Employment Application form

Personal Details

Future correspondence


References will be requested as part of the recruitment process and will form part of the decision-making process.

One referee must be your current or most recent employer and both referees must be able to comment on your suitability for the job for which you have applied. Please do not give names of friends or family members. Your referees will be asked for details of any disciplinary action taken against you whilst in their employment. After a conditional offer has been made your referee will be asked for information regarding your sickness absence record during the past 24 months.

Remember to ask your referees for permission before you give their name.

Work History

Please provide a complete record of your employment and other relevant activities, including any part-time, casual or voluntary work. As we are CQC regulated you will need to provide your work history from leaving school. We need details of paid or unpaid employment, and any periods of non-employment e.g. childcare, unemployed, etc. Start with your current or most recent position, ensuring that any gaps are explained. Please give exact names and current addresses of previous employers/voluntary work areas. Please also advise us of any change to your name relevant to previous employment, i.e. known by your maiden name.

We reserve the right to take up references from any previous employers, or places where you have carried out voluntary work.

please provide a phone number and email address if possible.

Relevant skills, experience and behaviours

If you are successful in the shortlisting process and invited for an interview, the panel may choose to ask questions to test the depth of your knowledge and experience on the requirements set out in the job description.

We recognise and welcome our responsibility to remove any barriers in our Recruitment and Selection process for people with disabilities. We have tried to do this, but if you have a disability and identify any barriers in the job description or application form, please tell us of these in your application. We are committed to making reasonable adjustments to the job.

Criminal Convictions

The job for which you are now applying may be subject to a Disclosure and Barring Service (DBS) check.

The Rehabilitation of Offenders Act 1974 provides that certain criminal convictions become ‘spent’ after the passage of time, that is the law will treat them for the most purposes as if they have never happened and it is not necessary to disclose them on application forms.

The Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 contains certain classes of employment where a person can be asked to disclose spent convictions. The job for which you are now applying falls within that order.

However, the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (as amended in 2013) provides that certain spent convictions and cautions are ‘protected’ and are not subject to disclosure to employers and cannot be taken into account.

If you fail to disclose that you have been convicted of a criminal offence or received a caution, reprimand or warning this may lead to dismissal or disciplinary action by Co-operative Care Colne Valley. Any information given will be treated in the strictest confidence and will be considered only in relation to an application for which the order applies.

For details of which criminal convictions must be declared please refer to the government guidance.

It is your responsibility to read this information in full and complete the application form accurately.

For jobs that are subject to a disclosure, please note that a criminal record will not necessarily bar you from employment. This will depend on the nature of the position for which you are applying and the circumstances and background of the offence/s.


Withholding or falsifying information could result in dismissal or disciplinary action.

If you fail to complete this section of the application form, you may not be shortlisted or invited to attend for an interview.

We will treat all information provided on this form in the strictest confidence. You may provide additional information in writing or you may indicate that you wish to discuss in more detail if invited for interview.