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Options Group is committed to Safer Recruitment

APPLICATION FORM
Please complete this application form in full either:
by printing and completing in black ink before returning to the address provided in the cover letter/email.
Or
by completing electronically before returning via email to the contact details provided in the cover letter/email.
JOB DETAILS

Position applied for:


Service:


Where did you hear about this position?


PERSONAL DETAILS
Title:
First name(s):
Last name:
Any previous names:
Address:
Postcode:
Telephone:
Mobile:
Email:
National Insurance Number:
Have you the right to work in the United Kingdom? Yes No

Do you have a work permit or visa to work in the UK? Yes No

Do you have a current full driving licence? Yes No

Do you have access to a car to use for work if needed? Yes No

Have you worked for this Service as an agency worker? Yes No

If yes, please state who and at what Service:

OFFICE USE ONLY
Date application received:
Yes No
Shortlisted:

Application code:
Date of interview:
Yes No
Attended:
Offered:
Accepted:

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Options Group is committed to Safer Recruitment
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Options Group is committed to Safer Recruitment


EDUCATION DETAILS
Dates Name and location of
secondary schools, colleges
and university
Qualifications and grades
obtained From
dd/mm/yy
To
dd/mm/yy







RELEVANT TRAINING & QUALIFICATIONS
Details of training course/qualification and Awarding Body Date attended course/obtained qualification







RELEVANT MEMBERSHIPS
Please state details of any professional
registration or membership including number,
date of issue and expiry



Please note you will be asked to provide original certificates of any qualifications or memberships should you be
invited to attend an interview



OFFICE USE ONLY

Application code:

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Options Group is committed to Safer Recruitment
EMPLOYMENT HISTORY

Please provide details of your full employment history, including temporary and voluntary work since leaving
secondary education. Please note that we may contact any previous employer to confirm the details given.


Current or most recent employer:

Company Name:
Address:
Job title:
Main duties:
Start date:
Leaving date:
Reason for leaving:
Notice period / Availability:


Previous employers:

Company Name:
Address:
Job title:
Main duties:
Start date:
Leaving date:
Reason for leaving:

Company Name:
Address:
Job title:
Main duties:
Start date:
Leaving date:
Reason for leaving:

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Options Group is committed to Safer Recruitment
Company Name:
Address:
Job title:
Main duties:
Start date:
Leaving date:
Reason for leaving:

Company Name:
Address:
Job title:
Main duties:
Start date:
Leaving date:
Reason for leaving:

Company Name:
Address:
Job title:
Main duties:
Start date:
Leaving date:
Reason for leaving:

Please continue on a separate sheet if required






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Options Group is committed to Safer Recruitment
GAPS IN EMPLOYMENT, EDUCATION & TRAINING
Please explain and give reasons for any gaps below

Date from: Date to: Explanations and reasons for gaps




OFFICE USE ONLY:
Exploration notes for gaps



Exploration notes for reason for leaving



Any other anomalies or discrepancies




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Options Group is committed to Safer Recruitment
SUPPORTING STATEMENT
In this section you must evidence how you meet the criteria for this position as detailed in the covering letter or email.
Criteria 1:



Criteria 2:



Criteria 3:


































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Options Group is committed to Safer Recruitment
REFERENCES
Please give details of two referees, including your current or most recent employer. Relatives or people writing solely in
the capacity of friends cannot act as referees.

If you are applying for a care or education position and not currently working within these sectors please provide an
additional referee from the last place you worked in care or education (using the reference three box).

Any offer of employment will be subject to receipt of satisfactory references.

REFERENCE ONE CURRENT OR MOST RECENT EMPLOYER
Name of referee:

Company name:
Address:

Postcode:
Tel. No.: Fax No.:
Email:

For education positions only:
Permission to contact before interview?
Yes No

If no, please state reasons:

REFERENCE TWO

REFERENCE THREE
Name of referee Name of referee:


Company name:



Company name:


Address:

Address:
Tel. No.: Tel. No.:


Fax No.:

Fax No.:
Email:

Email:
For education positions only:

For education positions only:

Permission to contact
before interview?

Yes

No






Permission to contact before
interview?

Yes

No





If no, please state reasons:


If no, please state reasons:


OFFICE USE ONLY:
Exploration notes for references





DECLARATION OF CRIMINAL RECORDS
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Options Group is committed to Safer Recruitment

The nature of the work for which you are applying means that this position is exempt from the provisions of the
Rehabilitation of Offenders Act 1974. Therefore, you must declare any convictions, cautions, reprimands, warnings and
bind-overs, including any that would otherwise be regarded as spent. Motoring offences, except for parking offences,
should also be declared. You must also disclose any charges which are or may be pending.
It is important to note that having a criminal record does not necessarily bar you from employment as decisions are
made taking the full circumstances into consideration.

I understand that work at Options Group is exempt from the Rehabilitation of Offenders Act 1974 and I declare the
following (please tick the appropriate box/es):




I have nothing to declare regarding my criminal record
Details of any current motoring offences:


I confirm that I am not registered as barred from working with children or vulnerable adults or subject to sanctions
imposed by a Regulatory Body

Declaration of any criminal record:



Conviction (spent)

Conviction (unspent)

Conviction pending


Caution/Reprimand(s)

Warning/Bind-over(s)



I am barred from working with children or vulnerable adults or I am subject to sanctions imposed by a Regulatory
Body

If any declaration is made above and you are offered an interview you will be asked to provide full details of them using
a Disclosure of Criminal Record Form which will be sent to you separately.

Any offer of employment will be subject to receipt of a satisfactory enhanced DBS disclosure.

Please sign and date below
If applying online should you be successfully invited to interview you will be asked to sign a printed copy of this declaration in
person.


SIGNATURE: DATE:

OFFICE USE ONLY:
Applicant to sign and date printed copy at interview.


SIGNATURE: DATE:










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Options Group is committed to Safer Recruitment
APPLICATION DECLARATION
I declare that the information contained in this form is accurate, true and complete.
I understand that giving false or misleading information will disqualify my application, or if discovered after appointment
may be regarded as grounds for dismissal.
I agree to the information I have provided (including any additional information submitted) being used for the purpose of
processing my application, in connection with my employment (if my application is successful) and for monitoring the
efficiency of the recruitment and other employment procedures.
I understand that Options Group reserve the right to validate all information I have provided and may retain this
information for a reasonable period of time following my application.

I will inform Options Group of any criminal records including motoring offences after the date of my application.

Please sign and date below
If applying online should you be successfully invited to interview you will be asked to sign a printed copy of this declaration in
person.


SIGNATURE: DATE:
OFFICE USE ONLY:
Applicant to sign and date printed copy at interview.


SIGNATURE: DATE:




























EQUAL OPPORTUNITIES MONITORING FORM
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Options Group is committed to Safer Recruitment

In accordance with its Equality Policy, Options Group will provide equal opportunities to all staff members and job
applicants and will not discriminate either directly or indirectly on the grounds of race, colour, ethnic origin, nationality,
national origin, sex, marital status, disability, sexual orientation, religion or age.
In order to ensure compliance with its Equality Policy, a system of monitoring has been set up. We have only asked for
your name so that monitoring can take place both at the shortlisting for interview stage and at the appointment stage.
Once an appointment has been made, the data given on this form will be stored on computer in an anonymised format
and the form will be destroyed.
You may decide not to answer one or any of the questions on this form but if you do respond, all information provided will
be treated completely confidentially and will be used solely by the Administration department for the purpose of equal
opportunities monitoring. The monitoring form does not form part of your job application and will therefore be detached
from it on receipt and stored separately. You can post this form separately if you wish. Thank you for your assistance in
completing this form.

Name (optional):


Job title applied for:


Location of job:


Gender: Male
Female
Prefer not to say

Marital status: Married
Single
Other (please specify)
Prefer not to say

Age band: Under 16
16-19
19-22
23-30
31-40
41-50
51-60
61-65
Over 65
Prefer not to say

Sexual orientation: Heterosexual
Homosexual
Bisexual
Transsexual
Prefer not to say

Disabilities: None
Physical disability
Mental disability
Prefer not to say


Race/nationality/
Ethnic origin:
White English
Scottish
Welsh
Irish
Other white background (please specify)

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Options Group is committed to Safer Recruitment
Mixed White and Black Caribbean
White and Black African
White and Black British
White and Asian
Other mixed background (please specify)

Asian Indian
Pakistani
Bangladeshi
British
Other Asian background (please specify)

Black Caribbean
African
British
Other black background (please specify)

Chinese

Other ethnic group (please specify)

Prefer not to say

Religion: Christian
Catholic
Jewish
Sikh
Muslim
Hindu
Buddhist
Rastafarian
None
Other religion (please specify)
Prefer not to say


For the purposes of the Data Protection Act 1998, I hereby confirm that by completing this form I give my consent to the
Company processing the data supplied on this form for the purpose of equal opportunities monitoring.
SIGNATURE: DATE:

OFFICE USE ONLY:
Applicant to sign and date printed copy at interview.


SIGNATURE: DATE:


Rejected before interview
Rejected after interview
Offered Job
Other: