Employment application

Section 1. Personal Details

Section 2. Health

Section 3. Criminal Convictions

If the post you are applying for is patient facing this post is exempt from the provisions of the Rehabilitation of Offenders Act 1974 (Exemptions) Order 1975. You must therefore disclose any criminal convictions, however long ago these occurred, if the application is to proceed.

The appointment to some Farleigh Hospice posts will be made subject to enhanced Disclosure and Barring Service (DBS) Check. The accompanying documentation for the post confirms if a DBS check is required.

Section 4. Education, Qualifications and Professional Memberships.

Please tell us about your qualifications, any professional body membership, and any relevant vocational training.

Qualification 1
Qualification 2
Qualification 3
Professional bodies

Section 5. Present/Last Employer

Section 6. Previous Employment

Please provide details of your previous employment, (minimum 3 years), beginning with the most recent.

Employer 1
Employer 2
Employer 3

Farleigh Hospice will collect, store and use the information provided by you on this application form for recruitment and selection purposes. You have the right to ask to see this data if you wish.

Section 7. Your Suitability for the Position

Section 8. Declaration

I declare that the information which I have given in this application form is true and complete. I understand that if it is subsequently discovered that any statement is false or misleading, this may lead to dismissal from employment with Farleigh Hospice.

Section 9. References

Please give the names of two people who are able to provide references relating to your work experience and your suitability for the post applied for. One referee should be your current or most recent employer. References from family or friends are NOT acceptable.

Reference 1
Reference 2

I give consent for Farleigh Hospice to approach my nominated referees

Section 10. Equal Opportunities

To help develop and implement our Equal Opportunities Policy all applicants are requested to answer the following questions. This information will be used solely for monitoring purposes and treated as confidential. It will be separated from your application form on receipt and before consideration of candidates takes place.

Ethnic Origin

How would you describe your ethnic origin? (ethnic categories based on 2001 census)

Sexual Orientation
Date of Birth