Complete the application form below to take the first step in making a difference to people’s lives every day!

Personal details:

Monitoring information

Here at NAViGO Extra we recognise and actively promote the benefits of a diverse workforce and are committed to treating all employees with dignity and respect regardless of age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex and sexual orientation.

Equality & Diversity

As an affiliate of NAViGO Health and Social Care CIC, NAViGO Extra are required to collect details about an applicant’s age and gender. This information is collected to fulfil that obligation and is used for monitoring purposes only.

Equality Act 2010: As Public Sector Employers, NHS organisations are required to collect details about an applicant’s ethnicity. This information is collected to fulfil that obligation and is used for monitoring purposes only.

I would describe my ethnic origin as (please tick):

Equality Act 2010: In order to comply with these regulations NHS Employers are monitoring sexual orientation and religion/belief in applications. Please answer the following questions.

The Equality Act 2010 protects disabled people – including those with long term health conditions, learning difficulties and so called “hidden” disabilities such as dyslexia. If you tell us that you have a disability we can make reasonable adjustments to ensure that any selection processes – including the interview – are fair and equitable.

Please state the type of impairment which applies to you. People may experience more than one impairment, in which case you may indicate more than one:  

Criminal Convictions

Rehabilitation of Offenders Act 1974 helps rehabilitated ex-offenders back into work by allowing them not to declare criminal conviction after the rehabilitation period set by the Court has elapsed and the convictions become “spent”.  During the rehabilitation period, convictions are referred to as “unspent” convictions and must be declare to employers.

Before you can be considered for appointment with the NHS we need to be satisfied about your character and suitability.

The NHS aims to promote equality of opportunity and is committed to treating all applicants for positions fairly and on merit regardless of race, gender, marital status, religion or belief, disability, sexual orientation and age.  The NHS undertakes not to discriminate unfairly against applicants on the basis of a criminal conviction or other information declared.

If you are applying for a post involving access to persons in receipt of health services, your offer of employment may be subject to a satisfactory disclosure from the Disclosure and Barring Service (DBS).  Failure to reveal information relating to any conviction could lead to withdrawal of an offer of employment.

Anyone applying for a position which involves a regulated activity and certain controlled activity from 12 October 2009 will require an enhanced DBS check and that disclosure will, where appropriate to the role, include information against the Independent Safeguarding Authority (ISA) barred lists for working with children, adults or both.


If you are related to a director, or have had a relationship with a director or employee of NAViGO Extra please state the relationship.

Part B

Details entered in this part of the form will be held in the workforce department of the recruiting organisation and will be made available to the shortlisting panel.

Education & Professional Qualifications

Training Courses Attended

Membership of Professional Bodies

Include in this section any relevant professional registrations or memberships.

If you answered “I have a current UK registration” then please enter the relevant details below. If professional registration is not required then go to Employment History.

Employment History

Please record below the details of your current or most recent employer. This could include volunteer work and work experience placements.


Employer 2

Employer 3

Employer 4

Employer 5

Employer 6

Additional Personal Information

Supporting Information


Please give the names of the people who have agreed to supply references. These should be your two most recent employers or supervisors, your line manager/volunteer supervisor or someone in a position of responsibility who can comment on your work/ work experience/ volunteer experience, competence, personal qualities and suitability for the post.

If you are a student please provide contact details of a teacher at your school, college or university. Please note that personal references such as friends and relatives are not acceptable.

For all positions you must provide two references.

Referee one

Referee two