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Step 1:

Application Details & Personal Details

Position Applied For

Previous URN Numbers (if applying for an RM role) *

Home Applied For

Title *

Surname *

Forename(s) in Full *

Previous Names & Dates of When Name Was Used (if applicable)

Current Address *

Postcode

Previous Addresses to Cover the Last 5 Years (Including Time at Addresses) *

Date of Birth *

Age *

Day Time Telephone Number *

Mobile Telephone Number *

Email Address *

National Insurance Number *

Do You Need a Work Permit to Work in This Country? *YesNo

Do You Hold a Full Driving Licence? *YesNo

Licence Number *

Do You Own a Vehicle? *YesNo

Do You Have Any Endorsements? *YesNo

If Yes, Please Give Further Details Including Dates *

Continuous Five-Year Address History With Dates (if applicable) *

Do You Have a DBS on the Update System? *YesNo

If Yes, Please Provide the DBS Certificate Number *

Do We Have Your Permission to Check This Certificate? *YesNo

Have You Previously Been in Care? *YesNo

If Yes, Please Provide Details *

Do You Know or Are You Affiliated With Anyone at Little Aira’s Home or Little Feet Services? *YesNo

If Yes, Explain the Person’s Relationship With You and How Long You Have Known Them *

Step 2:

Please Tell Us About the Children in Your Household

Do You Know or Are You Affiliated With Anyone at Little Aira’s Home or Little Feet Services? *YesNo

If yes, how many children are in your household? *

Has any of the children in your household had any involvement with social services? *YesNo

If you have answered yes to this question, please provide a description below. *

Step 3:

Education & Qualifications (chronological order):

Education Record 1

Place of Study *

Dates to/from *

Course Title *

Qualification *

Education Record 2

Place of Study *

Dates to/from *

Course Title *

Qualification *

Education Record 3

Place of Study *

Dates to/from *

Course Title *

Qualification *

Step 4:

Training – please include any special training or short courses relevant to this application

Education Record 1

Place of Study

Organizing Body

Dates to/from

Education Record 2

Place of Study

Organizing Body

Dates to/from

Education Record 3

Place of Study

Organizing Body

Dates to/from

Step 5:

Full Employment History

Please give details of ALL your past employment including any voluntary work, excluding your present or last employer and stating the most recent first.

(Please provide full dates from school through to employment).

Name and Full Address of Employer (including telephone number and postcode) *

Contact Name for Verification Purposes

Dates From–To (Exact)

Position Held / Main Duties

Salary

Reason for Leaving

Step 5:

Gaps in Employment

Please provide information relating to any gaps in employment

(The information provided here will be discussed with you during your initial interview)

Please provide an explanation for the gap in your employment.

From (Day/Month/Year)

To (Day/Month/Year

Please provide an explanation for the gap in your employment.

From (Day/Month/Year)

To (Day/Month/Year

Please provide an explanation for the gap in your employment.

From (Day/Month/Year)

To (Day/Month/Year

Step 6:

Present or Most Recent Employer

Are You Currently Employed?YesNo

Name & Address of Employer

Postcode

Telephone Number

Job Title

Date Appointed

Brief Description of Duties

Salary/Wages

Other Benefits / Bonuses

Reason for Leaving

Step 7:

References

References 1

Name of Employer

Referee Name

Position

Address

Email Address

Telephone Number

Relationship

References 2

Name of Employer

Referee Name

Position

Address

Email Address

Telephone Number

Relationship

References 3

Name of Employer

Referee Name

Position

Address

Email Address

Telephone Number

Relationship

Step 8:

Absences

How many periods of absences have you had in the last two years?1–34–67+

How many days absent have you had in the last two years?1–78–2122+

Are there any ongoing medical conditions that will require additional support? If yes, please provide details.

Are you currently awaiting any medical treatment for any health conditions that you will need adjustments to working conditions for? If yes, please provide details.

Step 9:

Please use this section to inform us about any former cautions or convictions these can be spent or unspent. Please declare any pending or ongoing police investigations.

Date

Please detail the alleged offence

What was the date of the outcome?

Is this a pending offence?YesNo

I certify that the information given above is true. I understand that failure to disclose convictions will disqualify me from appointment.

I hereby give consent to the company completing such checks as are necessary with records held by the Company and/or other agencies to verify the information provided above.

I further understand and agree that if, for whatever reason, my application is either refused or withdrawn, but information is revealed which leads the company to conclude that I may pose a risk to vulnerable adults and/or children, it will keep this information for an appropriate period.

I understand that the company may reveal this information to any other agency or company. I understand that, if practicable, I will be alerted prior to such a disclosure and be invited to comment.

If you take up employment it is necessary for you to inform the person with personnel responsibilities of any cautions, bind over orders or convictions you sustain during the subsequent course of your employment.

FAILURE TO DO SO WILL LEAD TO A DISCIPLINARY INVESTIGATION OR AN APPLICATION FOR EMPLOYMENT NOT BEING APPROVED.

Signed

Date

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Contact Information

Office No.101, 46 Station Road, North Harrow, Harrow, England, HA2 7SE
info@little-feet.co.uk
career@little-feet.co.uk
referrals@little-feet.co.uk
Little.Haven@little-feet.co.uk
02038591470