Staff Application Form - Garvald West Linton

1. Post applied for:

Positon applied for

2. Personal Details

First

Last

Address

Street Address

Address Line 2

City

County / State

Postcode

Country

Tel Day

Tel Evening

Email

3. Education and Training - School Education

School Education

Qualifications	Subject	Grade

Further and Higher Education - Institution Attended

Further and Higher Education - Details

Qualifications	Subject	Grade

Other training relevant to this application

Do you hold a full driving license?

Yes

No

4. Employment

Name of Current Employer

Start Date

Summary of duties and responsibilities held

Previous employment history – most recent first. Please details of any gaps in employment.

Name of Employer	Start Date	End Date	Job Title	Reason for Leaving

5. Registration

Are you registered with the Scottish Social Services Council?

Yes

No

If yes, on what part(s) of the register are you registered?

If yes, what is your registration number?

Are you registered with any other professional body?

Yes

No

If yes, please give details

6. Disciplinary Record

Are you currently the subject of a disciplinary investigation?

Yes

No

Are you currently suspended?

Yes

No

Is there a current disciplinary finding against you?

Yes

No

Have you ever had your employment terminated because of unprofessional behaviour or misconduct?

Yes

No

Have you ever left an organisation before the outcome of a disciplinary investigation was known?

Yes

No

Have you ever been disqualified from any professional training programme?

Yes

No

Have you ever been suspended or deregistered by any other regulatory body or licensing/registration organisation because of unprofessional behaviour or misconduct?

Yes

No

If you have answered yes to any of these questions, please give a brief summary below

7. Protection of Vulnerable Groups Scheme

Are you a member of the protection of vulnerable groups scheme?

Yes

No

If yes, please give your membership number

If a member of the scheme, is this in respect of working with children or adults or both?

Children

Adults

Both

8. Statement in support of application

Referring to the job description please tell us about your experience, knowledge and skills you feel relevant to the post.

9. References

Please provide contact details of two referees. One of whom must be your current or most recent employer.

Current or Most Recent Employer Name

Reference 1 Name

Reference 1 Position

Reference 1 Email

Reference 1 Telephone

Other references

At least one is required, but you can add more by using the + at the end of the row.

Second Reference Details

Name	Position	Email	Telephone

10. Data Protection

The information provided by you on this form and any supplementary forms will be used to assist with the process of recruitment in accordance with Garvald West Linton’s recruitment and selection policy. If you are successful in your application the information provided will be used for personnel record and payroll purposes. By signing the declaration in section 12 of this form it is understood that you consent to the use of your personal information for the above purpose. If you are unsuccessful your information will be destroyed.

11. Declaration

I confirm that, to the best of my knowledge, the information supplied by me on this application form and on any additional sheets is correct. I accept that false information or omission may lead to my dismissal without notice.

Date

Please tell us where you heard about Garvald West Linton

Notes for applicants:

Successful applicants will be required to prove their right to work in the UK prior to confirmation of a start date.

This post is exempt from the Rehabilitation of Offenders Act 1974 by the (Exceptions) Order 1975. Applicants selected for interview are required to disclose all convictions (spent or unspent). A criminal convictions declaration form will be sent to applicants along with their invite to interview.

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