Name: The Hollies
Address: Drake Lane, Dursley, GL11 5HA, GB
Telephone: 01453 541400

Position applied for
Date
Surname
First name
Address
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Home number
Day time number
Mobile number
Email
Work permit required?
YesNo
Do you consider yourself to have a disability?
YesNo
Do you hold a current clean driving licence
YesNo
If yes, please tell us if there are any ‘reasonable adjustments’ we can make to assist you in your application or with our recruitment process.
Type of licence
N.I. No.
Pin number (if applicable)

Employers name
Job title
Start date - Finish date
Employers address
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Duties/responsibilities
Salary / grade
Period of notice required
Reason for leaving

Employers name
Job title
Start date - Finish date
Address
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Duties/responsibilities
Reason for leaving

It may be useful to include details of any voluntary work or unpaid duties, which you may have performed, or any relevant training courses or seminars, which you may have attended.

Note that the rehabilitation of offenders act is not applicable, and all spent convictions must be noted. If you have no convictions or pending proceedings, you should write "none"

Name
Address
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Position held
Telephone

Name
Address
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Position held
Telephone
We will only contact with these referees after we seek your permission first.

I hereby certify that the information given on this application form is accurate and complete to the best of my knowledge and belief, and i am not aware of any other matters, which may materially affect my suitability for employment with The Hollies Care Centre. I understand that any wilful omission or inaccuracy is regarded as an act of gross misconduct, which may result in summary dismissal.

Open for New Residents