Online Application Form

Position Applied for:*
If you take up employment with East Cheshire Hospice, this form will be kept on your personnel file, and some details (personal information, qualifications, employment) will be held on the Personnel Information System. Personal information requested for Disclosure and Barring Service purposes, will be retained securely only if it is relevant for the application process/ compliance with the Asylum and Immigration Act 1996. East Cheshire Hospice is an inclusive employer and seeks to provide equality of opportunity for all.
Personal details
Name*
Forename(s): Surname/family name:
Preferred Name
(if applicable)
Middle/Other Names
(if applicable)
Home Tel No:*
Mobile Number:*
Email Address:*
Home Address*
Street Address Address Line 2 Town/City County Postcode Country
Are you eligible to work in the UK?*
- Yes
- No
Do you possess a full UK driving licence?
- Yes
- No

Employment History
Please record below the details of your previous employment, (minimum of 3 years employment history required), beginning with the most recent first. Please record the details of your current or most recent employer.
Most Recent Previous Employer
Employers Name:
Employers Address:
Street Address Address Line 2 Town/City County Postcode Country
Job Title
Type of Business
Leaving Date (if applicable)

Day
Month
Year
Period of Notice
Reason for Leaving
Description of duties and responsibilities
Previous Employer 2
Job Title and Employer
Start Date
Day
Month
Year
End Date
Day
Month
Year
Reason for Leaving
Brief Description of Duties and Responsibilities
Previous employer 3
(Please list most recent first)
Job Title and Employer
Start Date
Day
Month
Year
End Date
Day
Month
Year
Reason for Leaving
Brief Description of duties and responsibilities

Subject/qualification	Place of study	Grade/result	Year Obtained

01625 610364