Post applied for:

Please let us know which post you wish to apply for:

Personal details (Part A)

Please provide your personal details below:

References

Please give names, addresses and telephone numbers of two people who can provide references for you. They must be your last two employers. If you are not currently in employment please see the enclosed guidelines on completing this form. Carers Trust reserves the right to contact other previous employers. We do not approach referees until after interview.

Details for Present/Previous Employer #1 (Required)

Details for Present/Previous Employer #2 (Required)

Rehabilitation of Offenders Act 1974 and Exception Order 1975

Because of the nature of the work for which you are applying, you must provide information about any criminal record. This includes convictions, cautions, reprimands and warnings. Our power to require this lies in the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 which removes the normal operation of the Act in relation to specific occupations, including the provision of home care services. In the event of being employed in connection with this application, any failure to disclose such convictions could result in dismissal or disciplinary action. The amendments to the Exceptions Order 1975 (2013) provide that certain spent convictions and cautions are 'protected' and are not subject to disclosure to employers, and cannot be taken into account. Guidance on criteria on the filtering of these cautions and convictions can be found on the Disclosure and Barring Service website.

Do you have any convictions, cautions, reprimands or final warnings that are not 'protected' as defined by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (as amended in 2013)?

If you do have any previous or outstanding convictions, cautions, reprimands or final warnings, you will only be asked to supply details of the type of offence, date, sentence, fine etc if you are invited for interview. Please see guidelines on completing the application form for further details.

Declaration

I declare that all the information I have given on this application form is true and accurate, to the best of my knowledge. Please note that if you give untrue or inaccurate information any employment contract may be invalidated and the employee subject to disciplinary action or dismissal.

Section A will be detached from your application. All short listing will be carried out on a completely fair basis with Equal Opportunities Legislation and Policy.