Home / Careers / Application Form

Application Form

New Job Application Form

The Position
Your Details
Current Employer
Personal Statement
Employment History
Qualificaitons
References
Interview
Additional Information
Data Protection
Criminal Convictions
Declaration

What position are you applying for?

Which location are applying to?

How did you hear about this vacancy?

Other

Full Name

Full Address (including post code):

Your Contact Number

Your Email Address

Business Name of Current Employer:

Full Address of Current Employer:

Contact name of the person we would go to for an Employment Reference:

Contact Email Address of the person we would go to for an Employment Reference:

When did you start working for this employer?

How much notice are you required to give this employer?

What was your job title with this employer?

What are your main duties and responsibilities?

1. Personal Reason/s for applying:

2. Skills

3. Knowledge

4. Experience

Please provide your full employment history explaining any gaps in employment

Please select the number of previous Employers you wish to reference

None

One

Two

Three

Four

Five

Employer One

Employer One Business Name

Employer One Contact Number

Employer One Address

Employer One Job Title

Employer One Main Duties & Responsibilities

Employer One Start Date

Employer One End Date

Employer One Reason for leaving

Employer Two

Employer Two Business Name

Employer Two Contact Number

Employer Two Address

Employer Two Job Title

Employer Two Main Duties & Responsibilities

Employer Two Start Date

Employer Two End Date

Employer Two Reason for leaving

Employer Three

Employer Three Business Name

Employer Three Contact Number

Employer Three Address

Employer Three Job Title

Employer Three Main Duties & Responsibilities

Employer Three Start Date

Employer Three End Date

Employer Three Reason for leaving

Employer Four

Employer Four Business Name

Employer Four Contact Number

Employer Four Address

Employer Four Job Title

Employer Four Main Duties & Responsibilities

Employer Four Start Date

Employer Four End Date

Employer Four Reason for leaving

Employer Five

Employer Five Business Name

Employer Five Contact Number

Employer Five Address

Employer Five Job Title

Employer Five Main Duties & Responsibilities

Employer Five Start Date

Employer Five End Date

Employer Five Reason for leaving

For each Qualification or Training Courses please provide the Subject and Level, the Location of the Qualification or Training and the Date

Cornwallis Care Services require three references from you. The first reference must be from your current employer or most recent employer. Ideally, the other two references would be a combination of another employer or character references from a professional person; e.g. a tutor. References from family members are not acceptable.

Reference One

Reference One Contact Name:

Reference One Job Title:

Reference One Address:

Reference One Contact Number:

Reference One Contact Email:

May this reference be taken up before or after interview?

Reference Two

Reference Two Contact Name:

Reference Two Job Title:

Reference Two Address:

Reference Two Contact Number:

Reference Two Contact Email:

May this reference be taken up before or after interview?

Reference Three

Reference Three Contact Name:

Reference Three Job Title:

Reference Three Address:

Reference Three Contact Number:

Reference Three Contact Email:

May this reference be taken up before or after interview?

I hereby give my consent to Cornwallis Care Service contacting the above references for the purpose of seeking a reference only Privacy Policy.

Do you require any special arrangements for the interview because of a disability?

Please give a brief detail of the effects of your disability on your day-to-day activities, and any further information that you consider would help us to accommodate your needs during the interview and support us to meet our obligations under the Equality Act 2010).

Are you related to any employee or associated Companies of Cornwallis Care Services or its Board?

Please state the person’s name and your relationship.

Have you taken a COVID-19 test in the past 14 days?

Please provide the date of your test/s and the outcome/s

Have you had a COVID-19 Vaccine?

Please provide the Date Received

Please state why?

Do you require a work permit to work in the U.K.?

Do you have a work permit?

Do you hold a full driving licence?

Do you have any current endorsements on your driving licence?

Information from this application form may be processed for the purposes registered by the Employer under the Data Protection Act 1998. Individuals have, the right of Access to Personal Date held about them, subject to a written request and a payment of a fee under the Act.

I hereby give my consent to Cornwallis Care Services processing the data supplied in the application form for the purposes of recruitment and selection. Privacy Policy.

You are required to disclose all criminal convictions, cautions, warning or reprimands, including any which may be ‘spent’ under the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 and 1986 and therefore even ‘spent’ convictions must be disclosed.

Any information you provide will be strictly confidential and will be considered only in relation to the particular application that you have made.

Disclosure of a conviction or caution does not necessarily mean that you will not be appointed or approved; a person’s suitability will be considered when all of the information is available; our main consideration will be whether the offence is one which would make a person unsuitable to work in a capacity that provides the opportunity for access to vulnerable adults and children.

A conviction includes:

A sentence of imprisonment, youth custody or borstal training;
An absolute discharge, probation order, conditional discharge, bind-over order, fit person order, supervision order or care order;
Any form of dismissal from the Armed Forces;
Detention by direction of the Home Secretary;
Detention centre, remand home, approved school or attendance centre orders;
A suspended sentence;
A fine or any sentence not mentioned above.

Do you have any conviction, caution, warning or reprimand?

Please enter the details of any conviction, caution, warning or reprimand below including the date and nature of the offence, where the offence occurred, the date of the conviction, caution, warning or reprimand and the court and sentence.

I declare that I have completed this application form and that all of the information provided, is, to the best of knowledge, complete and correct and I understand that if I knowingly provide false information, incomplete or misleading statements, my application will be ‘null and void’ and any employment offered will be withdrawn or terminated. Privacy Policy.

On behalf of Cornwallis Care Services, thank you for choosing us to come and work for. We wish you every success in your application.