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Position Applied For*

Personal Details

First Name*

Last Name*

Have ever been known by another name such as marriage or name change?

Address*

Street Address City Postcode

Telephone Number

Mobile Number*

Email Address*

National Insurance Number

Full Current, clean driving license?*

Yes
No

Car Owner?*

Yes
No

Where did you hear about the LOVE CARE*

Regulatory Body Details

Are you registered with the PVG Scheme?*

Yes
No

PVG Scheme Membership Number

(if no PVG please complete the information below)

Date of Issue

Are you registered to work with

Adults
Children
Both

Are you registered with the SSSC (Scottish Social Services Council)

Yes
No

SSSC Certificate No ( if Known)

Eligibility To Work In The UK

(UK legislation requires all candidates to provide appropriate evidence)

Do you have legal right to work in the UK

Yes
No

If No, Do you hold a Visa

Yes
No

Visa Type

Health & Safety Information

Do you consider yourself to have a disability

Yes
No

If Yes, please provide further information

Do you require any reasonable adjustments to be made for any interview or assessment

Qualifications

Education History

Name of Institution Attended	Qualifications / Grades Gained	Start Date	End Date

Work History

Name of Company	Position	Start Date	End Date	Salary / Hourly Rate	Reason for Leaving	Brief Description of Duties

Please detail any gaps in your employment history

References

(Please detail your most recent 2 employers / recent place of study. The first one should be your present (or most recent) employer. If only 1 can be provided then please detail a professional character referee for the second reference. Additional references will be obtained where required. We cannot accept two references from the same company. Any offer of employment with LOVE@care is subject to the receipt of satisfactory references)

References

Name	Position	Company Name	Telephone Number	Email Address	Your Position within Company	Start Date	End Date

Resubmission / Issue With Referees

All Job offers are based on Satisfactory application, Interview, Training and Compliance are you happy to proceed?

Yes
No

Rehabilitation of Offenders Act 1974

Due to 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 (Exclusions and Exceptions) (Scotland) Order 2003 (As amended)

Applicants are therefore required to provide information about convictions, cautions, reprimands, warnings or any other criminal record information which for other purposes are "spent" under the provisions of the Act

Any information provided will be treated completely confidentially and will be considered only in relation to positions to which the order applies.

Have you ever been convicted, or are you currently under investigation for, any criminal offence(s)

Yes
No

If Yes, please provide details

Data Protection Act 1998

LOVE@care will use the information you provide in this application form for the purpose of processing your application and monitoring the recruitment process. Should your application be successful, we may be required to share some fo the information you provide with statutory bodies including the Care Inspectorate and the Department of Work and Pensions.

The information you provide in this form will be stored securely and will not be retained longer than necessary. Unsuccessful applications will not normally be kept for longer than a year. You have the right to access the information that LOVE@care holds on you. If you would like to do this, please contact the HR department.

LOVE@care has a written policy on the recruitment of ex-offenders, which is available to all applicants. Having a criminal record will not necessarily bar you from working, this will depend on the nature of the position together with the circumstances and background of any particular offences.

DECLARATION
I certify that the information contained within this application form, my CV and any attachments provided are truthful and accurate. I understand that withholding, or providing false information may affect my application. I understand that any offer of employment will be subject to the verification of my Right to Work in the UK including verifications of any qualifications.

I agree to the information for which I have provided (which may include sensitive or personal data) being used or shared as necessary for the legitimate purposes connected with recruitment and selection.

The information supplied above may be verified by LOVE@care. I consent to the processing of date in accordance with the current Data Protection legislation.

I agree to inform LOVE@care of any change to my information / circumstances which may affect my application

I agree

Print Name*

Date*

Important Information, Please Read

LOVE@care is committed to the promotion of equal opportunity in all services provided and is committed to ensuring all staff employed will equally promote this policy. We welcome all applications from people who feel they are able to carry out the required duties regardless or previous experience. If there is any way we can support you to apply for this post, please contact us on 01355 239 609. LOVE@care has adopted the two tick's disability symbol and will interview all applicants who meet the minimum criteria for a job vacancy.

Successful applicants will be required to join the PVG scheme - The Protecting Vulnerable Groups Scheme (PVG Scheme), which delivers on the provisions outlined in the Protection of Vulnerable Groups (PVG) (Scotland) Act 2007 will:

• Help to ensure that those who have regular contact with children and protected adults through paid and unpaid work do not have a known history of harmful behaviour. Disclosure information will not be used for any other purpose than in connection with this application and a criminal record will not necessarily be a bar to employment. We will check professional registers: SSSC, NMC and other professional bodies.

All successful applicants will be required to join the PVG scheme. The fees to join this scheme are £59 for a new member and £18 for an exisiting member. The fees must be paid by the successful applicant prior to employment.

PLEASE COMPLETE THE DETAILS BELOW IF YOU AGREE TO THE ABOVE AGREEMENT

Print Name*

Date*

This is part of LOVE@care's drive to become more environmentally friendly and save waste

Data Protection

I agree to the handling and storage of this data by LOVE

Communications Preferences

I would like to receive information by email
I would like to receive information by telephone

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