Education & Employment History 

Please provide details of qualifications obtained, these may be from school, higher education, or further education.  
School / College / University Attended
Qualifications / Results
Year
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Row 6
Row 7
Row 8
Row 9
Row 10
 
Please provide a full employment history, including reasons for leaving each employment.  
Employment Dates
Company Name & Address
Position Held
Reason For Leaving
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Row 3
Row 4
Row 5
Row 6
Row 7
Row 8
Row 9
Row 10

Health Declaration 

Please indicate if you ever suffered with any of the following conditions.  
(If answering yes, please provide further details such as dates, duration, and outcomes in the additional notes section below.) 
Record of Immunity - Have you been immunised against the following? 

Confidential DBS Screening Application 

Due to the nature of the work involved, we are required to undertake a DBS screening on applicants to assess their suitability for the role, please only complete the form if you consent to us completing this screening process. 
If you are not registered on the DBS update system we will be required to obtain a new DBS for you as part of the screening process, which will be sent to your home address, where this is required we will ask applicants to contibute a non-refundable payment of £35 toward the cost of the DBS screening. If an applicant rejects a position offered, chooses to leave during their probationary period, or is dismissed for misconduct during the probationary period we will request/reclaim payment of a further £35 to cover the cost of the DBS screening process.  
Those who are registered with the update service will not be required to do this, instead they should provide their DBS details so that we may carryout a screening.  
If you are not registered with the update service please answer the remaining questions in this section.  
 
Please provide a FIVE YEAR address history. 
Address - Number / Street / Town / County /Postcode
Date Moved In
Date Moved Out
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Row 8
Please detail any other names you have used. 
Name
First or Last Name
Date Started Using Name
Date Stopped Using Name
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Row 5
Row 6
If you have answered yes to the question above, please provide details below. We appreciate that you may feel embarrassed about having to declare such matters but you will be given full opportunity to explain the circumstances of any conviction, caution or bind over order and it is possible that these will not exclude you from employment. 
Date
Court
Offence
Penalty
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Row 3
Row 4
Row 5

Equal Opportunities Monitoring 

Information from this section of the form will NOT be used to decide whether or not to invite an applicant for interview or to offer employment. It will instead be used for internal equal opportunities monitoring, and will be treated confidentially. 
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