Employment application

This form matches our official Medhealth Employment Application document. Please complete every section honestly. We cannot accept CVs alone in place of this form.

Medhealth Care and Support Ltd, Brampton House Business Centre, 10 Queen Street, Newcastle-under-Lyme ST5 1ED. Tel: 07984 388 946

Complete in full using clear block capitals where possible. This form will be kept in confidence. No applicant will be unfairly discriminated against, including on account of age, cultural, religious or political beliefs, disability, ethnicity, gender, race, relationship status, sexual orientation, or Trade Union membership or stewardship.

If you need support to complete this form (for example large print or extra time), contact the Registered Manager on 07984 388 946.

Use Submit application at the end of the form to send your answers securely. A copy is emailed to our team at info@med-health.co.uk (or the address set in site email settings). You can print or save as PDF first if you want a copy for your records.

Position Position applied for Preferred employment type (e.g. part time, full time)

Personal details

Surname

First name(s)

Current address

Postcode

Telephone (home)

Telephone (mobile)

Email address

Do you drive?

Yes No

Details

Are you a United Kingdom (UK), European Community (EC) or European Economic Area (EEA) national?

Yes No

If no, please detail current immigration status and the relevant visa held (including visa number) National Insurance number

Are you related to a member of staff or a service user at Medhealth Care and Support Ltd?

Yes No

If yes, give details

Equality Act 2010

Under the Equality Act 2010, a disability means a physical or mental impairment that has a substantial and long-term adverse effect on your ability to carry out normal day-to-day activities. Further information: Definition of disability (GOV.UK).

For this application and interview only, is there anything we should know so we can make reasonable adjustments?

Yes No Prefer not to discuss

Details (optional)

Education

All qualifications will be subject to a satisfactory check.

School / college / university — qualifications gained and year Further qualifications (optional)

Training courses attended or completing

Evidence of attending courses may be required.

Subject, location or details, dates

Employment history

Record your full employment history beginning with your current or most recent employer. Use a separate sheet if required and sign any extra sheet(s).

Employer 1 (most recent)

Name and address

Start date

End date

Nature of business Position held and reason for leaving Salary / rate

Employer 2

Name and address

Start date

End date

Nature of business Position held and reason for leaving Salary / rate

Employer 3

Name and address

Start date

End date

Nature of business Position held and reason for leaving Salary / rate

Please detail any gaps in employment and state why

Supporting statement

Explain why you are applying. Refer to the job description and person specification. Describe strengths, skills from work, home and other activities that set you apart.

Your statement

Referees

You must provide references from your two most recent employers. If you cannot obtain two professional references (for example after a long period raising children), provide a character reference and discuss with us. All referees will be contacted — please tell them you have named them.

Current or most recent employer (referee)

Name

Job title

Address

Postcode

Tel

Previous employer (referee)

Name

Job title

Address

Postcode

Tel

Character reference (if used instead of a second employer)

Name

Relationship to you

Address

Postcode

Tel

Safeguarding — ex-offenders declaration

This section is seen only by those involved in recruitment and is treated in strict confidence.

Medhealth Care and Support Ltd promotes equality of opportunity and treats all applicants fairly regardless of ethnicity, disability, age, gender or gender reassignment, religion or belief, sexual orientation, pregnancy or maternity, and marriage or civil partnership. We undertake not to discriminate unfairly on the basis of a criminal conviction or other declared information. Answering “yes” below does not necessarily prevent employment — it depends on the nature of the role and your circumstances.

Are you currently bound over, or do you have any current unspent convictions from a court or court-martial in the UK or elsewhere?

Yes No

If yes, give details

Do you have any current unspent police cautions, reprimands or final warnings in the UK or elsewhere?

Yes No

If yes, give details

Privacy

Medhealth Care and Support Ltd collects data only for explicit, legitimate recruitment purposes. By signing below you consent to us holding the information in this application. If you are shortlisted, data may also include shortlisting scores and interview records. We retain data until the vacancy is filled; after that we delete it or ask whether you wish us to keep it for future roles. Data is stored securely. You have rights to access, rectify, erase, restrict processing, withdraw consent, and to be informed about processing. To discuss this or withdraw consent, contact the Registered Manager or Nominated Individual on 07984 388 946. Privacy policies are available on request.

Declaration

The information in this application is true and complete. I understand that any deliberate omission, falsification or misrepresentation may lead to rejection or, if employed, dismissal. Where applicable, I consent to Medhealth Care and Support Ltd seeking clarification of professional registration details.

Name (print)

Date

Signature (type your full name if submitting electronically)

This form uses automated spam filters. Your application is emailed to our recruitment inbox (same default as our contact form). See our privacy policy.