Application for Work

Personal Details

Title *

First name *

Middle name

Last name *

Address *

Postcode *

Date moved in *

(mm/yyyy)

Tel *

Mobile

Email *

Confirm email *

DOB *

National Insurance no. *

Do you drive? *

Yes No

Public transport - please enter your preferred home station

Interested in which location? *

How did you hear about us? *

Emergency Contact

Emergency tel *

Next of kin name and relationship *

Address *

Postcode *

Please complete the entries below clearly stating your employment history for the last 5 years. Please note that all periods must be accounted for including maternity leave, unemployment, visits to other countries etc. Please ensure that you write the start month and year, and finish month and year for each job/ period of other undertaking. Please note that periods of over one month must be verified by a suitable professional person (e.g. Job centre plus official, doctor, teacher etc.)

Please provide as much detail as you can. We will need to contact these organisations to verify your work history.
Please start with the most recent first, and work chronologically backwards.
Please don't leave the 'date finished' field blank if still employed in this role.

Please provide at least 1 work history.
Please sign at the bottom to verify your work history and to give consent for us to contact the listed workplaces.

Career History 1

Date started *

Date finished

What were you doing?
(E.g. job title, unemployed, maternity) *

Organisation name *

Address *

Postcode *

Contact name *

Telephone / Fax *

Email

Career History 2

Date started

Date finished

What were you doing?
(E.g. job title, unemployed, maternity)

Organisation name

Address

Postcode

Contact name

Telephone / Fax

Email

I confirm that this is a true account of my career history and give my consent to contact the above named for references.

Professional Qualifications & Training

Please enter your professional qualifications into the fields below. Note, if unqualified please state 'unqualified'.

Professional qualification *

Where obtained *

Date from/to *

Please give the dates of training such as:

Child safeguarding course

COSHH and risk awareness updates

Lifting and handling

Food hygiene

Paediatric first aid

Other training

Other training date

Experience

Please tick if you have experience in each of the following areas.
You must have experience in at least 1 category.

Nursery baby room

Nursery toddlers

Nursery pre-school

LSA/SEN

Playwork - ASC/Playscheme

Cook

Cover supervisor

TA

Other

Rehabilitation of Offenders

The post that you have applied for is excepted from the Rehabilitation of Offenders Act 1974, which means all convictions, cautions, reprimands, spent convictions and final warnings on your criminal record need to be disclosed. Please be aware that an Enhanced Disclosure will be sought through the Criminal Records Bureau in the event of a successful application.

Only relevant convictions and other relevant information will be taken into account so disclosure need not necessarily be a bar to obtaining this position.

Have you ever been convicted by the courts or cautioned, reprimanded or given a final warning by the police? *

Yes No

If yes, please specify details

Offence

Where committed

Date from/to

Police Enquiries

Are you aware of any police enquiries undertaken following allegations made against you, which may have a bearing on your suitability for this post? *

Yes No

If yes, please specify details

Enquiry

Police Station

Date from/to

Name History

Have you used any other first or last names? If so, please specify.

Please note - It is important that you do not leave any date gaps between name changes.

Date from

Date to

Name

5 Year Address History

Have you changed address in the last 5 years.

Please note - It is important that you do not leave any date gaps between address changes.

Date from

Date to

Address

Postcode

Disqualification by Association Declaration

Bretsa are required to ask all employees to make a declaration about whether they are a disqualified person under the Childcare (Disqualification) Regulations 2009.

A person may be disqualified under the regulations because:

They have certain orders, directions or restrictions placed upon them in relation to children or childcare
They have been cautioned or convicted of certain offences
They live or work in the same household as someone who is disqualified

You are required to complete the declaration below confirming that you are not disqualified under these regulations.

Section 1 - Orders or other restrictions

Have any orders or other determinations related to childcare been made in respect of you or anyone else in your household? *

Yes No

Have any orders or other determinations related to childcare been made in respect of a child in your care? *

Yes No

Have any orders or other determinations been made which prevents you or anyone in your household from being registered in relation to childcare, children’s homes or fostering? *

Yes No

Have you had any changes in circumstances since your last DBS check was carried out? *

Yes No

Are you barred from working with children by the Disclosure and Barring Service (DBS)? *

Yes No

Are you prohibited from teaching? *

Yes No

Section 2 - Specified and Statutory Offences

Have you ever been cautioned, reprimanded, given a warning for or convicted of:

Any offence against or involving a child? (A child is a person under the age of 18) *

Yes No

Any violent or sexual offence against an adult? *

Yes No

Any offence under the sexual offences act? *

Yes No

Have you ever been cautioned, reprimanded, given a warning or convicted of any similar offence in another country? *

Yes No

Section 3 - Disqualification by Association

To the best of your knowledge is anyone in your household (family, lodgers, house sharers, household employees) disqualified from working with children under the Regulations, for any of the reasons in sections 1 and 2 above? *

Yes No

Section 4 - Provision of Information

If you have answered YES to any of the questions above you should provide details below in respect of yourself, or where relevant the member of your household: (You may provide this information separately if you wish, but you must provide this without delay).

Section 5 - Declaration

In checking this box, I confirm that the information provided is true to the best of my knowledge and that I will notify Bretsa immediately of any information that affects my suitability for working with children, including cautions, convictions, warnings, orders, and other determinations made in respect of me or a member of my house that would disqualify me from working with children. *

Bank Details

Please note - if you do not submit your details with your first timesheet there will be a delay in your payment

Bank name

Bank address

Account holder name

Account number

(8 digits)

Ref number

Sort code

(6 digits)

Eligibility to Work Within the UK

Are you legally eligible to work in the UK *

Yes No

If no, please specify details

Do you require a work permit? *

Yes No

If yes, please specify details

Do you have any endorsements in your passport which limit your stay or length of employment in the UK? *

Yes No

If yes, please specify details

Working Hours

Current law states that Bretsa Recruitment must limit your work to 48 hours per week unless you declare otherwise. You may refuse work at any time and will never be asked to work over 48 hours per week. However you may do so if you choose that the limit shall not apply to you. Bretsa Recruitment wishes to have an agreement with you.

It proposes an agreement (which will apply until terminated by notice) on the basis that:

The 48-hour limit on average weekly working time will not apply to you;
You may terminate the agreement (so that the 48-hour time limit would apply to you) by giving the person at the Company to whom you usually report 4 weeks written notice.

Under the Regulations, the Company must keep records relating to your working time.
This is the case whether or not you reach an agreement with the company about waiving time limits.

Please read the statement below and delete as appropriate:
I agree to opt out of the limit of 48 hours per week *

Yes No

Health and Disability

The following questions on health and disability are asked in order to find out your needs in terms of reasonable adjustments to access our recruitment service and to find out your needs in order to perform the job or position sought.

Do you have any health issues or a disability relevant to the position or role you seek?

Yes No

If yes, please specify

If you have a disability, what are your needs in terms of reasonable adjustments to enable you to perform the role sought?

Please specify

If you have a disability, what are your needs in terms of reasonable adjustments in order to access this recruitment service and to attend interview, or to take aptitude tests etc?

Please specify

Do you currently take any medication?

Yes No

If yes, please specify

Curriculum Vitae

Please upload an up to date CV - simply browse and choose your recent CV then press upload.

Previous Agency Placements Since 1st October 2011

Since 1st October 2011, have you worked for the same nursery, school or setting for more than 12 weeks without taking a break of at least 6 weeks?

If yes, please state the agency, nursery/school/setting name, dates (mm/yyyy) and duration of placements.

Application for work

Personal Details

Emergency Contact

5 Year Career History

Career History 1

Career History 2

Professional Qualifications & Training

Experience

Rehabilitation of Offenders

Police Enquiries

Name History

5 Year Address History

Disqualification by Association Declaration

Section 1 - Orders or other restrictions

Section 2 - Specified and Statutory Offences

Section 3 - Disqualification by Association

Section 4 - Provision of Information

Section 5 - Declaration

Bank Details

Eligibility to Work Within the UK

Working Hours

Health and Disability

Curriculum Vitae

Previous Agency Placements Since 1st October 2011

Data Protection Statement

Declaration

Terms and Conditions