Alpha Carehomes | Confidential Application for Employment

Initial Details

Personal Details

National Insurance Number

PIN No
(Qualified Nurses Only)

Do you have any relatives or friends that work for Alpha Care Homes?		Have you ever previously worked for Alpha Care Homes?
If so please provide details		Do you know any residents currently residing in any of the care homes?

THE IMMIGRATION AND ASYLUM ACT 1996

Do you require a work permit to be employed in the UK?
Please note: all candidates who are invited for interview will be asked for documentary proof of entitlement to be employed in the UK (i.e. birth certificate or passport showing EEA citizenship or entitlement to work in the UK, National Insurance card, P45 or P60 showing name or NI number or letter from the Home Office showing right to work in the UK).

THE REHABILITATION OF OFFENDERS ACT 1974

Have you ever been convicted of a Criminal Offence?
If so please provide details
By virtue of the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975, the provisions of Section 4.2 of the Rehabilitation of Offenders Act 1974 do not apply to any employment which is concerned with the provision of health services and which is of such a kind as to enable the holder to have access to persons in receipt of such services in the course of his/her normal duties. Your answer to the following question should include any “spent” convictions

EMPLOYMENT HISTORY

Current / Most Recent Employer
Employers Name		Position Held
House Number / Name		Start Date
Street		End Date
Town/City		Basic Salary
Postcode
Please summarise your current duties and responsibilities
Reason for leaving this position		Notice Period

PREVIOUS EMPLOYMENT (excluding current employment; most recent first)

Previous Employers

Add Previous Employer
Employers Name		Position Held
House Number / Name		Start Date
Street		End Date
Town/City		Basic Salary
Postcode
Please summarise your current duties and responsibilities
Reason for leaving this position		Notice Period
Click here when complete

EDUCATION and TRAINING HISTORY

Qualifications

Add Qualification (completed or in progress)
University / School / College
Subjects Studied
Qualification level obtained or to be obtained
Click here when complete

INFORMATION IN SUPPORT OF YOUR APPLICATION

Please use this space in support of your application to provide evidence to show how you meet the role requirement. This can include previous experience, examples of achievements, evidence of updating knowledge and skills, other interests including hobbies. (Please continue on a separate sheet if necessary).
Enter anything you would like to mention in support of your application

REFERENCES

*Any offer of employment will be subject to obtaining references that are satisfactory to the Company*. Please give names and addresses of two referees whom we can approach; one of whom must be your current, or most recent, employer. The Company, at its discretion, reserves the right to take up additional references.
Reference 1		Reference 2
Name *		Name *
House Number / Name *		House Number / Name *
Street *		Street *
Town/City *		Town/City *
Postcode *		Postcode *
In what Capacity do you know the referee *		In what Capacity do you know the referee *

DECLARATION

I agree to terms and conditions *	I declare that the information given in this document is correct to the best of my knowledge and belief. I understand that any wilful mis-statements render me liable to disqualification or to dismissal, if engaged. I consent to the information I provide being kept on file and processed for recruitment purposes in accordance with the principles of the Data Protection Act 1998.
	Submit Completed form

Confidential Application for Employment