Application information

Please outline your reasons for applying for this post and how your experience, knowledge, training, skills and abilities are relevant for the post.

Employment History

Present or most recent employment

Job title

Employers name and address

Salary (actual)

Hours worked per week

Date started

Leaving date (if applicable)

Reason for leaving (if applicable)

Notice period (if applicable)

Brief description of duties/responsibilities

Previous employment

Use the + button to add as many as necessary

Job title

Employers name and address

Salary (actual)

Hours worked per week

Date started

Leaving date

Reason for leaving

Brief description of duties/responsibilities

+

Education and Qualifications

Use the + button to add as many as necessary

Qualification

Subject(s)

Grade(s)

Place of study

Year obtained

+

Relevant training courses attended

Please give the following details for each completed course: course title, training provider and year of completion

Are you applying for a clinical role?

Yes No

Rehabilition of Offenders Act

If the position you are applying for is exempt from the provisions of section 4 (2) of the Rehabilitation of Offenders Act 1974 by virtue of the Rehabilitation of Offenders Act (Exceptions) Order 1975 (as amended), because of the nature of the work, you are not entitled withhold any information of any unspent convictions, cautions, reprimands or warnings and if you do it could result in withdrawal of any job offer made, dismissal or disciplinary action. Where applicable, applicants are therefore required to give all relevant information about convictions, which for other purposes are “spent” under the provisions of the Act. Any information given will be completely confidential and will only be considered in relation to an application for positions to which the order applies. Having a criminal record will not necessarily bar an applicant from working with St Helena.

Do you have any unspent, spent convictions, cautions, reprimands, bind overs or pending prosecutions to declare?

Yes No

Are you currently subject to any form of Police Investigation?

Yes No

Please note: in accordance with our policy, it may be necessary to undertake a Disclosure and Barring check.

Monitoring

What is your date of birth

Please indicate your gender

Are you married or in a civil partnership?

Yes No Prefer not to say

Please indicate your ethnic origin

Please indicate your religion or belief

Please indicate your sexual orientation

According to the definition of disability do you consider yourself to have a disability?

Yes No

Have you experienced a significant bereavement during the past year?

Yes No

Are you currently in a relationship with, or related to, a current St Helena employee?

Yes No

References

Please provide the name and contact details of three references. The first two referees must be your two most recent employers or course tutor if you are a student. The third referee should be someone who knows your professional work well enough to be able to comment meaningfully about your ability to carry out this job. They must be over 18 years old, not be related to you, and have known you for at least one year. The third reference might be a personal friend. Job offers may be withdrawn if references satisfactory to the Hospice are not forthcoming.

Reference 1 - your current, or most recent, employer

Full name

Position/job title

Address

Relationship

Telephone number

Email address

Can this referee be approached prior to interview?

Yes No

Reference 2 - a previous employer

Full name

Position/job title

Address

Relationship

Telephone number

Email address

Can this referee be approached prior to interview?

Yes No

Reference 3 - personal reference

Full name

Position/job title

Address

Relationship

Telephone number

Email address

Can this referee be approached prior to interview?

Yes No

File upload

Declaration

CV

Please select a file

I hereby confirm that the information I have provided on this application form is, to the best of my knowledge, true, accurate and complete. I understand that if I provide any false or misleading information, I shall be subject to serious disciplinary action that may result in my dismissal.

Yes

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Your details

Application information

Employment History

Present or most recent employment

Previous employment

Education and Qualifications

Relevant training courses attended

Rehabilition of Offenders Act

Please note: in accordance with our policy, it may be necessary to undertake a Disclosure and Barring check.

Monitoring

References

Reference 1 - your current, or most recent, employer

Reference 2 - a previous employer

Reference 3 - personal reference

File upload

Declaration

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Your details

Application information

Employment History

Present or most recent employment

Previous employment

Education and Qualifications

Relevant training courses attended

Rehabilition of Offenders Act

Please note: in accordance with our policy, it may be necessary to undertake a Disclosure and Barring check.

Monitoring

References

Reference 1 - your current, or most recent, employer

Reference 2 - a previous employer

Reference 3 - personal reference

File upload

Declaration

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