Job application

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Date

Confidential Application Form

Protecting your data

St Nicholas Hospice Care will only ever use your data in relevant and meaningful ways to you.

You can learn more about data protection and change your preferences at www.stnicholashospice.org.uk/yourdata.

Are you currently employed by St Nicholas Hospice Care?*

Yes
No

Post applied for

Upload your CV

Max. file size: 100 MB.

We will base your application on the information you provide in this form, however, if you would like to upload a CV, then please do so here.

Personal details

Title

Name

First Last

Known as

National Insurance number

Email address*

Address

House name/number and street Address Line 2 Town County Post code Country

Telephone number

References

Please give the name of two people who are able to provide references relating to your work experience and your suitability for the post applied for. One referee must be your current or most recent line manager or HR department. You should not include close relatives.

Reference one

Name

First Last

Position

Relationship to applicant

Company name

Telephone number

Email

Reference two

Name

First Last

Position

Relationship to applicant

Company name

Telephone number

Email

Please note that any offer of employment is subject to the receipt of satisfactory references.

Education and training

Secondary education

Name of school and location

Examinations

Subjects, grade and date obtained

From

To

Further education and training

University/College name and location

Subject qualification

Grade/Class, date obtained

From

To

Professional/vocational qualifications

College/Institute or other body

Subject and qualification/level

From

Date

Current studies

Brief description

Is the course full or part time?

When will the course be completed?

Other training courses attended

Including short courses/work place training

Course title

Organising body

From

To

Membership of professional or statutory body

Details

Registration number

First registration date

Renewal date

Current or most recent employment

Name of employer

Nature of business

Website

Position held

Please summarise your current responsibilities, including staff management and budgets

Date started

Date left (if relevant)

Working hours

Salary

Reason for wishing to leave/leaving

Period of notice (if current post)

Employment history

Start date	End date	Employee name and nature of business	Position held	Hours	Reasons for leaving	Salary

Please provide a minimum of three years' employment history.

Relevant skills and experience - Support statement

Please set out briefly how your expertise and experience match the requirements for this post, using the role profile to assist you. To make your application stand out, take a little time to think about why you are applying and what you can bring to the post. Think about unpaid/voluntary work you may have done; this can be just as valuable as paid work. Please give examples of when you have used specific skills and experience. Do not just provide a list.

Supporting statement

Additional information

Do you have the right to work in the UK?

Yes
No

Further comment

Transport

Do you have a current driving licence?

Yes
No

Do you have any points on your licence? If so, how many?

Do you have use of a car and are you willing to use it for business purposes?

Yes
No

Past disciplinary

Have you ever been the subject of, or connected with a disciplinary investigation with your current or previous employer?

Yes
No

If yes, please give details including outcome(s)

Disability requirements and equal opportunities

It is important that this section is completed if you have a disability so that we can provide assistance to help you with your application and future employment as necessary and as applicable:

Do you consider yourself to have any disabilities which may affect your application?

Yes
No

Please describe such disabilities below, providing details of:

Any reasonable adjustments which you feel should be made to the recruitment process to assist you in your application for the role. Any reasonable adjustments which you feel should be made to enable you to carry out the role.

Equality

St Nicholas Hospice Care is committed to providing equality of opportunity to all applicants. To ensure that our equal opportunities policies are operating effectively, we routinely monitor those who apply to us for employment. To do this, the Hospice would be grateful if you would answer the following questions (if you choose not to answer these questions your application will not be affected). Thank you for your help. This information will not be passed to those making short-listing or selection decisions.

Gender

Male
Female
Other
Prefer not to say

How would you describe your ethnic origin?

White

British
Irish
Other

Mixed background

Asian & White
Black African & White
Black Caribbean & White
Other

Asian / Asian British

Bangladeshi
Indian
Pakistani

Black / Black British

African
Caribbean
Other

Chinese / Chinese British

Chinese / Chinese British
Other

What is your age?

How did you find about this vacancy?

e.g. Bury Free Press, website, local newspaper, social media, recruitment sheet etc.

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Protecting your data

St Nicholas Hospice Care will only use your data to inform you about general news, further support, and information about our services - to contact you, we may use post, email, telephone, or SMS.

You can learn more about data protection, changing your preferences or stopping contact at www.stnicholashospice.org.uk/yourdata or by picking up the phone and speaking with our Supporter Care team on 01284 715566.

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Phone

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Job Application

Confidential Application Form

Personal details

References

Reference one

Reference two

Education and training

Secondary education

Further education and training

Professional/vocational qualifications

Current studies

Other training courses attended

Membership of professional or statutory body

Current or most recent employment

Relevant skills and experience - Support statement

Additional information

Transport

Past disciplinary

Disability requirements and equal opportunities

Equality

How would you describe your ethnic origin?

Protecting your data

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