Form Name
APPLICATION FORM
Reference No. HRF4
Please use either blue or black ink or type to complete this application form. Once
completed, please return via post to Cedar Care Homes, Mortimer House, Clifton Down
Road, Clifton, BS8 4AE, via online https://cedarcarehomes.com/careers, or, if already
arranged for an interview, please bring it along with your required ORIGINAL documents.
Please Note
• The information requested within this Application is essential. Please ensure
that you complete ALL of the sections as FULLY as possible.
• Should you require any information or advice on completing the form, please
contact the HR department on 0117 9467216, or we can assist in during the
interview.
• Please note that we require to see ORIGINAL of all the documents during the
interview to verify the information you provide.
• Please see Pg. 12 for the checklist of documents required.
For office notes only
1
PART A: GENERAL INFORMATION
To assist us in our recruitment process, we would like you to complete the following table of
information as accurately as possible:
Kaskar / Farid Mr
Surname / Family Name Title
Ullah
Forenames(s)
Care Assistant
Post applied for
Delete as Full Part Bank
Date 21 Feb 2024
appropriate time time
How did you become aware of this vacancy? Yes
If you were informed by a friend, please state Mr Zahid Ali (on
their Name and Home where they work PSW in
Scotland)
Any Role
Any other roles you would consider
PART B: PERSONAL DETAILS
Please tell us about you:
Village & Post Offie Thana, Tehsil 23000
Current Address Batkhela District Malakand, KP, Post code
Pakistan
Alternative contact
telephone number +923448910919
Alternative contact +923360088910
mobile number
[email protected] Email address
Do you have a UK valid, full and current driving licence? Yes No
Do you have the use of a car? Yes No
Pakistani
Nationality
If not a UK citizen, what is your status in the UK i.e. type of VISA and validity
Please attach a copy of your documents – work permit, passport, endorsement, etc.
Date valid from
Type of VISA Date valid to
2
PART C: EDUCATION HISTORY
Please provide the most recent education/ training programme first:
C1: SECONDARY, FURTHER AND HIGHER EDUCATION / VOCATIONAL TRAINING AND
QUALIFICATIONS
Name of School /College/ University Name/ level/ grade or
Start Date End Date
attended qualifications obtained
2016 2020 Institute of Management Sciences MBA
Peshawar Pakistan
Please provide the most recent qualification first:
C2: OTHER QUALIFICATIONS/ COURSES THAT MAY SUPPORT THE APPLICATION
Name of School /College/ University Name/ level/ grade or
Start Date End Date
attended qualifications obtained
We are interested to know all Professional Memberships and Registrations that you have
regardless of apparent relevance:
C3: PROFESSIONAL MEMBERSHIP/ REGISTRATION
Category of Membership/
Name of Professional body Membership Reference No. Validity Date
3
PART D: WORK HISTORY & REFERENCES
In addition to submitting your curriculum vitae (CV) with this application, please provide
details of your current and previous employment below.
For Legal Compliance reasons, we will need to obtain references from your most
recent employers. This is a MANDATORY requirement and you MUST therefore
provide the information where it is stated as MANDATORY. We will not be able to
consider your application without this information.
If this is your first employment and you are just starting after the completion of your
education, please proceed to section D4 on Pg. 08.
Please start with most recent previous employment first.
D1: Your Current or Most Recent Employer – This information is MANDATORY:
Company Name
Address
Type of business Position held
Leaving date
Start date
(if applicable)
What is your salary?
What length of notice are you required to
give?
Brief description of
main duties and
responsibilities
Reason for leaving /
seeking to leave
We will need to contact this person for a reference. Do you
Yes No
agree to this?
If “No” please provide reasons below
May we contact the referee prior to your interview? Yes No
4
Referee Name Referee Job
Title
Telephone Fax
Email address
If you have worked for the company detailed in section D1 for over 5 years, you may
nominate a Supervisor from the same company to provide a professional reference in
the first part of section D2 below.
D2: Recent Previous Employers – This information is MANDATORY:
Company Name
Address
Type of business Position held
Start Date Leaving Date
Reason for leaving
We will need to contact this person for a reference. Do you Yes No
agree to this?
If “No” please provide reasons below
Yes No
May we contact the referee prior to your interview?
Referee Name Referee Job Title
Telephone Fax
Email address
Company Name
Address
Type of business Position held
Start Date Leaving Date
Reason for leaving
We may need to contact this person for a reference. Do you
agree to this? Yes No
If “No” please provide reasons below
5
Yes No
May we contact the referee prior to your interview?
Referee Name Referee Job Title
Telephone Fax
Email address
Please provide the details of your employment preceding the above mentioned spanning
back to the beginning of your working career, in descending date order in the following
section D3 provided below. The provision of Referees for these employers is OPTIONAL.
The following section MUST be completed even if you are submitting a copy of your
curriculum vitae (CV). Please use a continuation sheet if necessary.
D3: Further Employment History
Company Name Job Title
Start Date Leaving Date
Reason for leaving
May we contact this referee prior to interview, without contacting Yes No
you first?
Referee name Referee Job
Title
Telephone Fax
Email address
Company Name Job Title
Start Date Leaving Date
Reason for leaving
May we contact this referee prior to interview, without contacting Yes No
you first?
Referee Name Referee Job
Title
Telephone Fax
Email address
Company Name Job Title
Start Date Leaving Date
Reason for leaving
6
May we contact this referee prior to interview, without contacting Yes No
you first?
Referee Name Referee Job
Title
Telephone Fax
Email address
Company Name Job Title
Start Date Leaving Date
Reason for leaving
May we contact this referee prior to interview, without Yes No
contacting you first?
Referee Name Referee Job
Title
Telephone Fax
Email address
Company Name Job Title
Start Date Leaving Date
Reason for leaving
May we contact this referee prior to interview, without Yes No
contacting you first?
Referee Name Referee Job
Title
Telephone Fax
Email address
If there are any GAPS in your Employment History – please provide details below:
Start Date End Date Reason
7
If this is your first job and you are unable to provide us with employer references, two
character references MUST be provided instead. This would preferably be your teacher or
mentor.
Character References can also be provided from professional persons (Doctors, Lawyers,
Experts,
etc.) who have been relatively close to you (family friend or neighbour). If you have been a part of
a volunteer scheme or clubs and societies, they are also considered to be source of character
reference.
Please provide the details of your referees in the table below:
D4: Character Reference Details
May we contact this referee prior to interview, without contacting No
you first? Yes
Referee Name Referee Job
Title
In what capacity For how long the From To
does the referee referee has
know you? known you?
Telephone Fax
Email address
May we contact this referee prior to interview, without contacting Yes No
you first?
Referee Name Referee Job
Title
In what capacity For how long the From To
does the referee referee has
know you? known you?
Telephone Fax
8
Email address
PART E: Reason for applying for the position
PART F: REHABILITATION OF OFFENDERS
All staff that are successful will be offered employment subject to the return of an enhanced
DBS Check. If you have been convicted of any crime, either in the UK or outside of the UK
(other than motoring offences) regardless of whether it would be a “spent” offence under the
Rehabilitation of Offenders Act, you are required to disclose it below:
The provisions relating to the non-disclosure of criminal convictions or cautions do not apply to
certain occupations. The job for which you are applying is included in the excepted types of
employment under the Rehabilitation of Offenders Act (Exception Order) 1975.
Have you ever been convicted or cautioned of any criminal Yes No
offence in your own country of origin or any other country?
(Admitting an offence does not automatically exclude you from being offered
employment)
If yes, please give details
and dates:
Failure to disclose any criminal offence could lead to your application being rejected, or
if you are appointed, to dismissal if it is subsequently learned that you have had
previous convictions or cautions.
It is also a requirement that any Overseas Employee intending to work in Nursing Homes must
submit a Police Clearance Certificate from their country of origin if they have lived in the U.K.
for less than six months.
9
Do you have a Police Clearance Certificate dated no longer Yes No
than three months before date of arrival in the UK?
If no, are you able to obtain one? Yes No
If you have answered no to the above question, we would be unable to proceed with
your application.
PART G: PRIVACY NOTICE
We only collect information that is required by law or is required for us to comply with
contractual obligations. Following the collection of the personally sensitive data, we ensure
that it is securely stored and only processed by trained staff who are aware of their personal
and our corporate responsibilities for complying with the GDPR.
We never share your personally sensitive information with persons outside of Cedar Care
unless we are obliged to do so (e.g. HMRC, Accountants for payroll purposes, CQC, or the
Safeguarding Adults Team for contact purposes to assist in investigations, etc.). Where
information is shared, we only share the information that is necessary to satisfy the purposes
for which it was shared.
Similarly, we only retain personally sensitive data for the minimum period and regular reviews
ensure that data is destroyed at the appropriate times.
By signing this document, you confirm your consent to us collecting, storing and
sharing when required, your personal data. You may withdraw your consent at any time,
but this may adversely affect our ability to continue your employment.
If you have concerns about our policy, in the first instance, you should contact the person who
has issued this form to you. If your concerns are not dealt with satisfactorily, you should
contact Mrs Minal Desai at [email protected], or by writing to her at Cedar
Care Homes, Mortimer House, Clifton Down Road, Clifton, BS8 4AE.
DECLARATION OF APPLICANT
I confirm that all the information in this application is correct to the best of my
knowledge. I realise that should any information prove to be false at a later date, this
could constitute grounds for withdrawal of any job offer.
10
Signed Dated
Print Name
OPTIONAL INFORMATION: EQUAL OPPORUNTITIES MONITORING
EQUAL OPPORTUNITIES IN EMPLOYMENT
Cedar Care does not discriminate, and our employment procedures ensure that we are
complying with Equal Opportunities Policies. To this end we would be grateful if you could
please fill in this questionnaire and return it with your application form. Your information will
remain confidential at all times. The information given is only used for statistical purposes
and is not a part of the selection process. Thank you for your co-operation in this area.
Application for post of
Please indicate your answer by ticking the appropriate box.
Sex Male Female
Date of birth
Marital status Single
Married
Divorced
Registered disabled Yes No
Any other disability Yes No
Have you any dependants Yes No
11
Please tick the box beside the Ethnic Group which you consider that you belong to. If you
wish, you can write further details beside the box. Please tick only one box.
White (UK & N. Ireland) Black (Caribbean)
White (Europe & Eire) Black (African)
Asian Oriental
Other
DOCUMENTS TO SEND OR BRING WITH YOUR APPLICATION
Tick If
DOCUMENT Essential Advised
available
PASSPORT X
BIRTH CERTIFICATE (If UK national with no
X
passport)
IDENTITY CARD X
UK DRIVERS LICENCE X
PROOF OF ADDRESS (i.e. Bank Statement, Utility
X
Bills, etc.)
PROOF OF PREVIOUS ADDRESSES (Last 5
X
years)
REFERENCES FROM LAST TWO EMPLOYERS,
IF NOT AVAILABLE TWO CHARACTER
X
REFERENCES FROM PEOPLE WHO ARE NOT
FRIENDS OR RELATIONS
CERTIFICATE OF SECONDARY EDUCATION X
CERTIFICATES OF HIGHER EDUCATION X
CERTIFCATES OF OTHER TRAINING X
CURRENT OR RECENT DBS CERTIFICATE
X
(Enhanced)
12
