Please complete all sections of this form.
Please complete the Recruitment Monitoring Form on the back page of this form. This section
will be detached before the selection process begins.
We are interested in your experience and any skills or training which show that you meet
the requirements of the job for which you are applying, therefore please feel free to include
information about non-work activities which are relevant.
Finally, please note that in order to save the charity’s resources we do not acknowledge receipt
of application forms.
Please list all of your previous jobs including any with your present employer. Please account for any gaps in employment. Start with
the most recent. Please be aware that references may be sought from your previous employers.
Please give details of secondary, further and higher education qualifications achieved. Start with the most recent, giving university/college details.
Please list below relevant job-related training you have undertaken and/or any professional qualifications received.
Please give any information which you think will help us to consider your application, including relevant experience (voluntary or paid), skills, abilities and any specialist knowledge you have. Take as a guide the content of the Job Description and Person Specification and tell us how you meet the requirements of the job.
Please give details of two employers who may be contacted for references in connection with your application.
One of your chosen referees must be your current or most recent employer. Referees must not be related to you.
Bethphage may contact additional previous employers in order to secure a reference from an appropriate care setting.
References will normally only be taken up once you are offered the job.
Whilst in many cases it may not exclude you from being offered the job, because of the nature of Bethphage’s services this post
is covered by the Rehabilitation of Offenders Act 1974 (Exceptions) (Amendments) Order 1986 and the Criminal Justice and Court
Services Act 2000. You must therefore disclose details of current or pending cautions, reprimands, final warnings and convictions.
We will only take this information into account if we consider it relevant to the post for which you have applied. However, any failure
to disclose such information will automatically result in withdrawal of any job offer. We undertake to discuss any matter revealed in a
Disclosure with you before coming to a decision.
Only successful applicants for this post will be subject to an enhanced check carried out through the Disclosure and Barring Service
I confirm that the information I have given on this form is true and correct. I understand that any untrue or misleading information may
lead to the withdrawal of a job offer, or termination of any employment contract offered to me, without prejudice or payment in lieu of
I understand that because of the sensitive nature of the duties, I will be required to give details of any current or pending criminal
convictions, cautions, reprimands and final warnings and any other information which may have a bearing on my suitability for the
post. I understand too that an Enhanced Disclosure will be sought in the event of a successful application. Only relevant convictions
and any other relevant information will be taken into account, so disclosure need not necessarily be a bar to obtaining a position.
I also hereby give my explicit consent to the processing of data contained or referred to in this form, in accordance with the Data
Protection Act 1998 and any subsequent legislation. I am aware that, should I be appointed, the documents I provide, such as
passport and work permits, may be made available to the relevant authorities on request, which may include the police.
Bethphage is committed to fair treatment for everyone.
We believe that equality and diversity is about treating people fairly, openly and honestly and recognising
that people have different needs, cultures, experiences and expectations.
It is the policy of Bethphage to ensure that no person, whether a job applicant, employee, person
we support or third party receives any less favourable treatment because of his or her age, disability,
gender, because they are pregnant or on maternity leave, married or in a civil partnership, because of
their race, religion or belief, sex or sexual orientation or any other condition or requirement that cannot
be shown to be a justifiable requirement of the job.
We have made a commitment to improve employment opportunities for people with disabilities, and
have adopted the two ticks symbol “Positive about Disabled People”. This means that Bethphage
has undertaken to guarantee an interview to all applicants with a disability who meet the essential
requirements of the job, as contained in the person specification.
Employers have a duty to make reasonable adjustments where, compared to a non-disabled person,
a disabled person is substantially disadvantaged by either the working arrangements (which include
the recruitment process) or the working environment. We will therefore ensure that medical fitness
requirements are determined having regard to the demands of particular posts and are applied fairly
and consistently and do not discriminate against those with particular medical conditions.
You should be aware that, if you wish to take advantage of this pledge, we may ask you to give
details of your disability. Any supporting information, for example a letter from a Disability Employment
Adviser, would be helpful. The information you provide will be shared with the people responsible for
short-listing applicants and organising the selection process.
This sheet will be detached from your application form and will not be seen by anyone involved in the selection process. We will
use this information for monitoring our recruitment processes and, if you are appointed, for our personnel/payroll records. Please
complete in block capitals or by ticking the relevant box.
I would describe my ethnic origin as (please indicate as appropriate)
In terms of my religion, I would describe myself as (please tick as appropriate)
(For definition, please refer to the policy statement above)
17 Lichfield Street
Tel: 01922 660813
Park Lane Centre
Tel: 01952 457382
Bethphage is a registered Charity No. 1046225 and a Registered Company Limited by Guarantee No. 2971171, the registered address is 8 Longbow Close, Harlescott Lane, Shrewsbury SY1 3GZ test