Fill out the application below and we’ll be in touch. Please complete this form in full. If the space provided is insufficient, please continue on a separate sheet. Once completed please send to Joanne Keane – j.keane@mayfield-trust.org.uk Post Details Post applied for Hours required Full time / Part time Full time Part time Where did you hear about this vacancy? Have you previously applied for a job with The Mayfield Trust? Yes No Are you related to anyone who currently works for, or is supported by The Mayfield Trust? Yes No If yes, please provide details Personal Details Title Surname First names Address Postcode Telephone number (home) Telephone number (mobile) Email address Do you consider yourself to have a disability? Yes No If yes, please give details of any assistance you may need with your application or at interview NMC PIN number (qualified nurses only) Do you hold a current full UK driving licence? Yes No Do you have any endorsements on your licence? Yes No If so, please outline Are you eligible to work in the UK? Yes No British citizen? Yes No Please provide details of your Right to Work in the UK (you will be asked to obtain a share code so this can be checked prior to interview) Right to Work type Hours permitted to work Right to Work expiry date Employment History Please provide a full record of all your previous employers. You must record reasons for any gaps in your work history. Current or most recent employer Employer name Employer address Postcode Telephone number Dates employed (from) Dates employed (to) Job title Responsible to Outline of duties and responsibilities Reason for leaving Length of notice required Previous employment Please provide details of all previous employment starting with the most recent (use a separate sheet if necessary). Previous employment 1 Employer name and address Job title Dates employed (from) Dates employed (to) Reason for leaving Business sector Previous employment 2 Employer name and address Job title Dates employed (from) Dates employed (to) Reason for leaving Business sector Gaps in Employment Please give details of all gaps in employment. Gap 1 Dates (from) Dates (to) Reason Gap 2 Dates (from) Dates (to) Reason Education & Qualifications School / College School / College Dates attended (from) Dates attended (to) Qualifications gained (state level and grade) Maths (grade) English (grade) Other business-sector relevant qualifications College / University College / University 1 College / University Dates attended (from) Dates attended (to) Qualifications gained (state level and grade) College / University 2 College / University Dates attended (from) Dates attended (to) Qualifications gained (state level and grade) NVQs, Diplomas & Other Sector-Related Qualifications Provide details of any Health & Social Care qualification you have at level 2 or above. Qualification(s) gained (state level and grade) College / training provider Date Sector Relevant Personal Development & Additional Learning Provide details of any sector-relevant training (for example manual handling, first aid, challenging behaviour). Further training & development / course details Date DBS (Disclosure & Barring Service) All positions are subject to an enhanced DBS check. Do you have a current DBS? Yes No DBS number Is it on the update service? (currently £13 per year) Yes No Do you have any unspent conditional cautions or convictions under the Rehabilitation of Offenders Act 1974? Yes No Do you have any adult cautions (simple or conditional) or spent convictions that are not protected as defined by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (Amendment) (England and Wales) Order 2020? Yes No References Please give the details of two people who have agreed to provide a reference for you. One must be your present or most recent employer and the other should be from a previous employer. Your referees should be your line managers and not colleagues, relatives or friends. Both references cannot be from the same company. 1st referee – current or most recent employer Company Referee name Position / job title Company address Postcode Telephone number Company email 2nd referee Company Referee name Position / job title Company address Postcode Telephone number Company email Character referee Referee name Known by you since Relationship Address Postcode Telephone number Email Personal Statements Provide details of experience, knowledge, skills, abilities, and any other relevant information Referring to the Job Capture Sheet, state why you consider yourself suitable for this job Which of our company values do you identify with the most and why? Have you ever been dismissed from a previous post or had an employment contract terminated for any reason, including redundancy? Yes No If yes, please give details Have you been subject to disciplinary action or safeguarding concerns in your current or any previous posts (including being the subject of any disciplinary / safeguarding process not yet concluded to resignation)? Yes No If yes, please give details Declaration In submitting this application, I declare that I am the person referred to on the form. I confirm that the information I have provided is true, complete and correct. I understand that providing incorrect information or a false statement may lead to withdrawal of any job offer or, if employed, disciplinary action including dismissal. I confirm that I am entitled to work in the United Kingdom and will provide the necessary documentation on request. I understand that any offer of employment will be subject to receipt of two satisfactory references and a satisfactory Disclosure & Barring Service check. Signed (full name) Dated I agree to the information contained in this application being processed under the Data Protection Act 2018 for the purposes of recruitment monitoring and forming part of any contract of employment, and I give my consent for The Mayfield Trust to obtain an enhanced check from the Disclosure & Barring Service. Data Protection: The information you have provided in this form will be used solely for recruitment purposes and will be processed in accordance with current data protection legislation. Submit application If you are having any problems with applying for your chosen role please email: j.keane@mayfield-trust.org.uk Get in touch Office hoursMonday–Friday9am–5pm Phone01422 322552 Emailinfo@mayfield-trust.org.uk
