Macdonald McEwan Registration Form

Macdonald McEwan Registration Form

Herkimer House, Linlithgow, EH49 7SF
Telephone: 01506 841 631
Email: admin@macdonaldmcewan.co.uk

About you: *

First Name	*
Surname	*
Address	*
Postcode	*
Mobile Phone	*
Home Phone	*
Email	*
NI Number	*
D:O:B	*

Please upload a copy of a recent proof of address

File: {{filename}}delete

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Driving: *

	Answer
Do you hold a full, current driving licence?	Do you hold a full, current driving licence? Answer
Do you have any endorsements?	Do you have any endorsements? Answer
Do you have access to a vehicle?	Do you have access to a vehicle? Answer

Please upload a copy of your driving licence

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Next of Kin: *

Name	*
Relationship	*
Mobile Phone	*
Home Phone	*

Right to work in the UK

Please upload a copy of your passport

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If you do not have a passport, please upload a copy of a P45/P60

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If you do not have a passport, please upload a copy of your birth certificate

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To be completed by Non-British and Non-EU Nationals ONLY:

Date of entry to the UK?
Which travel document do you hold?
VISA expiry date?

Declaration of offences: Because of the nature of the work for which your are applying the provisions of Section 4 (2) of the Rehabilitation of Offenders Act 1974 do not apply by virtue of the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 or the Rehabilitation of Offenders Act 1974 (Exclusion and Exceptions) (Scotland) Order 2003. Applicants are therefore NOT entitled to withhold information about convictions which for purposes are “spent” under the provisions of the Act, and in the event of employment, any failure to disclose such convictions will result in your removal from our register. Any information you give will, of course, remain confidential.
*

	Answer
Have you ever been convicted of a criminal offence?	Have you ever been convicted of a criminal offence? Answer
Do you have criminal proceedings pending?	Do you have criminal proceedings pending? Answer
Have you ever been checked by DBS or PVG?	Have you ever been checked by DBS or PVG? Answer
I agree Macdonald McEwan can request a DBS or PVG	I agree Macdonald McEwan can request a DBS or PVG Answer

Details of Criminal Convictions

Please upload your most recent PVG or DBS certificate

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Employment History:

Please provide details of all your employment starting with the most recent / current position, and any gaps. Please make sure you cover the past five years.
*

Employer Name	*
Dates From	*
Date to	*
Position / Grade	*
Salary or hourly rate	*

Job Details

Employment History 2

Employer Name
Dates From
Date to
Position / Grade
Salary or hourly rate

Job Details

Employment History 3

Employer Name
Dates From
Date to
Position / Grade
Salary or hourly rate

Job Details

Employment History 4

Employer Name
Dates From
Date to
Position / Grade
Salary or hourly rate

Job Details

Employment History 5

Employer Name
Dates From
Date to
Position / Grade
Salary or hourly rate

Job Details

Employment History 6

Employer Name
Dates From
Date to
Position / Grade
Salary or hourly rate

Job Details

Referees

Please provide information for three referees spanning at least five years.

One must be your most recent employer.

Please send this link: Reference Request to each referee you detail
*

Full Name	*
Relationship to You	*
Company Name	*
Address	*
Telephone	*
Email	*

Referee 2

Full Name
Relationship to You
Company Name
Address
Telephone
Email

Referee 3

Full Name
Relationship to You
Company Name
Address
Telephone
Email

I confirm I have sent the Reference Request link to each referee I have listed

It can also be found here: https://macdonaldmcewan.co.uk/referencerequestform.html *

Yes
No

Qualifications *

College / University	*
Qualification	*
Grade / Class (if applicable)	*
Date	*

Please upload a copy of your qualification certificate

File: {{filename}}delete

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Qualifications 2

College / University
Qualification
Grade / Class (if applicable)
Date

Please upload a copy of your qualification certificate

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Are you SSSC or Social Work England registered? *

Yes
No

Please confirm the date your SSSC or Social Work England registration expires

	DD/MM/YYYY

Please upload a copy of your SSSC or Social Work England certificate

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I have sent Macdonald McEwan copies of: *

	Yes	No
Passport	Passport Yes	Passport No
P45 / P60	P45 / P60 Yes	P45 / P60 No
Driving Licence	Driving Licence Yes	Driving Licence No
SSSC Certificate	SSSC Certificate Yes	SSSC Certificate No
Social Work England Certificate	Social Work England Certificate Yes	Social Work England Certificate No
PVG Certificate	PVG Certificate Yes	PVG Certificate No
DBS Certificate	DBS Certificate Yes	DBS Certificate No
Recent Proof of Address	Recent Proof of Address Yes	Recent Proof of Address No

Declaration:

By submitting this form, I agree to the information in this form being stored for the purposes of my application, for monitoring and for reasonable research into the application process, in accordance with the Data Protection Act 1984. I confirm that I have completed this application form and that to the best of my knowledge the information I have provided in it is true, accurate and correct. I understand that providing misleading or false information to support my application will disqualify me from registration.

I am aware that I must report any pending criminal proceedings which may jeopardise my registration with Macdonald McEwan.

I am aware that it is my reponsibility to maintain my registration with the appropriate registered body (SSSC, GTCS, HCPC, Social Work England ) and inform Macdonald McEwan if I become de-registered for any reason.
*

Initials	*
Date	*