Segal Gardens Application
The completion of this application form is part of stage one. This application will be reviewed and a decision made as to whether to proceed to stage two, the interview, based on the information. Please answer in as much detail as possible so we have as much information about you as this is vital in deciding the best candidates for interview. Good Luck.
Name *
Your answer
Date of birth *
MM
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DD
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YYYY
If you obtained this position, would you continue in any other employment? *
Email Address
Your answer
Do we need to make any disability-related adjustments to allow you to take part in the recruitment process? *
Are you entitled to enter or remain in the UK and undertake the work in question? *
Position Applied For *
Full time or Part-Time *
Address *
Your answer
Telephone Number *
Your answer
Do You Currently Drive *
Required
Education & Training
Secondary School Attended and date of leaving *
Your answer
Please list School / College / University and qualifications gained *
Your answer
Training History
Your answer
Additional Courses Attended
Your answer
Employment or time away from employment history
Please give full details from school leaving to current - list each in order with all dates.)
Name and address of employer *
Your answer
Date Employed *
Your answer
Nature of Business *
Your answer
Position Held *
Your answer
Reason For Leaving *
Your answer
Name and address of employer
Your answer
Date Employed
Your answer
Nature of Business
Your answer
Position Held
Your answer
Reason For Leaving
Your answer
Name and address of employer
Your answer
Date Employed
Your answer
Position Held
Your answer
Reason For Leaving
Your answer
Name and address of employer
Your answer
Date Employed
Your answer
Position Held
Your answer
Reason For Leaving
Your answer
If Additional Employment Information Is Required Please Do So Below. Please follow the Same Format.
Your answer
Assistance With Interview & Assessment
Any offer of employment may be made subject to a satisfactory medical report.
Do you require us to make any special arrangements in order for you to participate in the recruitment process? For example large print forms? Or additional time to complete forms? *
Identity
Identity Details - National Insurance Number *
Your answer
Capacity to Work
Capacity To Work In The UK - Are There Any Restrictions To Your Residence In The UK Which Might Affect Your Right To Take Up Employment In The UK. If Yes please give details. *
Your answer
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? *
If yes please provide details
Your answer
Referees
You must provide references from your two most recent employers. Please provide an additional character referee. All will be contacted, therefore please inform the referees of the fact that you have used their name. If you are unable to provide the required references, please discuss this matter with us.
Name *
Your answer
Address *
Your answer
Email address *
Your answer
Telephone Number *
Your answer
Job Title *
Your answer
Name *
Your answer
Address *
Your answer
Email address *
Your answer
Telephone Number *
Your answer
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”.

Personal Specification
Please tell us what has interested you about this position, what would you bring to the role? *
Your answer
Please advise us if you are related to or know any persons currently or previously employed by HWCGS Care Ltd. *
Your answer
Declaration
The above information is true. I understand that any job offer made on the basis of untrue or misleading information may be withdrawn or my employment terminated. Please type name below *
Your answer
Declaration under the Protection of Freedoms Act 2012
The post for which you are applying is a ‘regulated activity’ within the meaning of Part 5 Chapter 1 of the Protection of Freedoms Act 2012 and it is a criminal offence for a ‘barred person’ to apply to work in a regulated activity. If you are a barred person you must not proceed with this job application.

If your application is successful you will be required to co-operate with us in obtaining a disclosure of criminal convictions and in checking your barred status with the Disclosure and Barring Service.

Are you a barred person? *
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? *
If yes please give full details
Your answer
Do you have any convictions, cautions, reprimands or final warnings that would not be filtered in line with current guidance? *
If yes please give full details
Your answer
Have you ever used or been known by a different name *
If yes please give full details and dates of name changes
Your answer
Signed (please type below to act as your signature) *
Your answer
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.


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