Parkside Job Application Form

Cautions, rehabilitation and criminal records

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 Exceptions Order 1975 as amended by the Exceptions (Amendment) Order 1986, which means that convictions that are spent under the terms of the Rehabilitation of Offenders Act 1974 must be disclosed, and will be taken into account in deciding whether to make an appointment. Any information will be completely confidential and will be considered only in relation to this application.

In addition you are required to submit to a Disclosure and Barring check/provide a PVG Scheme Record or Scheme Record Update. Any disclosure made by the Disclosure and Barring Service will remain strictly confidential.

Position applied for *

Name *

Title

Address *

Postcode *

Telephone number *

Nationality *

Place of birth *

National Insurance Number *

Email address *

Record of Employment (please include present and previous employers covering the last 10 years) *

Experience and qualifications *

Name and address of 1st referee *

Name and address of 2nd referee *

Details of home addresses covering the last 5 years (include address, postcode, month / year from, month / year to *

Details of your Secondary/Further Education (include place of education, start date, end date and exam results) *

Have you ever been convicted in a Court of Law and/or cautioned in respect of any offence? *

Yes

If you answered "Yes" to the above question, please give further details

I understand that if I am successful in being offered this position it will be subject to at least: a. two satisfactory references b. any necessary checks that may have to be made, including police checks. c. suitable proof of identity *

Confirmed

The information I have given in this application is true and I understand that I may be dismissed if I gain this position through false information. *

Confirmed

Signed and date *

* Required Fields