1. Online Job Application Form

Please complete as many of the fields as possible and click on the 'Submit' button at the end of the form.

In addition to this form, all applicants are required to complete and submit our Recruitment Monitoring form , Rehabilitation of Offenders statement and a short Health Questionaire in order to complete the job application. You will be automatically directed to these additional forms upon completion of this application.

Job Title

Reference

1. PERSONAL DETAILS

	Mr Mrs Miss Ms Other
Surname
First Name
Address including Postcode
Telephone (home)
Telephone (mobile)
Telephone (work)
Email address

2. CURRENT EMPLOYMENT

Job Title
Name & Address of Current Employer
Present Salary
Date of Appointment
Period of Notice Required

3. BRIEF DESCRIPTION OF CURRENT JOB

Description of Current Job

4. EDUCATION

(up to when leaving full time education)

Secondary School/College/University	Qualification	Grade

5. PROFESSIONAL QUALIFICATIONS & TRAINING

Organisation	From	To	Qualifications	Grade

What training and development opportunities do you think you will need to undertake this role effectively?

6. NON-QUALIFICATION COURSES COMPLETED

(i.e. in-house training at work)

Course	Length of Course	Date

7. MEMBERSHIP OF PROFESSIONAL BODIES

Body	Membership Status	Since

8. ABOUT YOU

Interests and Leisure Activities

9. EMPLOYMENT HISTORY

From	To	Employer Name & Address	Reasons for Leaving	Final Salary

10. REASONS FOR APPLICATION

What are Your Reasons for Applying for This Job?

11. ESSENTIAL INFORMATION

The following questions are linked to the essential requirements for this post, please ensure you answer all of the questions in this section in order for your application to be considered.

Are you willing to support people on a one to one basis in the community, once trained to do so?	YES NO
Are you willing to work shifts as part of a rolling rota, including evenings, some weekends and overnight support?	YES NO
Are you willing to undertake continual training and development as part of your role?	YES NO
Do you hold a current full driving license?	YES NO
Have you held a full UK driving license for one year or longer?	YES NO
Do you own a car that you can use for work?	YES NO
Are you willing to use your car to transport the people you will be supporting in the community?	YES NO
Does your car insurance include insurance for business use?	YES NO
If not, are you prepared to add this to your insurance for the purposes of this role?	YES NO
Do you need a work permit?	YES NO
If yes, do you currently hold a valid work permit?	YES NO Not Applicable

12. SOURCE OF THE APPLICATION

How did you hear of this job opportunity?	If successful, when can you start?

13. REFERENCES

Please give details of three references, two of these should be from your present and/or most recent employer. No reference providers should be related to you.

Please ensure that you include a telephone number and email address for each reference.

Professional/work Reference 1:
Name
Position
Company
Address
Telephone
Email Address
In what capacity does the person know you?

Professional/work Reference 2:
Name
Position
Company
Address
Telephone
Email Address
In what capacity does the person know you?

Professional/work Reference 3:
Name
Position
Company
Address
Telephone
Email Address
In what capacity does the person know you?

References are normally taken up prior to interview. Do you have any objections to this?

YES NO

14. Are you related to a Nexus-support employee or service user?

If so, please include the following information:

Name
Relationship

15. Preferred work duration

What type of work are you looking for? Full Time Part Time

Approximately how many hours a week are you seeking to work?

16. DECLARATION

I hereby declare that to the best of my knowledge, the statements provided in this application are true. I accept that any deliberate miss-statement made may result in dismissal, if engaged.

Please type your full name in the box below	Date

Clicking on the button below will submit your Job Application to Nexus-Support and take you to the Recruitment Monitoring Form which all applicants are required to complete and submit.