Application Form Please complete the short application form below… 1Page 1 2Page 23Page 34Page 4 Thank you for applying to join The Myton Hospices, please fill in the form below, there will be an optional page at the end - if you wish not to provide this information you will still need to submit your form at the bottom of this page. Role you are applying for is {role_title} Step 1: Personal Details Title* Mr Mrs Miss Ms Dr First name* Surname* Email* Mobile number*Please enter your postcode and select your address* Address line 1* Address line 2 Address line 3 City / Town* County Postcode* Step 2: Skills and Experience Please outline your experience and skills relevant to the position for which you are applying. Please expand on your previous employment and highlight any information which demonstrates your suitability. Refer to the job description and person specification.Please upload your most recent CV* Drop files here or Select files Max. file size: 5 MB. Skills and Experience, please outline why you would be suitable for this role* Step 3: Current or Most Recent Employer Please provide the names and addresses of your current employer as detailed below. Also, one additional reference. Both will need to have consented to be approached on our behalf. No approach will be made to your present or previous employers before an offer of employment has been made.Are you currently in employment?* Yes No Please let us know what you have been up to in the last six months*Current or Most Recent Employer Current or most recent employer name* Current or most recent line manager* Current or most recent line manager contact number* Current or most recent line manager email* Position held* Current salary (£)* Start date DD slash MM slash YYYY End date DD slash MM slash YYYY Reason for leavingReference 2 Employer name* Line manager* Email* Contact number* Position held Current salary Start date DD slash MM slash YYYY End date DD slash MM slash YYYY Do you hold a full valid driving licence, which enables you to drive in the UK?* Yes No Do you have access to a car during working hours?* Yes No Where did you hear about this vacancy?* Charity Jobs website Facebook Friend or colleague Google Indeed website Instagram Linkedin Local advertising / paper Myton’s website Newspaper / Magazine NHS Jobs website Other Other website Third Sector Jobs website Twitter Please tell us where* Step 4: Rehabilitation of Offenders Act 1974 and Declaration Because of the nature of the work for which you are applying, some of our posts are exempt from the provisions of Section 4 (2) and 4(3)(b) of the Rehabilitation of Offenders Act 1974 by virtue of the Rehabilitation of Offenders Act (Exemptions) Order 1975. Applicants for some posts, therefore are not entitled to withhold information about convictions, which for other purposes are ‘spent’ under the provisions of the Act. In the event of employment, any failure to disclose such convictions or other sanctions could result in dismissal or disciplinary action being taken by the Hospice. If employed you are also under a continuing duty to disclose such sanctions. For more information about posts that are not exempt from the provisions please contact the HR department. Any information given will be completely confidential. Have you ever been convicted of any criminal offence required by law to be disclosed, been bound over or received a Police caution in the UK, or a criminal conviction in any other country?* Yes No Please give details*Are you currently the subject of any Police investigation and/or prosecution in the UK or any other country?* Yes No Please give details*DeclarationI confirm that to the best of my knowledge the information and the responses I have given are correct. I consent to the Hospice using and keeping information I have provided in this application I understand that the information provided will be used to make a decision regarding my suitability for employment Click here for a full description of the terms and conditions that apply to your application* I confirm Your privacy We promise to do our best to keep your details safe and secure and will only process your data in accordance with the current Data Protection legislation. Our Privacy Policy explains how we keep this promise and you can read more online at www.mytonhospice.org/privacy-policy If you change your mind about hearing from us please email DSCT@mytonhospice.org or call us on 01926 358383. I have read and accept The Myton Hospices Privacy Policy* I accept
