The Royal Alfred | Application Form

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Please note the information you submit here will be emailed to our HR team and used only to process your application. It will only be sent to the third parties mentioned in the application form, which is necessary to complete your application. Your data will be stored confidentially on our secure server and not be used for marketing purposes. We treat submission of this application form as acknowledgement of and agreement with this notice.

Application for employment

Step 1 of 12

Personal Information
Application for the post of:*
Title*
- Mr
- Mrs
- Miss
- Ms
- Other
If you have chosen 'Other' please clarify here:
Forename(s) in full:*
Surname:*
Home address:*
Postcode:*
Full home telephone number:*
Mobile telephone number:
Full work telephone number:
Email address:
Are there any restrictions on your right to work in the UK?*
If ‘Yes’, please give details:
National insurance (NI) number:*
Registered Nurse Only:
NMC PIN number:
NMC expiry date:

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Present or Most Recent Employment
Job title:*
Employer's name:*
Employer's address:*
Postcode:*
Date commenced:*
Present salary:*
Length of notice required:*
Reason for wishing to leave:*
Please detail the duties and responsibilities of your present/most recent job. Indicate to whom you are/were responsible and those responsible to you:*

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Previous employment
Employer's name and address:*
Position held:*
Date from:*
Date to:*
Reason for leaving:*
Additional previous employment
Employer's name and address:
Position held:
Date from:
Date to:
Reason for leaving:
Untitled

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Skills, knowledge and experience
Please demonstrate your ability to meet the requirements of the job by giving clear, concise examples following the criteria in the job description. You may use relevant examples from paid work, voluntary work or other activities outside employment.
Please provide your response here:*

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Core values of care
Belvedere House aims to provide its residents with a secure, relaxed, and homely environment in which their care, wellbeing and comfort is of prime importance.

The document below outlines our core values of care and our team worker values, which underpin everything we do at the Home. Please read these carefully before answering the next question.
Download our core values of care and team worker values.
Your approach to this role
With reference to the Royal Alfred’s core values of care and team worker values, please write below a statement demonstrating your approach to the above qualities, giving examples of how you would incorporate them into your working day.
Statement demonstrating your approach:*

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Training
Please give details of any training you’ve received or courses you’ve attended which you consider to be relevant to your application.
Please provide details:*

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First referee (Current or most recent employer)
Please submit the details of at least two references.

Please note: family or friends aren’t acceptable as referees.
Name:*
Address:*
Postcode:*
Phone number:*
Fax number:
Email:
Position / job title:*
Second referee (Previous employer)
Name:*
Address:*
Postcode:*
Phone number:*
Fax number:
Email:
Position / job title:*
Additional referee (Previous employer)
Name:
Address:
Postcode:
Phone number:
Fax number:
Email:
Position / job title:
Untitled

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Disabilities
Do you have any disabilities which we should be aware of?*
If ‘Yes’, please describe any special arrangements you may require to enable you to attend/undertake tests or the interview:*

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Criminal Convictions
Belvedere House is committed to safeguarding and promoting the welfare of its residents and expects all staff to share that commitment.

As the job for which you are applying involves substantial opportunity of access to vulnerable adults, it is exempted from the provisions of the Rehabilitation of Offenders Act 1974 (Exemptions) Order 1975. Therefore, you are required to disclose any and all current or ‘spent’ criminal convictions, cautions, reprimands, bind overs or warnings you may have incurred, regardless of how long ago.

Any information given will be treated in confidence and used only in connection with this application. Belvedere House complies fully with the DBS Code of Practice regarding the correct handling, use, storage, retention and disposal of disclosures and disclosure information. It also complies fully with its obligations under the Data Protection Act 1998 and other relevant legislation pertaining to the safe handling, use, storage, retention and disposal of disclosure information.

All applicants who are offered employment will be subject to an Enhanced Disclosure check from the Disclosure and Barring Service (DBS) before their appointment is confirmed.

The disclosure of a current or spent conviction does not necessarily mean that your application will not be progressed or that an offer of employment cannot be confirmed, however failure to disclose something which later appears on your DBS Disclosure Certificate could result in an offer of employment being withdrawn or dismissal if already employed. The main consideration will be whether the nature or timing of the offence makes you unsuitable for work within a social care environment.

In addition to this disclosure, you are also required to declare to Belvedere House if you later become convicted of any criminal offence or become subject to any investigation regarding safeguarding issues at any time during your employment.

Please complete the criminal convictions declaration below.
Do you have any criminal convictions or cautions, either considered spent or otherwise?*
Declaration A
I have no criminal convictions or cautions, either considered spent or otherwise.
Type your full name:*
Dated*
Declaration B
I have the following criminal convictions or cautions.

Please give details in the box below, including:
1. The dates and nature of offences
2. Sentence received and circumstances surrounding the conviction
3. Any other information you feel we should know about, e.g. incidents with police involvement
4. Details of any current criminal investigations or pending prosecutions
5. Details of any investigations under Adult Protection/Safeguarding procedures
Please provide a response here:
Type your full name:*
Dated*
Safeguarding
Have you ever been the subject of a safeguarding enquiry?
Are you, or have you previously, been included on the DBS or ISA adults’ barred list?
If ‘Yes’, please give details:

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Close relatives
Are you, to your knowledge, related to any existing employee, Board member or resident of The Royal Alfred Seafarers’ Society?
If ‘Yes’, please give details:

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Other Information
Where did you see this post advertised?*

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Declaration
I declare that all the information I have given on this application form is true to the best of my knowledge and belief. I understand that my application will be subject to compliance with the Asylum and Immigration Act. I declare that by personally completing and submitting this application form I hereby give express consent for The Royal Alfred Seafarers’ Society to process these details as appropriate for my application. I understand that either withholding or giving false information will disqualify my application, or, if discovered after appointment, may be grounds for dismissal.
Signed:*
Dated*
Email
This field is for validation purposes and should be left unchanged.

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Work with us

Application for employment

Step 1 of 12

Personal Information

Registered Nurse Only:

Present or Most Recent Employment

Previous employment

Additional previous employment

Skills, knowledge and experience

Core values of care

Your approach to this role

Training

First referee (Current or most recent employer)

Second referee (Previous employer)

Additional referee (Previous employer)

Disabilities

Criminal Convictions

Declaration A

Declaration B

Safeguarding

Close relatives

Other Information

Declaration

Head Office
at Weston Acres

Care Team
at Belvedere House

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