Application For Employment

Personal Details

Current Post

Educations/Qualifications

Employment History

Health Questionaries

References

Attach CV

Declaration

Equality

Personal Details

Full Name

Title

First Name

Middle Name

Last Name

Address

Address line 1

Address line 2

City

State / Province

Postal code / Zip Code

Country

Phone Number

Email Address

Please give details of any current endorsements(s):

Do you require a work permit?

If so, do you have a valid work permit?

Are you related to any member of staff at JSR Healthcare, If yes, please give details:

Current Post

`Employer (1)`

Job Title:

Employer

Notice Required

Brief description of duties:

Reason for wanting to leave:

Employer (2)

Employer

Job Title:

Date Commenced:

Notice Required

Brief description of duties:

Reason for wanting to leave:

Educations/Qualifications

`Please give details of your education, starting with the most recent:`

School/College/University Name (1)

Grade(s)

Examination(s) Passed

School/College/University Name(2)

Grade(s)

Examination(s) Passed

Employment History

Name of the Organisation (1)

Position Held/ Job Title

Employment Dates

Brief Outline of Duties and Responsibilities

Reason for Leaving

Name of the Organisation(2)

Position Held/ Job Title

Employment Dates

Brief Outline of Duties and Responsibilities

Reason for Leaving

Health

Do you have a health problem which may affect your ability to do the job?

If YES, please give details:

Have you had any periods of illness during the past 3 years?

Additional Health Information

References

Please give names and addresses of your two most recent employment referees, or academic
referees if you are a student.
If you do not wish an approach to be made at this stage, please enter a cross in the box alongside
their name

Referee Name (1)

Position / Job Title

Address

Phone Number

Relationship to you

Referee Name (2)

Position / Job Title

Address

Telephone Number

Relationship to you

Please use this part of the application form to describe how you meet the criteria for the job which
is set out in the person specification.
Make sure that you include all relevant skills and knowledge – this may have been gained from
your current or previous jobs, from voluntary work or from working in the home or in the
community. Give specific examples wherever possible. Consider all the relevant skills and
knowledge you have and make sure you tell us about it. Explain why you are interested in this
post and what you can bring to it.

Attach CV *

Upload

Drop file here or click to upload

Maximum file size allowed: 2500KB

I confirm that the information provided in this application is to the best of my knowledge correct
and complete. I understand that false information or deliberate omission of any material fact may
result in dismissal or withdrawal of a job offer.
Data Protection Act (DPA) 1998
JSR Healthcare is the Data Controller.
The personal data that you provide will only be used for the selection process, to establish and
maintain any subsequent employment contract and to monitor the provision of Equality and
Diversity within JSR Healthcare as dictated by statutory legislation.
We will not disclose your personal details to anyone outside of the company who is not acting on
our behalf unless we are required to in line with the DPA 1998. We would ask that you keep us
informed of any changes to your personal details so that the information we hold is accurate. You
also have the right to request to see personal details that we hold and is personal to you.
I give JSR Healthcare permission to process personal information about me as described above and
in line with the DPA 1998.

Full Name

Date Picker

Policy:
It is the policy of JSR Healthcare not to discriminate on the grounds of race, skin
colour, religions or cultural beliefs or because of gender, sexual orientation, age, HIV
status, disability or health.

Monitoring:
In order to assist us in monitoring the effectiveness of our policy you are asked to
complete the section below. This information is for statistical purposes only, and will
not be used by those involved in the selection process. This sheet will be treated as
confidential and will be separated from your job application before short listing.

Gender

Disability

A disability or health problem does not preclude full consideration for the job and applications
from suitable people with disabilities are welcome. All information provided by applicants will
be treated as confidential.

Do you have a long term health problem or disability which we should be aware of?

If Yes, give Details:

Employment Status

Are you presently employed?

Where did you see/hear about this vacancy?

Application For Employment

Personal Details

Current Post

Employer (1)

Employer (2)

Educations/Qualifications

Please give details of your education, starting with the most recent:

Employment History

Health

References

Please give names and addresses of your two most recent employment referees, or academicreferees if you are a student.If you do not wish an approach to be made at this stage, please enter a cross in the box alongsidetheir name

Disability

A disability or health problem does not preclude full consideration for the job and applicationsfrom suitable people with disabilities are welcome. All information provided by applicants willbe treated as confidential.

Employment Status

`Employer (1)`

`Please give details of your education, starting with the most recent:`

Please give names and addresses of your two most recent employment referees, or academic
referees if you are a student.
If you do not wish an approach to be made at this stage, please enter a cross in the box alongside
their name

A disability or health problem does not preclude full consideration for the job and applications
from suitable people with disabilities are welcome. All information provided by applicants will
be treated as confidential.