Welfare Visit Report

ROYAL MASONIC BENEVOLENT INSTITUTION

APPLICATION FOR EMPLOYMENT

Private and confidential

Please write in block letters, using black ink, or type Where necessary, continue your answers on a separate sheet of paper Please note that failing to complete the application form in full could automatically render your application unsuccessful

1: ABOUT THE POST

Which post are you applying for?

2: ABOUT YOU

Surname: Title:

Forename/s: Address: Post Code: Telephone number (home): Telephone number (mobile): Email address:

3: EDUCATION

Please include address details for education establishments – General Education and Further Education

General Education / Establishment / Course Level Grade Start / Finish Date

Further Education / Establishment Qualification Grade/Class Start / Finish Date

P.I.N. registration number and dates (if applicable) P.I.N : Date achieved:

RMBI APPLICATION FOR EMPLOYMENT 4: YOUR CURRENT/MOST RECENT EMPLOYER

Address: Post Code: Telephone number: Current post title: Brief description of duties:

Date Date employment ended (if applicable): appointed: Current pay £ per hour / annum (delete one) Period of notice required to give to current employer:

5: EMPLOYMENT HISTORY

Please provide details of your full employment history from leaving full time education to present with details of any gaps, listing the most recent first. - Please use a continuation sheet where necessary

RMBI APPLICATION FOR EMPLOYMENT Name and address of Dates Position held Pay/Benefits Reason for leaving past From employers To

6: RIGHT TO WORK

Do you have YES NO the right to If yes, please detail what type of right to work you have (e.g. British Passport, Student Visa, etc.):

7: REFERENCES

Please provide details of referees (someone in a managerial position or from Human Resources) covering the last five years of your employment history. recent employer. If you have any gaps in your employment history in the last five years or any of your employers have ceased trading please also provide full details of a character referee who has preferably known you for five years – Please use a continuation sheet where necessary

Referee 1 Referee 2

Name: Name: Company Company Name: Name: Job Title: Job Title: Address: Address:

Postcode: Postcode:

RMBI APPLICATION FOR EMPLOYMENT Telephone Telephone number: number: Work Email Work Email address: address: May this referee be approached prior to interview?

YES NO

8: REHABILITATION OF OFFENDERS

As an organisation using the Disclosure & Barring Service (DBS) to assess applicants’ suitability for working with vulnerable adults, the RMBI complies with the guidance given by the DBS Code of Practice. A copy of the Code of Practice is available on request from the interviewing manager. Certain occupations are exempt from the Rehabilitation of Offenders Act, the relevant exemption is: Any office or employment concerned with providing care services to vulnerable adults which would normally enable access to vulnerable adults The amendments to the Exceptions Order 1975 (2013) provide that certain spent convictions and cautions are “protected” and are not subject to disclosure to employers, and cannot be taken into account. Guidance and criteria on the filtering of these cautions and convictions can be found on the Disclosure and Barring Service website.

In accordance with the above, do you have any convictions, cautions, reprimands or final warnings that are not “protected” as defined by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (as amended in 2013) by SI 2013 1198?

YES NO

9: WHY ARE YOU A This is an opportunity to draw attention to aspects of your career, training courses attended, interests, ambitions, etc. which make you suitable for a post in this field – please use a continuation sheet where necessary.

RMBI APPLICATION FOR EMPLOYMENT 10: DECLARATION

I understand that for the purposes of the Data Protection Act 1998, information on my application will be used for the purposes of Human Resources records and payroll. My details may be passed to the relevant third party agencies for payroll purposes. Sensitive data will only be used for monitoring purposes to meet the RMBI’s legal obligations such as equal opportunities. The information given in this application is, to the best of my knowledge, true and accurate. I understand that any false declarations may lead to the withdrawal of a job offer or termination of employment. I allow the RMBI to undertake the necessary regulatory checks needed to undertake my role at the time of recruitment and any subsequent checks thereafter. I also authorise the RMBI to copy and securely store my enhanced Disclosure & Barring Service (DBS) disclosure certificate. I do (tick box) subscribe to the DBS Update Service and allow the RMBI to receive up to date information in relation to my enhanced criminal record DBS disclosure certificate for the purposes of asking an exempted question for a prescribed purpose within the meaning of section 113B of the Police Act 1997.

Signature of applicant:

RMBI APPLICATION FOR EMPLOYMENT