Employment Application

Royal Trinity Hospice Employment Application Form

Thank you for choosing to apply for a role with Royal Trinity Hospice.

Please note that our online job application form does not allow you to save the form and return to your work at a later date, so we recommend that you complete the form fields offline and only fill in the form below when you are ready to submit your application,

About you

Professional registration and/or memberships (clinical and other professional staff)

Employment history

Current or most recent employment
Previous employment
Previous employment
Previous employment

Education and training


Please provide contact details of two referees, one of which should be your most recent employer

Referee one
Referee two


To protect vulnerable groups within society, there are a number of posts within Royal Trinity Hospice that are exempt from the provisions of the Rehabilitation of Offenders Act 1974 (as amended). As the post you have applied for falls within this category, it will be exempt from the provisions of the Rehabilitation of Offenders Act by virtue of the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975.

Applicants for such posts are not entitled to withhold information about convictions or other relevant criminal record information which for other purposes are ‘spent’ under the provisions of the Act. If you are successful with this application, any failure to disclose such information could result in dismissal or disciplinary action. Any information provided will be confidential and will be considered only in relation to posts to which the Order applies.


Supporting statement


• I declare that the information contained in this application form is accurate and complete. I understand that any deliberate omission, falsification or misrepresentation will be grounds for rejecting this application for selection and/or appointment and that if appointed, could lead to dismissal.
• Where applicable, I consent that the organisation can seek clarification regarding professional registration details.
• I give Royal Trinity Hospice consent to process the information provided on this form in accordance with the Data Protection Act 1998. I understand the Hospice requires the data for operational, managerial and associated purposes relevant to the payment of remuneration, pensions and the maintenance of Human Resources records for all employees.
• I understand that job applications for unsuccessful candidates are normally retained for 6 months from the date of interview and that the application form of successful candidates will be retained on their personal file.

Equality and diversity monitoring form

This part of the form will not be seen by the interview panel prior to interview and is not used in any decision making.

You do not have to complete this part of the form but doing so enables us to monitor the effectiveness of our equality and diversity policy. We recognise the benefits of a diverse workforce. We are committed to treating all job applicants and employees with dignity and respect regardless of race, ethnic background, nationality, marital or civil partnership, colour, gender, trans-gender status, pregnancy, disability, age, sexual orientation, religion or belief. We therefore welcome applications from all sections of the community.

The information you provide is for monitoring purposes only, no information will be shared to other parties or used in any way which allows any individual to be identified.

Ethnic origin

How would you describe yourself?

I hereby give my consent to Royal Trinity Hospice processing the data supplied in this form for the express purpose of monitoring.