Application for Employment

PRIVATE & CONFIDENTIAL Please complete in BLOCK CAPITALS

A. ABOUT THE VACANCY

Position Applied for:

How did you hear of this vacancy?

B. PERSONAL PARTICULARS

Full Name: Mr/ Ms/ Mrs/ Miss

Forename:

Surname:

Address:

Postcode

Home telephone no: Mobile:

Business:
(Tick box if you do not want to be contacted at work).

E-mail address:

Do you have the right to work in the United Kingdom? Yes/No

Do you have another job? Yes/No

Are you claiming any benefits? Yes/No

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 C. EDUCATION AND QUALIFICATIONS

University/College/ Dates Subjects Studied Qualifications

schools Institute Type of Training Obtained
Attended
From To

Professional Associations: Please state whether you are a member of any technical or
professional association, and if so which:

Foreign Languages: Please list any foreign languages you speak and your level of
competence, both oral and written:

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 D. EMPLOYMENT HISTORY
Please list starting with the most recent, all the organizations for which you have worked
previously:

Name(s) and Address(es) of Dates Position Held/ Reason for Leaving

Employer(s) Main Duties
From To

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Please give details of any experience, skill or achievements which you feel may be relevant in your
application for employment. (Continue on separate sheet if necessary).

E. SUPPLEMENTARY INFORMATION

Have you ever been convicted of a criminal offence: (which is not a spent conviction Yes / No
under the Rehabilitation of Offenders Act 1974 as modified by the Legal Aid, Sentencing
and Punishment Act 2012).If yes, please give details:

Are you currently subject to any contractual "restraints of trade" clauses?

If yes, please give details:

Yes / No
Do you have any commitments which might limit your working hours?

If yes, please give details:

Yes / No
Are you willing to work overtime and weekends when required?
Yes / No
Have you worked for us before? If yes, please provide reasons for leaving:

Yes/No

F. LICENCE INFORMATION

Do you have a current full driving license? Yes/No

Any current endorsements? If yes, give details. Yes/No

Any motoring prosecutions pending? If yes, give details. Yes/No

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 G. OTHERS
Please give the names and addresses of two referees who are not related to you, who we
can approach for a confidential assessment of your suitability for this job. (One of these
must normally be a previous employer).
Can we approach your present/most recent employer?Yes / No

Reference 1 Reference 2

Name: Name:

Position: Position:

Address: Address:

Post code: Post code:

Telephone: Telephone:

Email: Email:

Do we need to make any disability-related adjustments to allow you to take part in the
recruitment process?

If you obtained this position, would you continue in any other employment: Yes/No

How much notice are you required to give to leave your present employment?

What is your expected salary range?

DECLARATION OF APPLICANT

 I authorise Seva Care to obtain references to support this application once an offer has
been made and accepted and release Seva Care and referees from any liability caused
by giving and receiving information.

 I confirm that the above information is correct. I understand that any job offer made on the
basis of untrue or misleading information may lead to rejection or, if employed, dismissal.

 I understand the Organization will use and keep information I have provided on this
application or elsewhere as part of the recruitment process and/or personal information
supplied by third parties such as references, relating to my application or future
employment. I understand that the information provided will be used to make a decision

regarding my suitability for employment and if successful the information will be used to

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 form my personnel record and will be retained for the period set out in the Organization’s
employee privacy notice.

 I am aware that It is Seva Care’s policy to employ the best qualified personnel and
provide equal opportunity for the advancement of employees including promotion and
training and not to discriminate based on race, gender, religion, national origin, physical
or mental disability, age, sexual orientation, and gender identity by employers

Signed: Dated:

FOR OFFICE USE ONLY INTERVIEW RECORD

Interviewed by: Date:

Interviewer’s report and reasons for decision as indicated below:

Decision: (Tick as applicable)

Accept________ Reject________ Further Interview__________

Rejection letter sent: Yes/No

APPOINTMENT RECORD (To be completed where there has been an offer of

employment).

Right to work in UK status? Yes/No

Appropriate documentary evidence checked.

CONDITIONAL OFFER LETTER REQUESTS FOR REFERENCES

Date sent: Date sent:

Response: Response:
Acceptance/Refusal/No reply Good/Satisfactory/No
Reply/Suspect/Unsuitable

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 Reference Checking Consent and Authorization Form

Disclosure

Please read the information on this form carefully and completely.

I have applied for employment with The Seva Care Group (UK) Ltd and have provided information
about my previous employment. I authorize Seva Care to conduct a reference check with my
present and/or previous employer(s). I understand that reference information may include, but not
be limited to, verbal and written inquiries or information about my employment performance,
professional demeanor, rehire potential, dates of employment, salary and employment history.

My signature below authorizes my former or current employers and references to release

information regarding my employment record with their organizations and to provide any
additional information that may be necessary for my application for employment to The Seva Care
Group (UK) Ltd. I knowingly and voluntarily release all former and current employers, references,
and Seva Care Group from any and all liability arising from their giving or receiving information
about my employment history, my academic credentials or qualifications, and my suitability for
employment.

I further authorize the Seva Care Group to obtain feedback and references from my supervisors
over the course of my employment with the Seva Care Group. I understand that subsequent and
continued employment with the Seva Care Group may be subject to this feedback. This form may
be photocopied or reproduced as a facsimile, and these copies will be as effective as a release or
consent as the original which I sign.

Name: ____________________________________

Signature: _____________________________________

Date: _____________________________________

Cell Phone: ______________________________________

Alternate Phone: ______________________________________

Email Address: ______________________________________

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