Online Application - May 2019 The White House Nursery Job Application Form Question Title * 1. Which nursery are you applying for? Alfreton Alvaston Borrowash Kids Club - Spondon Oakwood Any OK Question Title * 2. Position applied for? Apprentice Nursery Nurse Senior Nursery Nurse Deputy Manager Manager Cleaner Cook Other (please specify) OK Question Title * 3. Personal Details Name Address Address 2 City/Town ZIP/Postal Code Email Address Phone Number OK Question Title * 4. Do you have a valid driving license? Do you have any endorsements? OK Question Title * 5. Are there any restrictions on you taking up employment in the UK? Yes No Other (please specify) OK Question Title * 6. School attended - include dates OK Question Title * 7. Qualifications gained at school OK Question Title * 8. College and/or university - include dates OK Question Title * 9. Qualifications gained at College/university OK Question Title * 10. Any further formal training OK Question Title * 11. Job related training courses - include dates OK Question Title * 12. Qualifications gained OK Question Title * 13. Name of current/last employer OK Question Title * 14. Address of current/last employer OK Question Title * 15. Current/last job title OK Question Title * 16. Description of duties at current/last job OK Question Title * 17. Reason for leaving your current/last job OK Question Title * 18. Length of service at your current/last job OK Question Title * 19. Notice required in current post (if applicable) OK Question Title * 20. CURRENT MEMBERSHIP OF PROFESSIONAL BODIES (i.e. CIPD, NMC) OK Question Title * 21. Please note any other employment you would continue with if you were to be successful in obtaining this position. OK Question Title * 22. References 1 Name Company Address City/Town ZIP/Postal Code Phone Number OK Question Title * 23. References 2 Name Company Address City/Town ZIP/Postal Code Phone Number OK Question Title * 24. Medical details - If you are offered employment, you will be required to complete a Pre-Employment Medical Questionnaire OK Question Title * 25. Interests, achievements, leisure activities (e.g. hobbies, sports, club memberships) OK Question Title * 26. Supplementary information - Describe the relevant experience, skills and knowledge you can bring to this job and further information to support your application, e.g. past achievements, future aspirations, personal strengths. (please add extra sheets, if required) OK Question Title * 27. Do you have any criminal convictions? OK Question Title * 28. Do you live in a household where any other person has received any convictions, cautions, court orders, reprimands or other grounds for disqualification from the registration under the childcare (disqualifications 2009) OK Question Title * 29. Are there any dates that you would be unavailable for interview in the next 3 weeks? OK Question Title * 30. I confirm that the above information is complete and correct and that any untrue or misleading information will give my employer the right to terminate any employment contract offered without notice. Yes No OK Question Title * 31. Should we require further information and wish to contact your doctor with a view to obtaining a medical report, the law requires us to inform you of our intention and obtain your permission prior to contacting your doctor. I agree that the organisation reserves right the right to require me to undergo a medical examination. In addition, I agree that this information will be retained in my personnel file during employment and for up to six years thereafter and understand that information will be processed in accordance with the Data Protection Act. Yes No OK Question Title * 32. I agree that should I be successful in this application, I will, if required, apply to the DBS/Disclosure for an Enhanced disclosure. I understand that should I fail to do so, or should the disclosure not be to the satisfaction of the company any offer of employment may be withdrawn and/ or my employment terminated without notice. Yes No OK DONE