Application Form

Please ensure that you complete the application form in full as we cannot accept CVs. Please complete with black ink and block capitals. This form will be kept in confidence. Please note that no applicant will be unfairly discriminated against. This includes discrimination on account of age, cultural, religious, political beliefs, disability, ethnicity, gender, race, relationship status, sexual orientation, and / or Trade Union membership or stewardship. If you have any special requirements to support you to complete this form (e.g. the need for large print or additional time), please contact the Registered Manager.
Work Preference
Full Time Part Time Bank Hours Requested: 4 Hrs / week
I understand this role may include: Shift work, Unsociable Hours, Lone working involved.
(Please check your availability below)

Personal Details

Are you a driver?
Do you Own Transport?
Any Endorsements?
Are you a United Kingdom (UK), European Community (EC), European Economic Area (EEA) National
Are you related to any of our current members of staff or Service Users?
impairment that has a “substantial” and “long-term adverse effect” on your ability to carry out normal day-to-day activities. Further information regarding the definition of disability can be found at: 2010.


*(All qualifications will be subject to a satisfactory check).

Training Courses attended or completing (evidence of attending courses is required)

Professional Memberships / Registrations

Employment History

Please record below the details of your full employment history beginning with your current or most recent first. Any gaps must be explained. Use a separate attached sheet if required; please sign the sheet(s)

Current / Most recent employer

Work Address

Current / Most recent employer

Work Address
Please email if require to provide more experience


Please provide names, addresses and telephone numbers for referees below who we may approach for a reference. You must provide references from your two most recent employers. In line with CQC requirements, we require references covering your last five years employment. If you have not had more than one employer in the last five years, we require a further reference. Please provide two character references if you are unable to obtain two professional references, e.g. in the case of an applicant who has been raising children for ten years. All will be contacted, therefore, please inform the referees of the fact that you have used their name. If you are unable to provide the required references, please discuss the matter with us.

Reference One


Reference Two


Safeguarding / Ex-Offenders Declaration

Please note this section will only be seen by those involved in the recruitment process and will be treated with the strictest confidence.
The Rehabilitation of Offenders Act 1974 aims to promote equality of opportunity and is committed to treating all applicants fairly regardless of ethnicity, disability, age, gender or gender re-assignment, religion or belief, sexual orientation, pregnancy or maternity and marriage or civil partnership. Saffron Support Ltd undertakes not to discriminate unfairly against applicants on the basis of a criminal conviction or other information declared. Answering 'yes' to the question below will not necessarily prevent your employment. This will depend on the relevance of the information you provide in respect of the nature of the position and the particular circumstances.
Are you currently bound over or do you have any current <b>UNSPENT</b> convictions that have been issued by a Court or Court-Martial in the United Kingdom or in any other country?
Do you have any current UNSPENT police cautions, reprimands or final warnings in the United Kingdom or in any other country?

Privacy Statement

We will only collect data for specified, explicit and legitimate use in relation to the recruitment process. By signing this application form, you consent to holding the information contained within this application form. If successfully shortlisted, data will also include shortlisting scoring and interview records. We would like to keep this data until the vacancy is filled. (We cannot estimate the exact time period, but we will consider this period over when a candidate accepts our job offer for the position for which we are considering you). When that period is over, we will either delete your data or inform you that we would like to keep it in our database for future roles. We have privacy policies that you can request for further information. Please be assured that your data will be securely stored by the Registered Manager and only used for the purposes of recruiting for this vacant post. You have a right for your data to be forgotten, to rectify or access data, to restrict processing, to withdraw consent and to be kept informed about the processing of your data. If you would like to discuss this further or withdraw your consent at any time, please contact the Registered Manager to discuss.


The information in this application form is true and complete. I agree that any deliberate omission, falsification or misrepresentation in the application form will be grounds for rejecting this application or subsequent dismissal if employed. Where applicable, I consent that can seek clarification regarding professional registration details.
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