Safer Recruitment Form

Full Name *

Email *

Phone *

I agree to receive messages from the White House Nursery about my application. I can unsubscribe at any time.

Personal Information 👤

Address

Street Address

City

State

Country

Postal code

National Insurance Number

Which nursery site/sites are you applying for? *

What position are you applying for? *

If invited to interview, you will be required to bring the original documents for proof of ID and the right to work in the UK (e.g. passport, driving licence, birth certificate)

Do you have a valid driving licence? *

Do you have any driving endorsements? *

If yes, please give details

Right To Work & Disqualification 📜

Do you have the right to work in the UK? *

Are there any restrictions on you taking up employment in the UK *

If yes, please give details

Have you lived or worked outside of the UK in the past 5 years? *

If yes, please give details including countries and dates

Is there any reason why you would be unsuitable to work with children? *

Do you have any pending criminal charges or ongoing investigations? *

Have you been disqualified from working with children under the Childcare Act 2006? *

Do you consent to an enhanced DBS check (including barred list check)? *

Do you live in a household where any other person has received any convictions, cautions, court orders, reprimands, or other grounds for disqualification under the Childcare (Disqualification) Regulations 2009? *

Do you have any criminal convictions? *

Education & Training 🎓

Please list the secondary school you attended, the dates your attended and the qualifications you gained (e.g. GCSEs or equivalent) *

Please list the college and/or university you attended and the qualifications you gained (including dates, awarding bodies, and course titles) *

Early Years Qualification – if applicable: Please state the Level (e.g. 2/3/4), qualification title, awarding body, and year completed

Have you taken part in any further formal or job-related training courses? Please list all relevant training, including course titles, dates completed, and awarding bodies where known. Examples include: Paediatric First Aid, Safeguarding, Food Hygiene, Health & Safety, Prevent Duty *

What qualifications have you gained from this training?

Current membership of professional bodies (e.g. CIPD, NMC)?

Employment History 💼

Please provide a full timeline of your employment history, starting with your most recent role. For each job, include:

Job title
Employer name
Start and end dates (month/year)
Key duties/responsibilities
Reason for leaving

Full Employment History *

Please provide an explanation for any gaps in your employment history

What is the notice period required in your current post (if applicable)? *

Please note any other employment you would continue if successful in obtaining this position

References 🧾

Reference 1 *

Full name
Position
Organisation name
Organisation address
Phone number
Email
Relationship to you

Reference 2 *

Full name
Position
Organisation name
Organisation address
Phone number
Email
Relationship to you

If shortlisted, do you consent to references being contacted before the interview? *

Health & Pre-Employment 🏥

If you are offered employment with us, you will be required to complete a Pre-Employment Medical Questionnaire. Do you agree to this?

Personal Statement 🌟

Please tell us about your interests, achievements and hobbies *

Please tell us about any relevant experience, skills and knowledge you can bring to this job, and any other information to support your application *

Availability 🗓️

Are there any dates you would be unavailable for interview in the next 3 weeks? *

Final Declaration ✅

I confirm that the above information is complete and correct. I understand that any false or misleading information may result in the withdrawal of an offer or the termination of any employment contract without notice. *

I confirm

I understand that if further medical information is required, the organisation may contact my doctor to obtain a medical report. I will be informed of this intention and my permission will be sought in advance. I agree that I may be asked to undergo a medical examination if necessary. I understand that this information will be stored securely in my personnel file for the duration of employment and up to six years thereafter, in line with the Data Protection Act.

I understand

I agree that if I am successful in this application, I will apply for an enhanced DBS check. I understand that failure to do so, or an unsatisfactory disclosure, may result in the withdrawal of any job offer or the termination of employment without notice. *

I agree

Please sign *

Clear

How did you hear about this role? *

If you were referred by a friend, what is their name?