Careers Application Form | Impression Health and Support

Application for employment – regulated activity

Position you are applying for

Forename(s)

Surname

Address

City/Town

Postcode

Telephone

Mobile

Emaila valid email

Education and training

High School

Date Fromof appointment

Date Toof appointment

College

Date Fromof appointment

Date Toof appointment

University

Date Fromof appointment

Date Toof appointment

Employment history

Name & address of employer

Date Fromof appointment

Date Toof appointment

Reason For Leavingyour full name

Name & address of employer

Date Fromof appointment

Date Toof appointment

Reason For Leavingyour full name

Name & address of employer

Date Fromof appointment

Date Toof appointment

Reason For Leavingyour full name

Please explain any gaps between employmentmore details

0 /

Driving

Current driving licence?pick one!

YesNo

If 'Yes', type of licence(s)your full name

Any current endorsements?pick one!

YesNo

If 'Yes', type of licence(s)your full name

Any motoring prosecutions pending?pick one!

YesNo

If 'Yes', type of licence(s)your full name

Further Details

Please detail any further information you wish to put forward in support of your application.more details

0 /

Question asked under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

Do you have any physical or mental health conditions which are relevant to your capability, after reasonable adjustments are made, to properly perform the tasks which are intrinsic to this employment? Yes/No If yes, give details:

References

I hereby authorise you to contact the references below to obtain any information which, in your opinion, will attest to my suitability, qualifications and work history.pick one!

Yes

Character reference nameyour full name

Relationshipyour full name

Character reference telephoneyour full name

Employment reference emaila valid email

Employment reference nameyour full name

Relationshipyour full name

Employment reference telephoneyour full name

Character reference emaila valid email

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”.

Declaration

Are you a barred person?pick one!

YesNo

Do you have any outstanding safeguarding investigations or suspensions, criminal prosecutions or convictions that might lead to your being barred from working on child-orientated premises (e.g. schools), with children or with protected adults?pick one!

YesNo

If “Yes”, give full detailsmore details

0 /

Do you have any convictions, cautions, reprimands or final warnings that would not be filtered in line with current guidance? See https://www.gov.uk/tell-employer-or-college-about-criminal-record for further guidance on how filtering applies.pick one!

YesNo

If “Yes”, give full detailsmore details

0 /

First nameyour full name

Surnameyour full name

Registration/PIN number (if applicable)your full name

Dateof appointment

If you have previously had any other surname(s) or forename(s), you must declare all of them below and state the date of each change and the reason.more details

0 /

Please upload any relevant files or certificates to support your applicationupload

Upload

Statement on the recruitment of ex-offenders

Introduction

As an organisation using the Disclosure and Barring Service’s (DBS) checking service to assess applicants’ suitability for positions of trust, we comply fully with the Code of Practice and undertake to treat all applicants for positions fairly. We undertake not to discriminate unfairly against any subject of a DBS check on the basis of a conviction or other information revealed.

We are committed to the fair treatment of our employees, potential employees and users of our services, regardless of their offending background.

Policy

We actively promote equality of opportunity for all with the right mix of talent, skills and potential and welcome applications from a wide range of candidates, including those with criminal records. We select all candidates for interview based on their skills, qualifications and experience.

A DBS check is only requested after a thorough risk assessment has indicated that one is both proportionate and relevant to the position concerned. For those positions where a DBS check is required, all application forms, job adverts and recruitment briefs will contain a statement that a DBS check will be requested in the event of the individual being offered the position.

Where a DBS check is to form part of the recruitment process, we encourage all applicants called for interview to provide details of their criminal record at an early stage in the application process. We request that this information is sent under separate, confidential cover, to a designated person within the organisation and we guarantee that this information will only be seen by those who need to see it as part of the recruitment process.

Unless the nature of the position allows us to ask questions about your entire criminal record, we only ask about ‘unspent’ convictions as defined in the Rehabilitation of Offenders Act 1974.

We ensure that all those who are involved in the recruitment process have been suitably trained to identify and assess the relevance and circumstances of offences. We also ensure that they have received appropriate guidance and training in the relevant legislation relating to the employment of ex-offenders, e.g. the Rehabilitation of Offenders Act 1974, and in the secure handling of “sensitive personal data”, e.g. DBS checks.

At interview, or in a separate discussion, we ensure that an open and measured discussion takes place on the subject of any offences or other matter that might be relevant to the position. Failure to reveal information that is directly relevant to the position sought could lead to withdrawal of an offer of employment.

This policy document is made available to all DBS applicants at the outset of the recruitment process and we make every subject of a DBS check aware of the existence of the Code of Practice and make a copy available on request.

We undertake to discuss any matter revealed in a DBS check with the person seeking the position before withdrawing a conditional offer of employment.