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The Mulberry Bush Application Form - Bitterne Park

Position applied for*

Where you heard about the job*

Date of application

Personal details

Firstname*

Surname*

Full postal address*

Home phone number*

E-mail address*

Mobile number*

National insurance number*

Right to work in the UK

Do you have the right to work in the UK? YesNo

If you are not a British or European Union National, are you entitled to take up employment in the UK? YesNo

Do you have a work permit? YesNoN/A

If yes please specify the terms of this permit/visa and expiry date

Passport number and type

Type of work

Are you looking for full time work or part time work? Full timePart time

If you are looking for part time work please give details of hours you are available

AM PM
Monday
Tuesday
Wednesday
Thursday
Friday

Have you applied for a role at The Mulberry Bush before?

YesNo

If Yes, please specify role previously applied for

Education & Qualifications

Please use the boxes below to tell us about the qualifications you have obtained throughout your secondary education, further education and professional training. Please continue on a separate sheet if required. You will be required to bring original copies of certificates to interview.

Qualification 1

Qualification gained/pending

Grade/level

Name of establishment school/college/university

Date achieved

Awarding body

Qualification 2

Qualification gained/pending

Grade/level

Name of establishment school/college/university

Date achieved

Awarding body

Qualification 3

Qualification gained/pending

Grade/level

Name of establishment school/college/university

Date achieved

Awarding body

Qualification 4

Qualification gained/pending

Grade/level

Name of establishment school/college/university

Date achieved

Awarding body

Other skills

Please use this space to detail any other skills you have i.e. musical ability, languages, computer experience, first aid and your level of ability e.g. basic, intermediate, advanced and any dates for renewing those qualifications.

Do you hold a full clean driving licence? YesNo

Are you a car owner? YesNo

If successful in securing this role, how will you travel to work?

Employment history

Please give full details of previous employment for the last 5 years. This should include all paid and unpaid employment, work experiences and placements. Exact dates of employment must be given. If you have held different posts with the same employer please include these separately.

Please indicate any reason for gaps in employment, include full time study and continue on a separate sheet if necessary. Please start with your present or most recent employer. If this is your first job application, please detail your last place of education.

Name of your current or most recent employer

Company name and address

Telephone number

Email address

Job title

Start date

Leave date

Main duties

Reason for leaving

Notice required/Date available to start work

Final salary/hourly rate

Previous employer

Employer address

Email address

Last position held

Start date

Leave date

Main duties

Reason for leaving

Notice required

Final salary/hourly rate

Previous employer

Employer address

Email address

Last position held

Start date

Leave date

Main duties

Reason for leaving

Notice required

Final salary/hourly rate

Previous employer

Employer address

Email address

Last position held

Start date

Leave date

Main duties

Reason for leaving

Notice required

Final salary/hourly rate

Please use this space to detail reasons for any gaps in your employment history.

Personal statement

Please list the 3 main reasons you believe you are well suited to this role

References

Please provide the names of two referees one of whom must be your current employer and the other a previous employer or professional acquaintance. If you have not previously worked, please list a teacher or university lecturer. The referee may not be a friend or member of your family. Please note a reference will not be obtained until an offer of employment has been made. All offers of employment are subject to satisfactory references being obtained.

Full name of referee 1

Job title

Company name

Address

Telephone number

Email address

Relationship to self

Can we contact this employer? YesNo

Full name of referee 2

Job title

Company name

Address

Telephone number

Email address

Relationship to self

Can we contact this employer? YesNo

Declaration

The job for which you are applying involves substantial access to children and is therefore exempt from the Rehabilitation of Offenders Act 1974. You are therefore required to declare any convictions or cautions you may have, even if they would otherwise be regarded as ‘spent’ under this act. The information you give will be treated in confidence and will only be taken into account in relation to an application where this exemption applies.

The disclosure of a criminal record will not bar/exclude you from appointment unless the company considers that the conviction renders you unsuitable for employment. In making this decision we will consider the nature of the offence, how long ago it occurred and what age you were when it was committed as well as any other factor which may be relevant. Failure to declare a conviction may, however, disqualify you from appointment or result in summary dismissal if a discrepancy is revealed once appointed.

Have you ever received a caution, including conditional cautions, been issued with a CCJ, or been convicted by a court of any offence? (you do not need to include minor driving offences)

YesNo

If yes please give details below

Have you ever been issued with a final written warning or dismissed by a former employer?

YesNo

If yes please give details below

All successful candidates will be subject to an Enhanced Disclosure and Barring Check (DBS)

At The Mulberry Bush our top priority is the Safeguarding of our children, we have a vigorous Child Protection Policy.

I confirm that the information given on this form is accurate, true and complete. I understand that any false statements may be sufficient cause for rejection or, if employed, summary dismissal.

Please note If successful in securing an interview you will be asked to provide proof of your eligibility to work in the UK, proof of a current passport and original copies of all qualifications relevant to the post to which you are applying.

The information that you provide will be handled and processed in accordance with the Data Protection Act 1998. It may be used by The Mulberry Bush for business purposes including the prevention and detection of fraud as well as for HR purposes and administration. If you are appointed, this information will form part of your employee record and will be treated as confidential and will not be disclosed to any unauthorised person.

I Agree to the terms Yes