Application Form

To apply for a job with EACH, please complete our application form...

Please fill in the details below and click on 'Submit'.

IMPORTANT - PLEASE NOTE:

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PERSONAL DETAILS
	Post applied for *	Please include the exact job title as per the job description
	Title *
	Surname *
	Forename(s) *
	Address *
	Postcode *
	Email *
	Daytime Telephone Number *
	Evening telephone number (if different)
	Do you have a current driving license? *
	Do you have the use of a car? *
	Do you need a work permit to work in the UK? *
	National Insurance Number
EDUCATION
	Please list the secondary schools you attended
	1: Name of secondary School *
	1: Dates from/to
	1: Qualifications attained (including grades)

	Please list the colleges and universities you attended
	1: Name of college/university
	1: Dates from/to
	1: Subjects taken and qualifications attained

	Membership of Professional Bodies (include NMC Registration where applicable)
	Date of qualifying
	PIN No/Membership No
	Expiry
	Other training/special courses etc. Include dates where appropriate
EMPLOYMENT HISTORY
	Please list your current or most recent employer first, and include temporary posts.
	1: Name and address of employer
	1: Date from and to
	1: Job title and duties
	1: Final salary and reason for leaving

	Notice required in current post
REFERENCES
	Please provide the names, full addresses and phone numbers of two persons from whom we may obtain WORK experience references (including current/most recent employer)
	Name *
	Job title
	Organisation
	Address
	Email
	Telephone number *
	Relationship
	Second Reference
	Name *
	Job title
	Organisation
	Address
	Email
	Telephone number *
	Relationship
EXPERIENCE/SKILLS/ABILITIES
	Please attach a Word document of not more than 2 typed pages, giving your reasons for applying for this post and tell us how your experience, skills and qualifications meet the requirements of the post. Please supply any additional information which you feel might support your application. You may draw on experiences from your personal life such as voluntary work or work in the home.

REHABILITATION OF OFFENDERS ACT 1974 (EXCEPTIONS ORDER 1975)
	As East Anglia’s Children’s Hospices meets the requirements in respect of exempted questions under the Rehabilitation of Offenders Act 1974, all applicants who are offered employment will be subject to a criminal record check (Enhanced Disclosure) from the Criminal Records Bureau before the appointment is confirmed. This will include details of cautions, reprimands or final warnings, as well as convictions. Having a conviction will not necessarily bar you from employment. This will depend on the circumstances and background to your offence(s). Your answer to the following question should therefore include any “spent” convictions or cautions.
	Have you ever been convicted of a criminal offence or had any police cautions? *
	If YES, please give details
DECLARATION
Please read this carefully before checking the box below
	I confirm that the above information is complete and correct, and that any untrue or misleading information will give the employer the right to reject my application, to withdraw any employment contract offered or, if employed, to dismiss without notice. I agree that the information provided in this application may be processed by the employer in relation to my application for this post to assist in the decision making process. I further expressly agree that, should it be necessary to validate any of the information provided herein, the employer may release this information for verification purposes. If successful in my application, it is agreed that any information provided will be retained by the employer in a secure confidential file and the contents only used for necessary business purposes subject to my express consent for disclosure where necessary.
	I confirm that all the information provided in this application is accurate and correct and has been completed by myself. I acknowledge that I have read and agree with the above declaration, and the policies that accompany this application. *

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