Full Employment History

This form has been provided to you to gather your full employment history. This is because we did
not collect this information when you originally applied for this role. Under the Health and Social
Care act 2008 (Amended 2014) individuals involved in regulated activity (regardless of pay) must
provide a full employment history and detail any gaps.
Please use this form and detail all previous employment from leaving school. It is also important
under the act to know why you left the roles so please make sure this is completed.
Once complete this form must be handed to your HR manager.
Name:
Month and year you left school:
Please detail employment and gaps in employment from the school leaving date above:
Date
from:

Date to:

Employers name and

location (and address if you
have it) or write Gap (to
indicate a gap in employment).

Retrospective full employment history

Role

Reason for leaving

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Date
from:

Name:
Date to:

Employers name and

location (and address if you
have it) or write Gap (to
indicate a gap in employment).

Retrospective full employment history

Role

Reason for leaving

V2 25/11/15

Full Employment History

Manager review sheet

Name of person undertaking regulated activity:

Name of HR manager reviewing the employment history:

Statement by HR manager:
I have reviewed the employment history of the individual named above and find the following (tick
one only):
The history is complete and no previous employments include work with children or vulnerable
adults. This form, with the employment history can be filed on the individuals file.
The history is complete; the pervious history includes work with children or vulnerable adults.
The reasons for leaving have been detailed and discussed (and documented below) and I am
happy that these are compatible with the current engagement in regulated activity.
The history is incomplete but I have discussed this with the individual and documented my
findings below which are I am content are compatible with the current engagement in regulated
activity.
I am not content with either the reasons for leaving or the incomplete history being compatible
with engagement in regulated activity and have taken appropriate actions.
Items discussed with individual:

Please detail if you are continuing on a separate sheet.

Name in block:
Signature to confirm outcome above:

Retrospective full employment history

Date:

V2 25/11/15