The White Swan, 46 Church Street

Old Basford
Nottingham
NG6 0GD

Tel: 0115 979 1234

Please complete all sections fully, and do not put ‘refer to CV’

Job Application Form

Vacancy Title:
Please tell us how you heard about this vacancy:

1. Personal details

Last Name: First Name:

Address:

Postcode:

Home Telephone No. Mobile No.

E-mail address:

National Insurance No.

Driving Licence
Yes No
Do you hold a full, clean driving licence valid in the UK?
Do you have access to a vehicle?

Yes No

2. Preferred hours

Full time OR Part time

We like our workers to be willing to work flexibly across the week, and need to know when other commitments mean
you may not be available to work: Please tick when you are unavailable:

Mon Tues Weds Thurs Fri Sat Sun

Early
Late
Nights
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 3. Education/Qualifications

If applying for a Registered Nurse role, please give UK PIN:

Copies of relevant qualifications will be required at interview.

Qualification
School (11+) Study Dates Date Obtained
and Grade

Qualification
College/University Study Dates Date Obtained
and Grade

Ongoing Professional Qualification

Study Dates Date Obtained
Development and Grade

Training and Development

Please use the space below to give details of any training or non-qualification based development which is relevant to the
post and supports your application.

Course Details
Training Course
(including length of course/nature of training)

Current Membership of any Professional Body/Organisation

Please give details:

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 4. Employment History

Previous Employment: Please include any previous experience (paid or unpaid), starting with the most recent first.

Current or most recent employer

Name of Employer:

Address:

Postcode:

Position Held:

Date Started: Leaving Date:

Reason for Leaving:

Salary on Contact Name of Line Manager for

leaving this post: reference:

Brief description of duties:

Previous employer

Name of Employer:

Address:

Postcode:

Position Held:

Date Started: Leaving Date:

Reason for leaving:

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Brief description of duties:

Previous employer

Name of Employer:

Address:

Postcode:

Position Held:

Date Started: Leaving Date:

Reason for Leaving

Salary on Contact Name of Line Manager for

leaving this post: reference

Brief description of duties:

Continue on separate sheet if necessary

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 5. Information in support of your application

Skills, abilities and experience

Please use this section to demonstrate why you think you would be suitable for the post by reference to the job
description and person specification (and by giving examples and case studies). Please include all relevant information,
whether obtained through formal employment or voluntary/leisure activities. Attach and label any additional sheets
used. See guidance sheet for further information.

Continue on a separate sheet if necessary

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 6. Convictions/ Disqualifications (DBS)

To ensure the safety of our residents, an enhanced DBS check must be completed for all positions. A criminal record will
not necessarily be a bar to obtaining a position at Eastgate Care Ltd. If a check is returned and reveals any information,
this will be discussed with the applicant. The Group HR Manager will make a decision as to whether the offer of
employment should be withdrawn.

Rehabilitation of Offenders Act 1974 (Exceptions)(Amendment) Order 1986

We would draw your attention to the following statement:-

“Because of the nature of the work for which you are applying, this post is exempt from the provisions of Section 4(2) of
the Rehabilitation of Offenders Act, 1974, by virtue of the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975
and the Rehabilitation of Offenders Act 1974 (Exceptions) (Amendment) Order 1986. Applicants are, therefore, not
entitled to withhold information about convictions which for other purposes are ‘spent’ under the provisions of the Act”.

Please provide details below if you have been convicted of a criminal offence or been the subject of a conditional
discharge or probation order. (Past criminal proceedings are not necessarily an obstacle to taking up a post. This occurs
only where the offence/s is/are deemed relevant. Any details will be discussed with you should you be the successful
candidate based on your supporting statement, interview and tests). Failure to disclose current or previous convictions
that are subsequently highlighted on the DBS check, may result in any offer of employment being withdrawn.

7. Reasonable Adjustments/Arrangements for Interview

Please contact us if you need the application form in an alternative format.

Do you require any reasonable adjustments? YES/NO

If "yes" please use the space below to tell us what these are?

If you need us to make any adaptations for your interview to accommodate any disability you may have please tell us what
these should be?

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8. Asylum & Immigration Act

Are you legally eligible to work within the UK Yes / No

If yes, please confirm the evidence you will be providing to support your eligibility.

If appointed when could you start? Give period of notice if applicable

9. References
Please give the detail of two EMPLOYER references – see guidance sheet for further information. Offers of Employment are
subject to the receipt of 2 suitable references.

Name of Referee
and relationship to
you:

Address:

Postcode:
Email: Tel:

Name of Referee
and relationship to
you:

Address:

Postcode:
Email: Tel:

10. Annual Leave

Do you have any annual leave currently booked: YES / NO

If ‘Yes’ please advise dates:

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11. Declaration

Statement to be Signed by the Applicant

Please sign in the appropriate place below. If this form is not completed and signed, your application will not be
considered.
I agree that Eastgate Care Ltd can create and maintain computer and paper records of my personal data, and that this
will be processed and stored in accordance with the General Data Protection Regulations (2018) and Privacy Notice.
I confirm that Eastgate Care Ltd has my permission to contact previous employers, and any referees noted in section 9
above, to obtain references.

I confirm that all the information given by me on this form is correct and accurate, and I understand that if any of the
information I have provided is later found to be false or misleading, any offer of employment may be withdrawn or
employment terminated.

Signed: Date:

Print Name:

Please see the attached Applicants Privacy Notice (pages 9, 10 and 11) in relation to data processing, which must be read
and signed.

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 EASTGATE CARE LTD
APPLICANT PRIVACY NOTICE

Data controller: Janine Morgan, Managing Director, Eastgate Care Ltd, The White Swan, 46
Church Street, Old Basford, Nottingham, NG6 0GD
Telephone: 0115 979 1234 ext. 7 and ext. 9
Email: janine@eastgatecare.co.uk

Data protection officer: Susan Young, Group HR Manager, Eastgate Care Ltd, The White
Swan, 46 Church Street, Old Basford, Nottingham, NG6 0GD
Telephone: 0115 979 1234 or 07779 265717
Email: sue.young@eastgatecare.co.uk

As part of any recruitment process, the Company collects and processes personal data relating to job applicants. The
Company is committed to being transparent about how it collects and uses that data, and to meeting its data protection
obligations.

What information does the Company collect?

The Company collects a range of information about you. This includes:

•your name, address and contact details, including email address and telephone number;
•details of your qualifications, skills, experience and employment history;
•information about any professional bodies you may be a member of, for example the NMC.
•information about your current level of remuneration, including benefit entitlements;
•whether or not you have a disability for which the Company needs to make reasonable adjustments during the
recruitment process; and
•information about your entitlement to work in the UK.

The Company may collect this information in a variety of ways. For example, data might be contained in application
forms, CVs or resumes, obtained from your passport or other identity documents, or collected through interviews or
other forms of assessment.

The Company may also collect personal data about you from third parties, such as references supplied by former
employers and information from criminal records checks. The Company will seek information from third parties only
once a provisional job offer to you has been made, and will inform you that it is doing so.

Data will be stored in a range of different places, including on your application record, in HR management systems and
on other IT systems (including email).

Why does the Company process personal data?

The Company needs to process data to take steps at your request, prior to entering into a contract with you. It may also
need to process your data to enter into a contract with you.

In some cases, the Company needs to process data to ensure that it is complying with its legal obligations. For example, it
is required to check a successful applicant's eligibility to work in the UK before employment starts.

The Company has a legitimate interest in processing personal data during the recruitment process, and for keeping
records of the process. Processing data from job applicants allows the Company to manage the recruitment process,
assess and confirm a candidate's suitability for employment, and decide to whom to offer a job. The Company may also
need to process data from job applicants, to respond to and defend against legal claims.

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The Company may process special categories of data, such as information about ethnic origin, sexual orientation or
religion or belief, to monitor recruitment statistics. It may also collect information about whether or not applicants are
disabled to make reasonable adjustments for candidates who have a disability. The Company processes such information
to carry out its obligations, and exercise specific rights in relation to employment.

The Company is obliged to seek information about criminal convictions and offences. Where the Company seeks this
information, it does so because it is necessary for it to carry out its obligations, and exercise specific rights in relation to
employment.

If your application is unsuccessful, the Company may keep your personal data on file in case there are future
employment opportunities for which you may be suited. The Company will ask for your consent before it keeps your data
for this purpose, and you are free to withdraw your consent at any time.

Who has access to data?

Your information may be shared internally for the purposes of the recruitment exercise. This includes members of the HR
and recruitment team, interviewers involved in the recruitment process, managers in the business area with a vacancy,
and IT staff if access to the data is necessary for the performance of their roles.

The Company will not share your data with third parties, unless your application for employment is successful, and it
makes you an offer of employment. The Company will then share your data with former employers to obtain references
for you, and the Disclosure and Barring Service to obtain necessary criminal records checks.

The Company will not transfer your data outside the European Economic Area.

How does the Company protect data?

The Company takes the security of your data seriously. It has internal policies and controls in place to ensure that your
data is not lost, accidentally destroyed, misused or disclosed, and is not accessed except by our employees in the proper
performance of their duties. Data is held securely, and if electronic, is subject to password protection and access
restrictions.

For how long does the Company keep data?

If your application for employment is unsuccessful, the Company will hold your data on file for 6 months after the end of
the relevant recruitment process. At the end of that period, or once you withdraw your consent, your data is deleted or
destroyed.

If your application for employment is successful, personal data gathered during the recruitment process will be
transferred to your personnel file, and retained during your employment. The periods for which your data will be held
will be provided to you in a new privacy notice.

Your rights

As a data subject, you have a number of rights. You can:

• access and obtain a copy of your data on request (Subject Access Request or SAR);
• require the Company to change incorrect or incomplete data;
• require the Company to delete or stop processing your data, for example where the data is no longer necessary for the
purposes of processing; and
• object to the processing of your data where the Company is relying on its legitimate interests as the legal ground for
processing.

If you would like to exercise any of these rights, please contact the Data protection officer, details as above.

If you believe that the Company has not complied with your data protection rights, you can complain to the Information
Commissioner.

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What if you do not provide personal data?

You are under no statutory or contractual obligation to provide data to the Company during the recruitment process.
However, if you do not provide the information, the Company may not be able to process your application properly or at
all.

Automated decision-making

Recruitment processes are not based solely on automated decision-making.

I confirm I have read and understood this Privacy Notice:

Name: Date:

Signed:

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GUIDANCE SHEET

Please read through the following guidelines that will help you complete the application form.
• You must complete all sections of the form, regardless of whether you are attaching a CV.
• Make ensure the form is clear and legible and try to avoid mistakes by writing out a version first to make sure you
are happy with the information you are providing. Always read through your final version before you send it.

If you require an acknowledgement of your application:

• If emailing you must activate a read receipt from your email account.
• If sending by post you must enclose a stamped addressed envelope.
• Please note with limited resources, we cannot verify if we have received your application over the phone.

To complete your application:

• Please type or write clearly in black ink.
• Ensure you clearly state the job title you are applying for.
• In the ‘Employment History’ section you must state why you have left a position.
• Always explain any gaps in work history.
• Proof of qualifications and membership to professional bodies will be required at interview.
• Proof of eligibility to work in the UK will be required at interview, in order for the interview to be conducted.

References

We will take up professional references once you have been interviewed and provisionally offered the post. Please make
sure that you have given the full contact details (including correct email address) of your referees, so that this does not
delay processing reference requests.

If you have no employer references, we will take up references with named individuals at colleges where you have studied,
or people who know you in a professional capacity. Please do not put down family members or people you live with as
referees.

You will only be confirmed in the post once we are satisfied with the information received from your referees.
Supporting Statement

The 'Why you feel you are suitable for this position' part of the form is called your supporting statement. It is the most
important part of the application form.

You should consider the following:

• Applications can only be assessed on the information you provide. You need to clearly demonstrate your
capabilities.
• You need to explain how you meet each of the person specification points, and provide examples from your
previous experience. Do not forget to present this in relation to the job description.
• Often the strongest applications are those that link the three elements highlighted above, and are presented in a
clear format (e.g. numbered points that correspond to person specification).
• We expect your supporting statement to be a minimum of half of a side of A4, and a maximum of 2 sides.
• Use concise, unambiguous sentences and avoid exaggerations.
• Honesty is always the best policy; please do not make false claims.
• If you are making a career change, stress what skills are transferable to the role you are applying for.
• Ensure you return your application in good time before the closing date - aim for the day before the deadline.

Finally good luck with your application and thank you for your interest in Eastgate Care Ltd.

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