the Home, and covers all occupations.

You are therefore requested to provide details of all convictions, including those which would otherwise be considered as “spent”. All employment applications will be considered carefully, and the disclosure of a conviction does not imply that this employment application will be rejected.

Records will be checked via the Criminal Records Bureau procedures.

Do you have a criminal conviction

Yes
No

If yes please give details here

Criminal Records – Disclosure Certificate

The Criminal Records Bureau (CRB) have issued a Code of Practice regarding Disclosure Information, a copy of which is available upon request. A Disclosure Certificate (standard or enhanced) will be requested from the CRB which will detail all convictions, including those which would otherwise be “spent”, as well as details of cautions, reprimands or final warnings. You will be advised of the type of certificate being requested, and asked to give your approval to this application. The Disclosure Certificate will only be requested in the event that you are successful in your application for employment.

Asylum and Immigration Act 1996

Under Section 8 of the Asylum and Immigration Act 1996 it is a criminal offence to employ a person aged 16 or over who issubject to immigration control unless: That person has current and valid permission to be in the United Kingdom and that permission does not prevent him or her from taking the job in question; or The person comes into a category specified by the Home Secretary where such employment is allowed Any employment offered will be subject to the successful applicant producing appropriate evidence that the Asylum and Immigration Act is not being contravened.
Are you eligible to work in the UK?	Yes No

Residential Care

Dementia Care

Nursing Care