Employment Application Form

If you are unable to fill out this online form, we can post a paper application pack to you - email [email protected] or call 01485 601700.


You will need to give the names of two people who are able to provide references relating to your work experience and your suitability for the post applied for. One referee should be your current or most recent employer. References from family or friends are NOT acceptable.

Health and Disability
Criminal Convictions

Because of the nature of the job for which you are applying, this post is exempt from the provisions of the Rehabilitation of Offenders Act 1974 (Exemptions) Order 1975. You must disclose any criminal convictions, however long ago these occurred, if the application is to proceed.
In addition to the above, The Norfolk Hospice uses Disclosure & Barring Service (DBS) to help assess the suitability of applicants applying for positions of trust. The appointment to some hospice posts will be made subject to an enhanced disclosure. The accompanying documentation for the post confirms the appropriate level of disclosure that will be required. If you are shortlisted for interview you will be asked to complete a self-declaration form, providing details of any previous, current or pending convictions.
Under the rules of the National Care Standards Commission, all new recruits are routinely screened by the DBS. Any appointment is conditional upon receiving satisfactory clearance. Failure to receive this clearance, or any discrepancy in information declared on the application form, may lead to the withdrawal of any offer or to summary dismissal.

Previous Employment

Please list all of your previous employments with your present/last employer first.

Please include the employer’s name, the post you held, your responsibilities, whether you were full or part time, the dates you were there and your reason for leaving.

Previous employment - with most recent first
Please list any further employment below
Education, Qualifications and Professional Memberships

Please tell us about your secondary and any higher education, including all qualifications. We would be interested to hear about any professional bodies that you are a member of and any vocational training which you have completed that may be relevant. Please provide dates, educational establishment, course and qualification awarded.

Your data

The Norfolk Hospice will collect, store and use the information provided by you on this application for recruitment and selection purposes. You have the right to see this data if you wish. (You are informed of this right in accordance with the requirements of current data protection legislation).

Supporting Statement

Please use the space below to express how you believe you match up to the role outlined in the job description and qualities described in the person specification. You should detail your skills and experience.