Application Details

Location

Have you previously applied for a position in our organisation?YesNo

If Yes, please tell us the role you applied for and date of application:

Have you previously worked for Horizon Care & Education?YesNo

If Yes, please provide details of role and dates of employment:

Have you been referred for the role by a Horizon colleague? (our ‘Refer-a-Friend’ scheme)YesNo

If Yes, please give the name of the colleague as they may be entitled to a scheme payment:

Personal Details

Title:MrMrsMiss
Other Title:

Surname

Forename(s)

Known As

Date of Birth

Previous Names (if applicable)

Home Address and Postcode

Daytime Contact Number:

Evening Contact Number:

Email Address:

Do you have the legal right to live and work in the UK?YesNo

National Insurance number:

Driver Information

What type of driving license do you hold?NoneFullProvisional

If you have a provisional license, are you learning to drive?YesNo

If applicable, please detail any points and/or driving convictions including dates:

Other Employment

Will you have any other employment if you came to work for Horizon (inc. bank/ agency)?YesNo

If Yes, please give details:

Working Patterns (residential care homes only) - Please tick/complete as appropriate
Are you available to work 24-hour shifts including sleep-ins?YesNo

Are you available to work weekends and bank holidays?YesNo

Are you available to work flexibly and demonstrate a high level of commitment?YesNo

Are there any limitations on your ability to work flexibly?YesNo

If Yes, what are they?

Are there any limitations if you were asked to extend your shift?YesNo

If Yes, what are they?

Employment History - It is very important that you complete this section fully

Please begin with most recent, giving details of any gaps in employment of more than 1 month and the reasons for these, indicating if any of your roles involved working with children or vulnerable adults (i.e., you worked in ‘regulated activity’ requiring a DBS check), including any voluntary work you have undertaken. A full history is required (including months and years), from leaving secondary education to the present.

1. Name, Address, email & phone number of Employer

Job Title and Brief Outline of Duties

Dates (Month and year are required)
From

To

Reason for Leaving (please ensure any gaps in employment are detailed below)

Worked with children or vulnerable adults?YesNo

2. Name, Address, email & phone number of Employer

Job Title and Brief Outline of Duties

Dates (Month and year are required)
From

To

Reason for Leaving (please ensure any gaps in employment are detailed below)

Worked with children or vulnerable adults?YesNo

3. Name, Address, email & phone number of Employer

Job Title and Brief Outline of Duties

Dates (Month and year are required)
From

To

Reason for Leaving (please ensure any gaps in employment are detailed below)

Worked with children or vulnerable adults?YesNo

4. Name, Address, email & phone number of Employer

Job Title and Brief Outline of Duties

Dates (Month and year are required)
From

To

Reason for Leaving (please ensure any gaps in employment are detailed below)

Worked with children or vulnerable adults?YesNo

5. Name, Address, email & phone number of Employer

Job Title and Brief Outline of Duties

Dates (Month and year are required)
From

To

Reason for Leaving (please ensure any gaps in employment are detailed below)

Worked with children or vulnerable adults?YesNo

Living/Working Overseas

Have you lived or worked outside the UK for more than 3 months in the last 10 years?YesNo
If yes, please provide details below:

1. Date From

Date To

Country

Reason

2. Date From

Date To

Country

Reason

3. Date From

Date To

Country

Reason

Vocational Qualifications: Do you hold any of the following qualifications?

Are you a qualified teacher?YesNo

If yes, what is your DfE no.:

NVQ / QCF Level 3 Diploma for the Children’s and Young People’s WorkforceYesNo

NVQ Level 4 HSC (CYP Pathway) plus Registered Managers AwardYesNo

QCF Level 5 Diploma in Leadership for Health and Social Care, Children and Young People’s ServicesYesNo

Education, Qualifications and Training (Please list in chronological order (starting with most recent)

If you are applying for a role as a Registered Manager, please ensure your full relevant qualifications are stated (i.e. NVQ/ GCSEs etc)
1. Course Title

Qualification

Place of Study

Start Date

End Date

2. Course Title

Qualification

Place of Study

Start Date

End Date

3. Course Title

Qualification

Place of Study

Start Date

End Date

4. Course Title

Qualification

Place of Study

Start Date

End Date

5. Course Title

Qualification

Place of Study

Start Date

End Date

Additional Information

Are you subject to any current or outstanding disciplinary procedures?YesNo

If yes, please provide details:

Have you ever had action taken against you by an employer or an authority regarding children under 18 years old?YesNo

If yes, please provide details:

If you are applying for a Registered Manager position, and have been registered with Ofsted or the CQC, please provide details of the URN for each home you have been registered at below:

Please include your achievements to date, any relevant knowledge, skills and experience and strengths you would bring to the role.

Please detail any leisure interests, sports and hobbies or other pastimes.

References

Please include below the name, status, address and telephone number of two referees, one of whom must be your current or most recent employer.
Note: As the role involves unsupervised access to children, we reserve the right to approach any past employer for a reference.
Information requested will include details of your past absences, performance, disciplinary records, reason for leaving and suitability to work with children and young people.

1. Current / Most Recent Employer and Name of Line Manager

Name and position:

Address:

Telephone Number:

Mobile Number:

Email Address:

Can we contact this person prior to interview for a reference?YesNo

2. Previous Employer and Name of Line Manager

Name and position:

Address:

Telephone Number:

Mobile Number:

Email Address:

Can we contact this person prior to interview for a reference?YesNo

DBS Check Information – for posts involving ‘Regulated Activity’ with Children

Rehabilitation of Offenders Act 1974: The post for which you have applied is exempt from the provisions of the Rehabilitation of Offenders Act 1974 and an Enhanced (Children’s and Adults Workforce) DBS with Children’s Barred List check will therefore need to be carried out if you are offered employment. If you are shortlisted for interview, you will be asked to complete a criminal records self-disclosure form.

Do you hold a DBS Certificate, dated within the last 12 months?YesNo

Are you subscribed to the DBS Update Service?YesNo

If YES, please provide the following:
Issue Date:

Certificate Number:

Applicant Declaration

I confirm that I have read, understood and have truthfully answered the above questions and that everything else in this application (including any additional pages) is, to the best of my knowledge, accurate and correct.

Name:

Date:

Data Protection: This form will be detached and will not be seen by the selection panel. Information in this application will be kept confidentially by Horizon Care and Education Group and used for the exclusive purposes of recruitment and employment. If you are unsuccessful, your personal data will normally be destroyed after 1 year. If you are successful, the data will be retained both for the duration of your employment and for a period after in line with our retention and disposal schedule. . By submitting this form, you are giving your consent to the processing of your personal data in the ways described above.
Job Applied For:

Date of Birth:

Age:

Name:

Date: