Online job application form

1 - Details of Position
Position you wish to apply for*
Location*
Job reference number

2 - Personal Details
Title*
First name (s)*
Surname*
Home telephone*
Mobile*
Email address*
NI number*
Home address*
Town*
Postcode*

3 - General Information
Have you been, or are you currently employed by MHC?*
If YES, please give job title, dates and reason for leaving*
Do you have an existing relationship with any MHC employee?*
If YES, please give details of person, and relationship*
Do you hold a current driving licence?*
Do you have any current endorsements?*
If YES, please give details of endorsements*
Where did you hear about this role?*
Please tell us where you heard about this role*
Refer a Friend (please state the name of the existing employee and department that they work in)*

4 - Safeguarding

This section of the application form will only be viewed by those who need to see it as part of the recruitment process. Any information disclosed will be treated strictly confidential.
You are required to declare all current ‘unspent’ criminal convictions or cautions (including reprimands and final warnings). You are not required to disclose convictions or cautions which have become 'spent', unless you are applying for a position involving regular contact with children or vulnerable adults. These roles may be eligible for a Disclosure and Barring Service (DBS) check which might be 'Standard' or 'Enhanced'.
Answering 'yes' to the question below will not necessarily bar you from appointment. This will depend on the relevance of the information you provide in respect of the nature of the position for which you are applying and the particular circumstances.
Before you complete the question(s) below please read guidance and criteria for the filtering of these convictions and cautions which can be found on the Disclosure and Barring Service website at: www.gov.uk/government/organisations/disclosure-and-barring-service
Do you have any 'unspent' convictions?*
If YES, please give full details of your 'unspent' convictions*
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 (Amendment) (England and Wales) Order 2013?*
If YES, please give full details of your convictions, cautions, reprimands or final warnings*
Are you currently bound by any barring decision made by the Disclosure Barring Service (DBS) from working with vulnerable adults?*
If YES, please give full details of the barring decision (vulnerable adults)*
Are you currently bound by any barring decision made by the Disclosure Barring Service (DBS) from working with children?*
If YES, please give full details of the barring decision (children)*

5 - Education and Professional Qualifications

Please provide the following. All qualifications disclosed will be subject to a satisfactory check.
Add as many rows as you need by clicking the + icon.
Qualifications
Subject Place of study Grade or result Year obtained or expected

6 - Relevant Training Courses Attended

Please provide details regarding training courses that you are currently undertaking or have completed.
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Courses
Course title Training provider Duration Year obtained or expected

7 - Membership of Professional Bodies (if applicable, please go to next section if not)

Certain roles within MHC can only be carried out by people with a UK professional registration, i.e. with the General Medical Council (GMC), Nursing and Midwifery Council (NMC), Health and Care Professions Council (HCPC) etc. Roles that require these registrations will state this within the Person Specification. Any offer of employment will be subject to confirmation of professional registration where applicable.
If the position you are applying for does not require you to have a professional registration, then you do not need to fill out this section of the form.
If you have a current UK Professional Registration please complete all of the following
Professional body and membership Membership registration Registration PIN Expiry or renewal date
Are you currently the subject of a fitness to practice investigation or proceedings by a licensing or regulatory body in the UK or in any other country?
If YES please state reasons why*
Have you ever been removed from the register or have conditions or undertakings been made on your registration by a fitness to practice committee or the licensing or regulatory body in the UK or in any other country?
If YES please state reasons why*

8 - Employment History

Please include details of your CURRENT and PAST employment history, including ALL gaps in unemployment. If required, please provide additional information regarding your employment history within the 'Supporting Information' section.
Current job title (if unemployed please state)*
Present employer name
Line manager
Address of employer
Postcode of employer
Date you started
Date you finished (if applicable)
Salary or wage
Notice period
Reason for leaving (if applicable)
Brief description of your duties and responsibilities
Employment History (Please state your PAST employment history, including ALL gaps in unemployment)*
Employer name or employment gap Position Date started (MM/YY) Date finished (MM/YY) Duties Reason for leaving or reason for employment gap
Please include information about any employment gaps should this not be stated on your CV or above. This is a mandatory requirement.
Upload a copy of your CV (Word, Text File, PDF)
Drop files here or

Accepted file types: txt, doc, docx, pdf, Max. file size: 8 MB, Max. files: 2.
Other Supporting Documents
Drop files here or

Accepted file types: txt, doc, docx, pdf, Max. file size: 8 MB, Max. files: 5.

9 - Reference Request

Please provide the names and full contact details of the people who have agreed to supply references. References must include at least two positions with separate employers, one from your current employer and one from your previous employer. As a minimum these references must cover a period of three years employment and/or training history, where this is possible.If you have not been in employment for a considerable amount of time but have had previous employment, then you should seek one reference from your last known employer and a personal reference from a person of standing within your community such as a doctor, solicitor or MP. Where it is genuinely not possible to obtain references from any of the sources outlined above, you must provide contact details of two personal acquaintances who would be willing to give a reference. Personal acquaintances must not be related to you, or have any financial arrangement with you.Please note that all reference requests will be followed up and verified by MHC. Referees may be approached prior to interview, unless you indicate otherwise below.

Reference 1
Type of reference (current employer, previous employer, character reference)*
Name of referee 1*
Relationship to applicant*
Referee job title (If applicable)
Company name (If applicable)
Address*
Postcode*
Contact telephone number*
Email address*
Can this referee be approached prior to interview?*
Reference 2
Type of reference (current employer, previous employer, character reference)*
Name of referee 2*
Relationship to applicant*
Referee job title (If applicable)
Company name (If applicable)
Address*
Postcode*
Contact telephone number*
Email address*
Can this referee be approached prior to interview?*

10 - Supporting Information

In this section you need to demonstrate that you have read the published person specification and how you meet the essential and (where relevant) desirable criteria for this particular post, if this has not been fully covered in the previous sections.

Please include your reasons for applying and take the opportunity to highlight your particular talents and strengths, (what you feel you can personally offer - what is unique to you - what sets you apart from your peers).

Please DO NOT include personal details or duplicate information already provided elsewhere in your application.
Supporting information

11 - Declaration

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 by the organisation. Where applicable, I consent that MHC can seek clarification regarding professional registration details.
I agree to the above declaration*
Phone
This field is for validation purposes and should be left unchanged.

Step 1 of 11

1 - Details of Position

2 - Personal Details

3 - General Information

4 - Safeguarding

5 - Education and Professional Qualifications

6 - Relevant Training Courses Attended

7 - Membership of Professional Bodies (if applicable, please go to next section if not)

8 - Employment History

9 - Reference Request

Reference 1

Reference 2

10 - Supporting Information

11 - Declaration

For more information on working for MHC, please call our recruitment admin team on 01824 790600 or click this link to send us an email

Subject	Place of study	Grade or result	Year obtained or expected

Course title	Training provider	Duration	Year obtained or expected

Professional body and membership	Membership registration	Registration PIN	Expiry or renewal date

Employer name or employment gap	Position	Date started (MM/YY)	Date finished (MM/YY)	Duties	Reason for leaving or reason for employment gap