Shops - St Elizabeth Hospice

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Vacancy Title

Personal details

Full name:*

First Last

Address:*

Street Address Address Line 2 City Postcode Country

Contact telephone number:

What time of day would you like us to call you?

Email address:*

Enter Email Confirm Email

Date of birth (if you are under 18)

Preferred Pronouns*

He/Him

She/Her

They/Them

Other

If Other, please tell us your preferred pronoun

References

Please supply contact details of two referees who must be over 18, not a relative and have been known to you for at least two years. Your referee can be a neighbour, friend or colleague (past or present). We will contact referees as part of the application process, it is hospice policy not to offer a formal start date until two satisfactory references have been received. We will request a professional reference for certain roles.

Reference 1 – Full Name:*

First Last

Job Title

Organisation

Address:

Street Address Address Line 2 City Postcode Country

Telephone number:

Email address:

Enter Email Confirm Email

Reference 2 – Full Name:*

First Last

Job Title:

Organisation:

Address:

Street Address Address Line 2 City Postcode Country

Telephone number:

Email address:

Enter Email Confirm Email

Criminal convictions/Probity declaration

Because of the nature of the work undertaken by St Elizabeth Hospice, we require you to answer the following questions. In the event of employment, any failure to disclose such convictions could result disciplinary action or dismissal by the hospice. Any information given will be completely confidential.

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 (as amended in 2013) by SI 2013 1198 as set out at http://www.legislation.gov.uk/uksi/2013/1198/pdfs/uksi_20131198_en.pdf.

Do you have any convictions?

Yes

Have you ever been disqualified from the practice of a profession or required to practise under specific limitations?

Disqualified?

Yes

Are you the subject of any current investigation or proceedings by a professional or regulatory body in the UK or any other country?

Subject of any current investigation?

Yes

Has your employment or contract ever been terminated or suspended – in the UK or abroad – on grounds relating to your fitness to practise (conduct or performance)?

Has your employment or contract ever been terminated or suspended

Yes

General Data Protection Regulations 2018

This application form has been designed to provide us with sufficient basic information to carry out a preliminary assessment of your suitability for the post. The information you supply in this form is confidential and will only be used by those involved in the appointment in line with the General Data Protection Regulations 2018. For further information please refer to the GDPR information for job applicants and the hospice’s privacy notice which can be found on the website.

Declaration

By ticking below, I confirm that the information given on this form is, to the best of my knowledge, complete and correct. I understand that any incorrect or incomplete information may lead to my application being refused. I confirm that I am legally eligible for a volunteering role in the UK (if you are eligible to work in the UK, you are eligible to volunteer). I understand that if I am accepted as a volunteer, my details will be held on a secure database for St Elizabeth Hospice use only..

Declaration*

I Confirm

Volunteer: Application Form for Shops

Personal details

Personal statement

References

Criminal convictions/Probity declaration

Declaration

Volunteer: Application Form for Shops

Personal details

Personal statement

References

Criminal convictions/Probity declaration

Declaration

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