Date: |
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About Yourself: |
Title: |
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Full Name: |
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Address: |
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Post Code: |
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Date you moved into the above address: |
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email address: |
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Work Tel No (if appropriate): |
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Home Tel No: |
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Mobile phone No: |
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Age: |
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Date of birth: |
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Nationality: |
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Religion: |
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Marital status: |
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Do you have children? |
No
Yes
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If so how many and how old? |
How Many
Age(s)
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Name and address of last school attended: |
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Name and address of college attended: |
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Qualifications achieved and pass dates: |
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Do you drive? |
No
Yes
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Do you own your own car? |
No
Yes
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Do you have a full clean driving licence: |
No
Yes
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If ‘no' how many points and for what: |
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Do you smoke? |
No
Yes
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Can you swim? |
No
Yes
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Do you have any allergies? |
No
Yes
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If YES Please specify: |
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Are you in good health? |
No
Yes
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Are you on any medication? |
No
Yes
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If yes please specify medication: |
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Have you got any disabilities that should be taken into consideration? |
No
Yes
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If YES please specify: |
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Please list your hobbies and interests: |
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Do you speak any languages and if so which? |
No
Yes
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If YES which languages? |
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Do you have a first aid certificate? |
No
Yes
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If YES when is its expiry date: |
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Have you been convicted of any criminal
offences? |
No
Yes
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If YES please specify: |
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Have you had a recent CRB check? |
No
Yes
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If YES please specify who did it giving -
Date: |
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Address: |
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Telephone Number: |
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Please supply your reference number: |
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Present Employer -
References will not be taken until resignation has been given
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Present Employer's Name: |
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Present Employer's Address: |
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Present Employer's Telephone No: |
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Present Employer's Ages of Child/Children:
(seperate with comma)
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Reason For Leaving Present Employer: |
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Previous Employment - Please complete below details of your last four positions. If you are newly qualified please give as many as possible (babysitting jobs, summer jobs, etc) |
| Job 1 |
Job 2 |
From (dd/mm/yyyy): |
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From (dd/mm/yyyy): |
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To (dd/mm/yyyy): |
|
To (dd/mm/yyyy): |
|
Position held and age of charges: |
|
Position held and age of charges: |
|
Duties and salary: |
|
Duties and salary: |
|
Reason for leaving: |
|
Reason for leaving: |
|
| Job 3 |
Job 4 |
From (dd/mm/yyyy): |
|
From (dd/mm/yyyy): |
|
To (dd/mm/yyyy): |
|
To (dd/mm/yyyy): |
|
Position held and age of charges: |
|
Position held and age of charges: |
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Duties and salary: |
|
Duties and salary: |
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Reason for leaving: |
|
Reason for leaving: |
|
About The Job |
| Position required: |
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Full or Part time: |
Full time
Part time
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If part time what days would you prefer? |
|
| If you have your own children would you want to take them to work with you? |
No
Yes
|
| What age group do you prefer to work with? |
|
| Do you have experience with the following: |
|
| Are you experienced in the following: |
|
| Do you require a position offering use of a car? |
No
Yes
|
| Would you consider housework? |
No
Yes
|
| Would you consider
feeding pets? |
No
Yes
|
| Date able to start: |
|
| Salary expected: |
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| Please state which areas you are able to work in and how far you are prepared to travel: |
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References - Please state the names, addresses and telephone numbers of three referees below. Giving full details of position held, what duties were involved, number and age of child/children and how long you were in the position. |
| References 1 |
References 2 |
From (dd/mm/yyyy): |
|
From (dd/mm/yyyy): |
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To (dd/mm/yyyy): |
|
To (dd/mm/yyyy): |
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Referee Name: |
|
Referee Name: |
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Address & Telephone Number: |
|
Address & Telephone Number: |
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Position & Ages: |
|
Position & Ages: |
|
| References 3 |
References 4 |
From (dd/mm/yyyy): |
|
From (dd/mm/yyyy): |
|
To (dd/mm/yyyy): |
|
To (dd/mm/yyyy): |
|
Referee Name: |
|
Referee Name: |
|
Address & Telephone Number: |
|
Address & Telephone Number: |
|
Position & Ages: |
|
Position & Ages: |
|
| |
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The declaration below must be agreed by all applicants before they can be interviewed by Early Birds or any prospective employers. The ability to use an old Criminal Records Check lies solely with Early Birds or the prospective employer. Applicant will not be discriminated for reasons of sex, age, race or disability. DATA PROTECTION REGISTERED - Registration No PZ9065075 Under the Data Protection Act 1998, we are obliged to inform you that we hold information about your application on a database and you are entitled to view this data yourself when you request it in writing. (A charge may be required for administration).
DECLARATION
I declare that the information given above is, to the best of my knowledge, true and correct and that misleading statements may be sufficient for cancelling any agreements made.
Owing to the nature of the duties within the job I may be appointed to I also understand that I will be asked to sign a declaration which will include details of any criminal convictions, cautions, reprimands and final warnings and any other information that may have a bearing on my suitability for the post.
I understand that an Enhanced Disclosure may be sought in the event of my application to the agency being successful.
I give my permission for members of staff at Early Birds to discuss with any prospective employers information which has been given on this application form, within my CV, CRB check, any further information given as written or verbal references and anything discussed during my interview or in subsequent telephone conversations with Early Birds staff. |
I have read, understand and agree with the Declaration above: |
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