Tel: (01429) 870247
Estate Office, Greatham, Hartlepool, TS25 2HS

Job Application Form

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A. Personal Particulars

Can we contact you at work?

Do you have the right to work in the United Kingdom?

B. Education and Qualifications

QUALIFICATIONS: Please give details of examinations attempted and results (including any examinations failed).

Please list the most recent qualifications first.

FURTHER AND HIGHER EDUCATION: Please give details of all further and higher education since leaving school including training courses and details of qualifications.

Start with most recent education.

PROFESSIONAL ASSOCIATIONS: Please state whether you are a member of any technical or professional association, and if so, which:

FOREIGN LANGUAGES: Please list any foreign languages you speak and your level of competence, both oral and written:


Please list starting with the most recent, all the organisations for which you have worked during the last 20 years:

Please explain any gaps in employment.


Please give details of any experience, skill or achievements which you feel may be relevant in your application for employment.

Are you currently subject to any contractual "restraints of trade" clauses?

Do you have any commitments which might limit your working hours?

Are you willing to work overtime and weekends when required?

Have you ever received a police warning/caution, or have committed a criminal offence?

Have you worked for us before?

Do you have a full driving licence?

Does your licence have any current endorsements?


Please give the names and addresses of two referees who are not related to you, who we can approach for a confidential assessment of your suitability for this job.

Can we approach your present/most recent employer?

May we contact the employer BEFORE an offer is made?


By submitting this form I agree with the statements given below.

I confirm that the above information is correct.

I understand that any false information or deliberate omissions will disqualify me from employment or may render me liable for dismissal.

I consent to the Organisation using and keeping information I have provided on this application or elsewhere as part of the recruitment process and/or personal information supplied by third parties such as referees, relating to my application or future employment. I understand that the information provided will be used to make a decision regarding my suitability for employment and if successful the information will be used to form my personnel record and will be retained for the duration of my employment. If I am not successful, I understand that the Organisation will retain the form for as long as is deemed necessary and that the Organisation may use it to contact me in the event of there being any other vacancies for which I may be suitable.

Hospital of God

Estate Office, Greatham, Hartlepool, TS25 2HS
Tel: (01429) 870247    Fax: (01429) 871469

Registed Charity Number 1123540 Registed Company Number 6533385
Registered in England and Wales