Community Voice Ltd Application Form

Community Voice Careline Response Limited
APPLICATION FOR EMPLOYMENT
Position applied for Closing date:
Thank you for your interest in employment at Community Voice Ltd. Please read any accompanying
information about the job role before completing this form. This application form enables us to give careful
consideration to your application and you are asked to answer all questions fully with the assurance that we
shall observe the strictest confidence. If your application indicates that you are a suitable candidate for the
position you will be invited for an interview. If you require any assistance in completing the application form
please contact the HR Department. Successful candidates will be asked to complete a medical questionnaire.
DO NOT ENCLOSE YOUR CV WITH THIS APPLICATIONFORM AS IT WILL NOT BE CONSIDERED BY THE SHORTLISTING PANEL.
Personal details
Forenames: Surname:
Address:
Post Code
Telephone no. (Home): Telephone No. (Mobile):
Please indicate which telephone number you would prefer
to be contacted on: Home Mobile
Previous Names (if applicable): National Insurance Number:
Email Address:
Complete for ‘Mobile’ roles only or where appropriate for job role Delete asappropriate
Do you hold a current full driving licence? YES NO
Do you have any current endorsements on your licence? YES NO
If you have ticked ‘yes’ to this question, please give details
Do you have access to a motorised vehicle for work YES NO
FOR OFFICE USE ONLY
DATE RECEIVED: SELECTED FOR INTERVIEW? YES/NO
REFERENCE NO. NOTES (for interview panel to clarify):

Community Voice Careline Response Ltd
CVHD42-5 Creation Date: 02/02/09 Controlled Review ed: 24.07.13 Next review date: 24.07.16 Page 2 of 6
References
Please give details of two persons who will provide a reference for you (neither should be a relative or friend).
One should be your present or most recent employer. Your second reference should be your last but one
employer however, we will accept a Personal/Character referee where this is not possible. We do reserve the
right to ask you to provide an additional reference in some circumstances. Owing to the nature of our
business, the provision of references is a condition of your employment and they will be sought immediately
on being offered a job role within the Company.
Name of Referee:
Job Title/Position Held in Company:
Company Name:
Company Address:
Telephone no.
Capacity in which they know you (eg. Manager,
Supervisor, Tutor, Organisation Leaders etc)
Name of Referee:
Job Title/Position Held in Company:
Company Name:
Company Address:
Telephone no.
Capacity in which they know you (eg. Manager,
Supervisor, Tutor, Organisation Leaders etc)
Delete asappropriate
Do you require a work permit to work in the U.K.? YES NO
Are there any particular requirements you would like us to make YES NO
to accommodate you, should you be invited for an interview?
If you have said ‘yes’ to this question, please give details:
Most job roles within Community Voice Careline Response Ltd are considered exempt from the
Rehabilitation of Offenders Act 1974 as they fall under the scope of Regulated Activity (dealing with
vulnerable & elderly adults)
Delete asappropriate
Do you have any convictions, cautions, reprimands or final warnings YES NO
that are not "protected" as defined by the Rehabilitation of Offenders
Act 1974 (Exceptions) Order 1975 (as amended in 2013) by SI 2013 1198?
ALL APPLICANTS MUST SIGN THIS DECLARATION:
I declare that the information I have declared regarding criminal offences is true and complete.
I understand that if it is subsequently discovered that this information is false or misleading, I
will be liable to have my application disqualified or subsequently will be liable to be dismissed
from employment by the organisation.
Signature ...................................................................... Date ..............................................

Please continue on an additional sheet if necessary.
Education History
Education (from Age 11) Dates Examinations passed Grade
Training Courses Attended
Date Details
Membership of Professional Bodies
Name of body, level and date of membership obtained (State whether by examination)
Hobbies and Spare Time Activities
Please indicate those periods when you would be available for work (please specify your
availability to match the job role you are applying for)
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Morning
Afternoon
Evening
Night

Present (or most recent) Employment
Employer’s name & address
Telephone no.
Nature of the Business: Job Title/Position held
Date commenced employment: Annual Salary, Hourly rate, grade and/or benefits
£
Notice required (or date left): Reason for Leaving (or wanting to leave):
Main duties and responsibilities
Previous Employment - most recent first (Please state your full employment history, including any
gaps when you were not working, ie bringing up family, sabbatical, unemployment etc)
Employer’s name & nature
of business
Position held/summary of key
responsibilities/salary on leaving
Dates employed
(to & from)
Reason for
leaving

Please continue on an additional sheet if necessary.
Additional Information - Please explain how your experience matches the requirements of this
job (please refer to any additional information that has been provided with this form)
Please continue on an additional sheet if necessary

A. Relatives/Other Interests Delete asappropriate
Are you related to or do you have a close personal relationship with any
employee(s) of Community Voice Careline Response Ltd (also known as
County Careline, Mobile Response,Suffolk Careline)?
Yes No
If yes, specify name(s), position(s)
and relationship(s)
If appointed, do you have any interests or hold any other jobs/responsibilities
that may conflict with employment by Community Voice Careline Response in
the role for which you have applied?
If yes, please detail on a separate sheet.
Yes No
B. Statement to be Signed by the Applicant
Please complete the following declaration and sign it in the appropriate place below (we will accept
electronic signatures for email applications). If this declaration is not completed and signed, your
application will not be considered.
I declare that the information contained in this form is true and complete. I understand that if it is
subsequently discovered that any statements are false or misleading, I will be liable to have my
application disqualified or subsequently will be liable to be dismissed from employment by the
organisation.
I herebycertify that:
 all the information given by me on this form is correct to the best of my knowledge
 all questions relating to me have been accurately and fully answered
 I possess all the qualifications which I claim to hold
 I have read and, if appointed, am prepared to accept the conditions set out in the
conditions of employment and the job description.
Signed: Date:
(NB. Candidates selected for interview will normally be notified within three weeks of the closing date.
Unfortunately applicants who do not hear from Community Voice Careline Response Ltd must conclude that
their application has been unsuccessful on this occasion. Thank you for your interest in this post. If you would
like to know if we have received your application form please enclose a stamped addressed post card.
Community Voice Careline Response Ltd undertakes that it will treat any personal information (that is
data from which you can be identified, such as your name, address, e-mail address etc) that you provide
to us, or that we obtain from you, in accordance with the requirements of the Data Protection Act 1998.
Please return your completed form to: HR Department, Community Voice Careline
Response Ltd, Unit 17 Hardmans Business Centre, New Hall Hey Road, Rawtenstall,
Lancashire. BB4 6HH
Declaration

Community Voice Ltd Application Form

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