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To register for employment with us please fill in the form below.

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Fields marked with an * are required

Private and Confidential

Current Driving Licence?

Are there any Restrictions on you taking up Employment in the UK?


Please give details of qualifications gained in education, one per line.

Employment History

Please include dates, company name, job title, rate of pay, duties and reason for leaving or notice required if current job.

Current membership of professional bodies (i.e. CIPD, NMC)

Professional Registration Number (where applicable)

Other Employment



Please note here the names and addresses of two persons from whom we may obtain both character and work experience references. Please include contact telephone numbers and/or email addresses.

General Comments

Please detail here your reasons for this application, your main achievements to date and the strengths you would bring to this post. Specifically, please detail how your knowledge, skills and experiences meet the requirements of this role (as summarised in the person specification).

Cautions, Rehabilitation and Criminal Records

Because of the nature of the work for which you are applying, this post is exempt from the provisions of Section 4(2) of the Rehabilitation of Offenders Act 1974, by virtue of the Exceptions Order 1975 as amended by the Exceptions (Amendment) Order 1986, which means that convictions that are spent under the terms of the Rehabilitation of Offenders Act 1974 must be disclosed, and will be taken into account in deciding whether to make an appointment. Any information will be completely confidential and will be considered only in relation to this application.

In addition you are required to submit to a Disclosure and Barring check/provide a PVG Scheme Record or Scheme Record Update. Any disclosure made by the Disclosure and Barring Service/Disclosure Scotland will remain strictly confidential.

Special Requirements (Care Sector)

Because this position involves the care of children and/or vulnerable adults employment is dependent on the following:

1. Your written consent to obtaining a Disclosure and Barring certificate from the Disclosure and Barring Service/Disclosure Scotland or an approved umbrella body or provision of a PVG Scheme Record/Scheme Record Update.
2. Such disclosure being acceptable to us.
3. Proof of identity – birth or marriage certificate (where appropriate) and passport (if available).
4. Two satisfactory written references.
5. That you will supply a photograph of yourself for retention in your records.
6. Evidence of physical or mental suitability for your work.

Declaration (Please read this carefully before signing this application)

1. I confirm that the above information is complete and correct and that any untrue or misleading information will give my employer the right to terminate any employment contract offered.
2. Should we require further information and wish to contact your doctor with a view to obtaining a medical report, the law requires us to inform you of our intention and obtain your permission prior to contacting your doctor. I agree that the organisation reserves the right to require me to undergo a medical examination. In addition, I agree that this information will be retained in my personnel file during employment and for up to six years thereafter and understand that information will be processed in accordance with the Data Protection Act.
3. I agree that should I be successful in this application, I will, if required, apply to the Disclosure & Barring Service/Disclosure Scotland for a Disclosure & Barring Certificate. I understand that should I fail to do so, or should the disclosure not be to the satisfaction of the company any offer of employment may be withdrawn or my employment terminated.

All organisations using the Disclosure and Barring Service and/or Disclosure Scotland to help assess the suitability of applicants for positions of trust and who are recipients of disclosure information must comply fully with the relevant Code of Practice. Amongst other things this obliges them to have a written policy on the recruitment of ex-offenders. This must be given to all applicants for posts where a disclosure will be requested. The Code also requires such organisations to have a written policy on the correct handling and safekeeping of Disclosure information. To assist organisations in meeting this requirement a sample policy statement on the recruitment of ex-offenders will be included with any stationery requests for Form AP2(H).