Glenbervie Employee Application Form

1.

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* 1. Position Applied For, please only choose two options at the most.

Deputy Care Home Manager

Complex Care Unit Manager

Administrator

Activities Coordinator - Care Home

Activities Coordinator - Complex Care Unit

Carer - No Experience

Carer - Experienced but no SVQ's

Carer with SVQ II

Senior Carer with SVQ III & Medication Certificate

Registered Nurse RGN

Registered Nurse RMN

Housekeeper

Domestic

Laundry

Maintenance

Part Time Maintenance/Gardener

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* 2. Please indicate whether you wish to work in the Care Home or the Complex Care Unit.

Glenbervie Care Home

Glenbervie Complex Care Unit

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* 3. Title

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* 4. Personal Details:

Full Name:

Address with Street, Town & Postcode:

Maiden Name:

Marital Status:

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* 5. Contact Details:

Landline:

Mobile:

Email Address:

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* 6. Please provide the following details:

Name of Next of Kin:

Emergency Contact Number:

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* 7. Do you have any Social Media Profiles? If so please provide your links:

Facebook:

Twitter:

Instagram:

Please provide your Social Media Links

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* 8. Please provide the following details:

Current Nationality:

National Insurance Number:

NMC Pin Number or Work Permit Number (If Applicable):

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* 9. Do you have a current driving licence:

Yes

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* 10. Do you have a current PVG (Disclosure Scotland):

Yes

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* 11. If you have a PVG please provide your number below:

PVG No:

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* 12. Are you currently Employed?

Yes

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* 13. Please provide the name and address of your current employer or most recent employer along with the position you had and reason for leaving if you are no longer employed there.

Name:

Address:

Position:

Not Applicable:

Reason for leaving, please be honest as we will make contact:

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* 14. Please provide the name and address of any previous employment in the last ten years (approx):

1/ Most Recent Employer - Name:

Address:

Tel. No. & Email Address of Contact:

Date & Position:

2/ Previous Employment:

Address:

Tel. No. & Email Address of Contact:

Date & Position:

3/ Previous Employment:

Address:

Tel. No. & Email Address of Contact:

Date & Position:

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* 15. Do you have any experience of the position you have applied for, if so please detail below.

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* 16. Please describe why you think you are suitable for this position.

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* 17. Please explain why you would like this job

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* 18. Do you own your own vehicle with full drivers licence and have class D1 (Minibus) Entitlement on your licence.

Yes

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* 19. Please provide your Secondary Education Details:

Secondary Schools Attended:

Dates Attended:

Qualifications Achieved:

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* 20. Please provide your Further Education Details:

Not Applicable:

University/College Attended:

Dates Attended:

Qualifications Achieved:

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* 21. Please give details of your leisure interests and any hobbies you may have:

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* 22. Please provide details of any future holiday commitments you have:

Details with dates:

Not Applicable:

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* 23. Where did you hear about this vacancy?:

Website: www.glenbervie.care

Facebook Page: www.facebook.com/glenberviecare

Facebook Page: www.facebook.com/osborneandallan

Radio

Word of Mouth

Falkirk Herald

Job Centre

Indeed

Roadside Banner

Other (please specify)

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* 24. What will your availability be on a daily basis for the whole week if you were to come and work for us? PLEASE BE AWARE THAT FLEXIBILITY IS KEY SO YOUR AVAILABILITY IS VERY IMPORTANT.
(We operate 12 hour shifts for Nurses & Senior Carers, all other positions we operate 3 shifts: Early: 7am - 2.30pm / Late: 2.30pm - 10pm and Nighsgift: 10pm - 7am - Please use the following to clarify your availability.
A = All / E = Early / L = Late & N = Nightshift.

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

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* 25. When would you be available for Induction? (Induction runs over 3-5 days depending on what position you have applied for)

Immediately

1 week

2 weeks

3 weeks

4 weeks

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* 26. Please provide two business references, one of which must be your current or most recent employer:

Reference 1 Name:

Reference 1 Address:

Reference 1 Telephone Number:

Reference 1 Mobile Number:

Reference 1 Email Address:

Reference 2 Name:

Reference 2 Address:

Reference 2 Telephone Number:

Reference 2 Mobile Number:

Reference 2 Email Address:

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* 27. Privacy notice

We process personal data relating to those who apply for job vacancies with us or who send speculative job applications to us. We do this for employment purposes, to assist us in the selection of candidates for employment, and to assist in the running of the business. The personal data may include identifiers such as name, date of birth, personal characteristics such as gender, qualifications and previous employment history.

We will not share any identifiable information about you with third parties without your consent unless the law allows or requires us to do so. The personal data provided during an application process will be retained for a period of at least six months or, if required by law, for as long as is required.

This privacy notice does not form part of an employment offer or contract between us. If we make an employment offer to you, we will provide further information about our handling of your personal information in an employment context separately.

If you would like to find out more about our data retention policy and how we use your personal data, you want to see a copy of the information about you that we hold or have any questions or issues regarding data protection, please email us with the Subject “Data Protection Request”.

Yes - I understand and accept your Privacy Policy.

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* 28. REHABILITATION OF OFFENDERS ACT (EXEMPTIONS) ORDER 1974
This post is exempt from the position of the Rehabilitation of Offenders Act (Exemptions) Order 1974. In order to protect the public, the post for which you are applying is exempt section 4(2) of the Rehabilitation of Offenders (exemptions) Order 1975. It is not therefore, in any way contrary to the Act to reveal any information you may have concerning convictions which would otherwise be considered "spent" in relation to your suitability for employment. Any information will be kept in the strictest confidence and only used in the consideration of the suitability of you for the position where such exemption is appropriate.

Please specify below details of all charges pending and or convictions. (Please specify "None" if appropriate and sign below:

Charges Pending:

Convictions:

I confirm the information I have provided is true and accurate - Signature: