Application for Work

Personal Details

Title *

First name *

Middle name

Last name *

Address *

Postcode *

Date moved in *

(mm/yyyy)

Mobile *

Email *

Confirm email *

DOB *

National Insurance no. *

Do you drive? *

Yes No

How did you hear about us? *

Emergency Contact

Emergency tel *

Next of kin name and relationship *

Address *

Postcode *

5 Year Career History and References

Please complete the entries below clearly stating your employment history for the last 5 years. This must include employment or study both in the UK or overseas.

Please note that all periods must be accounted for including maternity leave, unemployment, visits to other countries, study etc. Please ensure that you write the start month and finish month and year for each job/study. Please only provide company or organisation email address. No personal email addresses will be accepted.

Please provide as much detail as you can. We will need to contact these organisations to verify your work history.
Please start with the most recent first, and work chronologically backwards.
Please don't leave the 'date finished' field blank if still employed in this role.

Please provide at least 2 work history references.
Please sign at the bottom to verify your work history and to give consent for us to contact the listed workplaces.

Career History 1

Date started *

Date finished

What were you doing?
(E.g. job title, unemployed, maternity) *

Reason for leaving

Organisation name *

Address *

Postcode *

Contact name *

Telephone *

Email

Career History 2

Date started *

Date finished

What were you doing?
(E.g. job title, unemployed, maternity) *

Reason for leaving

Organisation name *

Address *

Postcode *

Contact name *

Telephone *

Email

Please explain any gaps in employment below

I confirm that this is a true account of my career history and give my consent to contact the above named for references.

Professional Qualifications & Training

Please only enter your childcare related qualifications into the fields below. Note, if unqualified please state 'unqualified'

Professional qualification *

Please give the dates of training such as:

Child safeguarding course

COSHH and risk awareness updates

Lifting and handling

Food hygiene

Paediatric first aid

Experience

Please tick if you have experience in each of the following areas.
You must have experience in at least 1 category.

Babies

Toddlers

Pre-school

LSA/SEN

Cook

TA

Other

Rehabilitation of Offenders

The post that you have applied for is excepted from the Rehabilitation of Offenders Act 1974, which means all convictions, cautions, reprimands, spent convictions and final warnings on your criminal record need to be disclosed. Please be aware that an Enhanced Disclosure will be sought through the Criminal Records Bureau in the event of a successful application.

Only relevant convictions and other relevant information will be taken into account so disclosure need not necessarily be a bar to obtaining this position.

Have you ever been convicted by the courts or cautioned, reprimanded or given a final warning by the police? *

Yes No

If yes, please specify details

Offence

Date from/to

Police Enquiries

Are you aware of any police enquiries undertaken following allegations made against you, which may have a bearing on your suitability for this post? *

Yes No

If yes, please specify details

Enquiry

Police Station

Date from/to

Name History

Have you used any other first or last names? If so, please specify.

Please note - It is important that you do not leave any date gaps between name changes.

Date from

Date to

First Name

Middle Name

Surname

5 Year Address History

Have you changed address in the last 5 years.

Please note - It is important that you do not leave any date gaps between address changes.

Date from

Date to

Address

Postcode

Children's Act 2006 Disqualification Criteria

Nexter are required to ask all employees to make a declaration about whether they are a disqualified person under the Childcare (Disqualification) Regulations 2009.

A person may be disqualified under the regulations because:

They have certain orders, directions or restrictions placed upon them in relation to children or childcare
They have been cautioned or convicted of certain offences

You are required to complete the declaration below confirming that you are not disqualified under these regulations.

Section 1 - Orders or other restrictions

Have any orders or other determinations related to childcare been made in respect of you? *

Yes No

Have any orders or other determinations related to childcare been made in respect of a child in your care? *

Yes No

Have any orders or other determinations been made which prevents you from being registered in relation to childcare, children’s homes or fostering? *

Yes No

Have you had any changes in circumstances since your last DBS check was carried out? *

Yes No

Are you barred from working with children by the Disclosure and Barring Service (DBS)? *

Yes No

Are you prohibited from teaching? *

Yes No

Section 2 - Specified and Statutory Offences

Have you ever been cautioned, reprimanded, given a warning for or convicted of:

Any offence against or involving a child? (A child is a person under the age of 18) *

Yes No

Any violent or sexual offence against an adult? *

Yes No

Any offence under the sexual offences act? *

Yes No

Have you ever been cautioned, reprimanded, given a warning or convicted of any similar offence in another country? *

Yes No

Section 3 - Provision of Information

If you have answered YES to any of the questions above you should provide details below: (You may provide this information separately if you wish, but you must provide this without delay).

Declaration

In checking this box, I confirm that the information provided is true to the best of my knowledge and that I will notify Nexter immediately of any information that affects my suitability for working with children, including cautions, convictions, warnings, orders, and other determinations made in respect of me or a member of my house that would disqualify me from working with children. *

Bank Details

Please note - if you do not submit your details with your first timesheet there will be a delay in your payment

Bank name

Bank address

Account holder name

Account number

(8 digits)

Sort code

(6 digits)

Your Present Circumstances

Read all the following statements carefully and select the one box that applies to you.

This is my first job since last 6 April and I have not been receiving taxable Jobseeker's Allowance, Employment and Support Allowance or taxable Incapacity Benefit or a state or occupational pension.

This is now my only job, but since last 6 April I have had another job, or have received taxable Jobseeker's Allowance, Employment and Support Allowance or taxable Incapacity Benefit. I do now receive a state or occupational pension.

I have another job or receive a state or occupational pension.

Student Loan Declaration

I left a course of Higher Education before last 6 April and received my first UK Student Load instalment on or after 1 September 1998 and have not fully repaid my Student Load. (Do not check the box if you are repaying your UK Student Load by agreement with the UK Student Loans Company to make monthly payments through your bank of building society account.)

Eligibility to Work Within the UK

Are you legally eligible to work in the UK? *

Yes No

Do you have any endorsements on your passport which limit your stay or length of employment in the UK? *

Yes No

Do you require a work permit? *

Yes No

If you don't hold a UK passport please provide a Share Code

Work Preferences

What is your preference? *

If part time, how many days per week?

How many hours per week are you available?

What type of work do you want to do?

Are there any places you would like to work?

Are there any places you would NOT like to work?

How far are you willing to travel?

Have you been referred by anyone? Please enter their name

Do you know anyone else who would like to join? We'll give you £100 for each person that completes 2 weeks work (80 hours)

Working Hours

UK law limits your work to 48 hours averaged over 13 weeks. You can opt out if you prefer, however you will never be required to work hours you do not agree to.

I agree to opt out of the 48 hour limit *

Yes No

Health and Disability

The following questions on health and disability are asked in order to find out your needs in terms of reasonable adjustments to access our recruitment service and to find out your needs in order to perform the job or position sought.

Do you have any physical or health conditions that impact your capacity to work
as required by Education Health Standards (England) 2003 Regulations? *

Yes No

If yes, please specify

Curriculum Vitae

Please upload an up to date CV - simply browse and choose your recent CV then press upload.

Previous Agency Placements

Are you now, or have you previously registered with an employment agency? *

Yes No

If so, which agencies did you register with?

Name

Date from

Date to

Reasons for joining

Reasons for leaving

Places of work