Candidates Application Form

Position Applied For:(Required)

Title(Required)

Name(Required)

First Last

Have you ever been known by any other names:(Required)

Yes

No

If Yes, enter names

Email(Required)

Phone(Required)

Date of Birth:(Required)

Place of Birth:(Required)

Country

Age:(Required)

Please enter a number from 18 to 65.

Gender:(Required)

Male

Female

Disclosure and Barring Service (DBS):(Required)

Yes

No

Are you aged 18 years or over:(Required)

Yes

No

Do you have a current full driving license:(Required)

Yes

No

Do you have your own transport:

Yes

No

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

(1) Referees(Required)

Please provide details of two referees, one of whom must be your present or most recent employer (this should be your manager/supervisor). We will not accept references from personal friends or relatives or work colleagues.

Name of Referee:

Referee Job Title:

Company Name:

Referee Telephone Number:

Referee Email:

Referee Address:

(2)Referees(Required)

Please provide details of two referees, one of whom must be your present or most recent employer (this should be your manager/supervisor). We will not accept references from personal friends or relatives or work colleagues.

Name of Referee:

Referee Job Title:

Company Name:

Referee Telephone Number:

Referee Email:

Referee Address:

May we contact your referees prior to job offer:(Required)

Referee 1:

Yes

No

May we contact your referees prior to job offer:(Required)

Referee 2:

Yes

No

Professional References

Please provide details of professional references that will defend your work character

Reference Name:

Telephone:

Email:

Address:

Notes

Education and Training(Required)

Please list your qualifications in reverse order, starting with the most recent first. Also, include any training that you have received which did not lead to a qualification but which you feel is relevant to the post. If short-listed for an interview, please be prepared to bring original copies of any certificates relating to post-school qualifications or vocational qualifications.

Date Obtained:

Place of study & address:

Examinations taken & grades:

Other Qualifications:

Please give details of any other qualifications obtained or relevant courses attended.

Date Obtained:

Place of study & address:

Examinations taken & grades:

4. Work Experience(Required)

Please give details of your current or most recent employment:

Name of Employer:

Employer Address:

Length of Employment:

Salary:

Date From:(Required)

Date To:(Required)

If currently employed how much notice are you required to give?(Required)

(weeks)

Main Duties and responsibilities:(Required)

Reason for leaving or seeking new employment:(Required)

Voluntary Work:

Please give details of any voluntary work undertaken:

5: List of Employer (Employment History): Note: Please click on the + sign to add more employment history.(Required)

Please give summary details of all your previous employment (most recent first for a minimum of 10 years if Applicable). Please ensure you include all part-time and temporary positions held, even those that are not relevant to your application. Please ensure you include any periods of unemployment or any other time that is not accounted for.

Name of Employer:

Employer Address:

Length of Employment:

Reason for leaving:

Willing to Relocate outside your present location:

Upload Documents Required for Employment.

Forms of proof of address (1/3)

Two forms of proof of address dated within the last 3 Month from the acceptable proof list:(Required)

Drop files here or

Accepted file types: pdf, doc, docx, Max. file size: 10 MB, Max. files: 4.

Acceptable Proof: • HMRC Letter • Bank Statement • Utility Bill • National Insurance Letter • Local authority letter • Others – check with us

Proof Of National Insurance (2/3)

Proof Of National Insurance from the acceptable proof list:(Required)

Max. file size: 5 MB.

Acceptable Proof: • NI Card • NI Letter • P45/P60 • Tax Code Notification Letter • Universal Credit Letter • DWP Letter

Right To Work (RTW) in the UK from the acceptable proof list:(Required)

Max. file size: 5 MB.

Acceptable Proof: • British Passport • EU Passport / EU ID Card with proof of settlement • NON-UK & EU Passports should be accompanied with a BRP Card

Photographic ID from the acceptable proof list:(Required)

Max. file size: 5 MB.

Acceptable Proof: • Passport • Driving Licence • ID Card • BRP

Criminal Check - upload DBS:

Max. file size: 5 MB.

Acceptable Proof: Updated Enhanced DBS or DBS registered with update service covering both children and adults (Contact support incase you have no DBS)

Upload CV:(Required)

Max. file size: 5 MB.

Training Certificates (3/3)

Training Certificates:(Required)

Drop files here or

Max. file size: 5 MB.

Acceptable certificate: A verified training certificate obtained about in relation to the job being applied for

Disclosure and Barring Service (DBS) Details:

Do you have a DBS

Enter DBS Number:

Move Enter DBS Expiry Date:

General Practitioner Details:

General Practitioner:

Complete New Employment Section

Employer : Committed Solutions

PAYE Reference:

For Official use

National Insurance (NI) No:

Payroll Number:

(Office use only)

Contact Information(In case of an emergency)

Name of person to contact:(Required)

Relationship to you:(Required)

Telephone

Mobile Number:(Required)

Bank Details:

Name of Bank:(Required)

Account Holders Name:*(Required)

Account Number:(Required)

Sort Code:(Required)

Employment Disclosure Section

Tick one of the following three statements:

This is my first job since last 6 April and I have not been receiving taxable Jobseeker's Allowance, Employment and Support Allowance, taxable Incapacity Benefit, State or Occupational Pension.

This is now my only job but since last 6 April I have had another job, or received taxable Jobseeker's Allowance, Employment and Support Allowance, taxable Incapacity Benefit. I do not receive a State or Occupational Pension.

As well as my new job, I have another job or receive a State or Occupational Pension.

Student Loans I make:

Type 1 Student Loan repayments through payroll

PostGrad Loan repayments through payroll

Type 2 Student Loan repayments through payroll

P45:

I attach a copy of the P45 from my previous employer

Employment Start Date:

Rehabilitation of Ex - Offenders Act 1974

You are advised that you are not entitled to withhold information about convictions, which are regarded as spent under the Act’. This is due to the nature of the work involved renders the post exempt from sec. 4(2) of the Act in accordance with the Rehabilitation of Offenders Act 974 (Exceptions) Order 1975. You are therefore required to give details of all convictions and cautions including ‘spent’ convictions. Any in formation, which you may give, will be strictly confidential and will be considered only in relation to this or a similar position for which you may be considered with Committed Solutions.

Have you ever been convicted of a criminal offence?

Yes

No

If yes, please give details of all convictions and cautions, including spent convictions and cautions: (please use a separate sheet if necessary)

You are required to complete the Disclosure and Barring Service (DBS) Disclosure form. All health professionals registered with Disclosure and Barring Service are subject to this disclosure process in the interests of all parties concerned.

Declaration

I declare that: All information given is true in every respect. I have read and understood the Terms and Conditions and I agree to comply with the current Health and safety at work Act (ii) I have never been charged with or convicted of an offence under any legislation dealing with Residential care or any offence involving dishonesty or violence. (iii) I have been issued with a staff handbook and informed of the importance of reading and understanding it

Printed Name

Signature

Date

Disclosure and Barring Service – ENHANCED DISCLOSURE

I understand that before I can commence work with Committed Solutions, I will need to be in possession of a DBS Enhanced Disclosure.

Forenames

Surname

Right To Work Enquiry Agreement

I agree and give permission for Committed Solutions to take appropriate action and contact the appropriate authorities as a part of their effort to validate my right to work in the UK.

Print Name

Signature

Date

Confidentiality Agreement

I agree that during the time I am engaged with Committed Solutions to work in any capacity: 1. I will not disclose to any person, any information obtained whilst attending an assignment. 2. I will hold in trust and confidence for Committed Solutions all such information, and never use it for any other purposes than for the benefit of Committed Solutions .

Print Name

Signature

Date

Committed Solutions Declaration

If you provide false or misleading information to support your application it will disqualify you from being engaged as an employee of Committed Solutions. If it is found that you provided false or misleading information to support your application after or during employment, Committed Solutions has the right to terminate your contract on this basis. I hereby declare that I understand and complied with the requirements laid down in the application and I agree that the information given on this form maybe used to obtain DBS checks on me from the policy authorities.

Print Name

Signature

Date

Complete Non-Disclosure Section

Non-Disclosure Form

During the course of my engagement with Client (referred to as the ‘Client'), I may learn of confidential information relating to the Client. Confidential information includes matters not generally known outside the Client, and includes various developments, inventions, improvements, methods, etc., relating to products, services marketed or used by the Client (e.g. relating to sales, costs, profits, organisation, customer lists, pricing methods, etc.). I agree not to disclose any confidential information to others or to make use of it either during or after my engagement by the Client, whether or not such information is produced by my own efforts, except as expressly permitted in writing by the Client. Also, I may learn of apparatus, methods, ways of business, etc., which in themselves are generally known but whose use by the Client is not generally known, and I agree not to disclose to others such use, either during or after my engagements. All inventions, discoveries, developments and improvements (hereafter referred to as ‘Inventions') made or conceived during the course of my engagement with the Client, whether the same are patentable or not, shall become and remain the sole and exclusive property of the Client. I agree to notify immediately the Client in writing of such Inventions, and hereby transfer all rights title and interest in and to any such Inventions to the Client. I hereby assign to the Client all rights title and interest in and to all copyrights on all writings, documents, reports, computer programs and other works made or written by me during the course of my engagement with the Client. My obligations under this Agreement shall survive the termination of my engagement with the Client regardless of the manner of such termination, and shall be binding upon my heirs, executors and administrators.

Signed:

Printed Name as the signature.

Name:

Date

How did you hear about us?(Required)

Search Engine

Online Advertising

Print Advertising

Blog or Social Media

Friends or Family Referral

Other

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

CAPTCHA

Email

This field is for validation purposes and should be left unchanged.

1 - Complete Application Form

Committed Solutions Employment Application Form

Upload Documents Required for Employment.

Forms of proof of address (1/3)

Proof Of National Insurance (2/3)

Training Certificates (3/3)

Disclosure and Barring Service (DBS) Details:

General Practitioner Details:

Have you suffered or are you suffering from any of the following:

Health Declaration:

Complete New Employment Section

Contact Information(In case of an emergency)

Bank Details:

Employment Disclosure Section

Equal Opportunities Monitoring

Rehabilitation of Ex - Offenders Act 1974

Declaration

Disclosure and Barring Service – ENHANCED DISCLOSURE

Right To Work Enquiry Agreement

Confidentiality Agreement

Committed Solutions Declaration

Complete Non-Disclosure Section

Non-Disclosure Form