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Personal Details

First Name *

Last Name *

Email Address *

Mobile Number *

Do you currently work for us? *

Upload your CV *

Address Information

Street Address *

City *

County *

Country *

Postcode *

Additional Information

Please give a supporting statement detailing how you meet the essential criteria for the role and how you would demonstrate the Derian Values if you were successful in applying for this role (further supporting documents can be uploaded at the end of this section) *

Please tell us why you want to work for Derian House *

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Registered Professionals: Please indicate your professional body and registration number (eg NMC/GMC)

Do you have a current driving licence? * Yes No

Rehabilitation of Offenders Act 1974

Because of the nature of the work for which you are applying the post is exempt from the provisions of this Act. Applicants are not entitled to withhold information about convictions which, for other purposes are ‘spent’ under the provisions of the Act.

In event of employment, failure to disclose any such convictions could result in dismissal or disciplinary action being. Any information given will be treated as confidential and will be considered in relation to an application for positions to which the Exemption Order applies.

Please indicate if you have any relevant spent cautions or convictions. (This information will only be used if you are successful in your application when the relevant DBS check is completed) * Yes No

Asylum Immigration Act 1996

The Asylum and Immigration Act 1996 makes it a criminal offence for us to employ those who do not have permission to live or work in the UK. Applicants will be required to provide documentary evidence of their right to work in the UK if invited for interview.

Do you have the right to live and work in the UK? Yes No

NI Number

Employment of Friends and/Or Relatives

To ensure equitable treatment of all employees, avoid possible conflicts of interest and prevent any perceived partiality during the recruitment / promotion process, Derian House has a policy to prevent the employment of relatives or close friends in certain circumstances. For example relatives or friends shall not work for the same supervisor/manager or in the same team/office/shift.

Please indicate below if you have a friend and/or relative who works for Derian House

Please indicate below if you have a friend and/or relative who uses Derian House Services

About My Application

I confirm I have the right to work in the UK
I confirm that my details are complete and correct
I confirm I have read and agree to Derian House Children's Hospice privacy policy