Your Personal Details
Residency & Work Permit Details
Current Position(s)
Hours you can work. (please TICK below as appropriate )
Skills & Qualifications
Further Education — Qualifications & Training
Experience, Skills & Competencies (Ratings: 1. Basic, 2. Fair, 3. Good, 4. High Level of Experience, 5. Expert in Field)
Languages (Ratings: 1. Basic, 2. Fair, 3. Good, 4. High Level of Experience, 5. Expert in Field)
Full Employment History — Attach additional sheets if required
Note. Be particularly careful to provide ALL previous employment or account for gaps in employment. College leavers must provide details of work experience during study or in vacations. Name & Address of Previous Employer Incl. Nature of business. Start with most recent first.
Supporting Statement
Please make full use of this section.
Please be sure to include: — The reasons why you are applying for this post. — Details of any relevant experience gained either at work or in a voluntary capacity. — Details of any relevant training/education you have.
People you have worked alongside often understand the day-to-day nature of your role better than a manager.
Please detail below the contact details of three former colleagues who can give a testimonial about your ability.
Declaration
I confirm that the information given by me in this application form is correct and that I have approached Serene360 Limited to assist me. I understand that the service is free to me and that any employer who you introduce me to, in either a Temporary, Contract or Permanent capacity, then has a legally binding contract to pay your charges. I will inform you immediately I am engaged through your introduction (up to 6 months of being introduced). I understand that being a party to any attempt to avoid payment of your charges could leave me open to criminal proceedings. I confirm I have received a copy of Terms of Engagement and agree to them. I wish my application to be dealt with by you and agree that the details on this form can be given to potential clients.
Disclosure and Barring Service (DBS) Checks
All applicants must answer all questions on this form. Failure to do so will render your application invalid. Because of the nature of work for which you are applying is to work with vulnerable people and/or children we have to complete an enhanced DBS check to see if you have any criminal convictions. Serene360 Limited assignments and jobs are exempt from the provisions of Section 4(2) of the Rehabilitation of Offenders Act 1974 (Exemptions) (Amendment) Order 1986. Applicants are, therefore, not entitled to withhold information about convictions, reprimands or final warnings which for other purposes are “spent” under the provisions of the Act. The information you give will be treated in confidence and only taken into account where, in the reasonable opinion of Serene360 Limited the offence is relevant to the post for which you are applying. Failure to declare a conviction may require us to exclude you from our register or terminate an assignment if the offence is not declared but later comes into light. Please note this information will only be provided to and checked with the police authorities after a recruitment interview has taken place.
I consent to the above information being checked with the police and I am aware that any “spent” convictions will be disclosed.
Code of Conduct & Confidentiality Agreement
I have read and understood the Professional Code of Conduct and have been issued with a copy. I will at all times adhere to the Code.
I agree that during the time I am engaged by SERENE360 LIMITED to work in any capacity of work — I will not disclose to any person, any information obtained whilst attending an assignment which is confidential. — I will hold in trust and confidence for SERENE360 LIMITED all such information, and never use it other than for the benefit of SERENE360 LIMITED.
Personal Health Questionnaire and Health & Safety Declaration
Do you or have you ever suffered from?
Not Corrected by Glasses *
Standing *
Chickenpox *
Nasal infection *
Please give dates of your last immunisation or vaccination
Personal Health Declaration
Working Time Directive
Opt Out of Maximum Hours
WTD 1998 says that you the Temporary Worker do not have to work on an Assignment with the Client in excess of the 48 hour Working Week unless you agree in writing that this limit should not apply.
Emergency Contact Details
Referees (x2)
Please give the details of your present employer and previous most recent employer. College leavers give names of lecturers/tutors/professors. If it is not possible due to no previous work experience provide names of persons best able to write a reference in support of your application. You must not give friends/relatives as referees.
Referee1
