Lighthouse Job Application Form

Full Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityCounty

Postcode

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email Address

example@example.com

Date of Birth

Date

Resume/CV Upload

Cover Letter

LinkedIn Profile (Optional)

Employment History

Marital Status

Accommodation

How would you describe your personal health?

Do you have any physical impairment, chronic disease or disability

If yes, please give details

Do you use alcohol?

Have you ever experienced mental or emotional health problems?

Have you ever seen a psychiatrist?

Are you currently under psychiatric care?

Are you prescribed any medication for mental or emotional health issues?

Have you ever had an eating disorder and/or have been know to self harm?

Do you have a criminal record?

If yes, please provide details

Are you subject to any statutory supervision or probation?

Please write in your own words why you want to apply here.

Reference 1 - Name

First NameLast Name

Reference 1 - Profession

Reference 1 - Contact Number

Please enter a valid phone number.Format: (000) 000-0000.

Reference 1 - Email

example@example.com

Reference 2 - Name

First NameLast Name

Reference 2 - Profession

Reference 2 - Contact Number

Please enter a valid phone number.Format: (000) 000-0000.

Reference 2 - Email

example@example.com

Permission to Contact Relevant Professionals

I understand that, to assist in the admission decision, it may be needed to contact professionals or agencies that have been involved in my care or support. I consent to these contacts being made only with my explicit permission, and I understand that any information gathered will be treated as confidential.

Requirement for Complete Information

I acknowledge that completing all requested information on this application form is essential for processing my application. I am aware that delays may occur.

Information Sharing for Application Processing

I consent to the potential sharing of information provided during my assessment with other relevant services, if necessary, to complete the application process.

Name

First NameLast Name

Date of Birth

Date

I have completed this application form truthfully and to the best of my knowledge. I understand that any misleading information could jeopardise my application process.

Signature

Date

Lighthouse Job Application Form

Applicant Contact Information

Professional Background

Family Information

Health Information

Mental & Emotional Health

Past Offences

Personal Statement

Reference 1 of 2

Reference 2 of 2

Consent and Declaration