APPLICATION FOR VACANCIES

Please return your completed application form by the closing date to:

Changing Lifes
Textile House
Dukesway
Team Valley
Gateshead
NE11 0LF / Tel: 0191 273 8891
Fax: 0191 256 2914
Email:

Please note that CV’s will not be accepted in support of or as a substitute for a completed application form.

PERSONAL INFORMATION (confidential)

APPLICATION FOR THE POST OF
Vacancy Title: / Sessional Worker
Vacancy Ref No: / N/A
PERSONAL DETAILS
Title: / Last Name:
First Name[s]:
NI Number:
Address:
Post Code:
Home Telephone:
Mobile Telephone:
Work Telephone:
Email Address:

KNOWLEDGE, SKILLS AND EXPERIENCE

EDUCATION
Course Details: / Grade:
TRAINING
Please give details of any other specialised training or qualifications not covered in previous sections e.g. short courses, on-the-job training, in-house training etc.
Course Details: / Grade:
MEMBERSHIP OF PROFESSIONAL/TECHNICAL BODIES
If you are a member of any professional/technical body please give details of the awarding body and class/grade of membership:
Professional Registration Number:
PRESENT ROLE
Job Title:
Current Employer:
Salary:
Start Date:
PLEASE GIVE DETAILS OF YOUR RELEVANT PRESENT & PREVIOUS EMPLOYMENT:
Employer (including dates) / Position / Brief Outline of Duties / Reason for Leaving / Notice Required
PERSONAL STATEMENT [continue on a separate sheet if necessary]
Please state below how you best meet the criteria set out in the person specification, particularly relating to your specialist knowledge, skills and competencies. It would be useful if you could consider how you could support our stated aim of being service user focussed.
DRIVING
Do you hold a current full driving licence? / Yes / No
Do you have any current/pending driving / Yes / No
endorsements or convictions?
Do you have access to a car? / Yes / No
CONFLICT OF INTEREST
Applicants are required to declare any relationship or interest to relatives or Partners connected either previously or currently to The Cyrenians, including whether they are a resident/client, in the space provided below.
Please note any such interest or relationship will not necessarily preclude employment.
REHABILITATION OF OFFENDERS ACT 1974
The Cyrenians meets the requirement in respect of exempted questions under the Rehabilitation of Offenders Act 1974, all applicants who are offered employment will be subject to a criminal record check, before appointment is confirmed. This will include details of cautions, reprimands or final warnings, as well as convictions. Applicants are therefore not entitled to withhold information about convictions which for other purposes are "spent" under the result in provisions of the Act, and, in the event of employment, any failure to disclose such convictions could dismissal or disciplinary action by The Cyrenians. Any information given will be completely confidential and will be considered only in relation for purposes to which the order applies.
Do you have a criminal record? / Yes / No
Are you aware of any police enquiries undertaken following allegations made against you, which may have a bearing on you suitability for this post? / Yes / No
If your answer is 'yes' to either of the above, please provide full details, including dates of the offence(s) and conviction(s) on a separate piece of paper and return with your application in a sealed envelope to 'HR' and marked 'Private & Confidential'.
For those candidates invited for interview relevant criminal records will be discussed to assess job related risks. Only relevant convictions and other information will be taken into account, so disclosure need not necessarily be a bar to obtaining this position.

As an organisation using the Criminal Records Bureau (CRB) Disclosure Service to assess applicants’ suitability for positions of trust, The Cyrenians complies fully with the CRB Code of Practice and undertakes to treat all applicants for positions fairly. It undertakes not to discriminate unfairly against any subject of a Disclosure on the basis of conviction or other information revealed.

REFERENCE
Please indicate two people who can provide references, one should be your current or most recent employer, and the other should be a previous employer.
CURRENT / MOST RECENT EMPLOYER / PREVIOUS
EMPLOYER
NAME: / NAME:
JOB TITLE: / JOB TITLE:
COMPANY: / COMPANY:
EMAIL
ADDRESS: / EMAIL
ADDRESS:
POST CODE: / POST CODE:
Your referees will be contacted if you are invited for interview, and will be applied for prior to any interview.
I am happy for you to contact my current employer prior to interview. / ¨
Please do not contact my current employer unless I am successful in obtaining the post. / ¨
WORK PERMIT
I am eligible to work in the UK and do not require a work permit. / ¨
I require a work permit for employment in the UK and hold a permit that will allow me to work for two or more years. / ¨
DECLARATION
We must interpret strictly and impartially the prescribed conditions regarding eligibility to work in the UK and qualifications, but it is not possible to investigate eligibility of every candidate before we interview. You should, therefore, satisfy yourself that you are eligible before you apply. If you are successful at interview, a complete enquiry into your eligibility will be made. If you are uncertain about any aspect of your eligibility please consult us.
Data Protection: We take our obligations under data protection legislation seriously. These require us to explain how the data you provide on the application form and any other data, which may be created in connection with your application, may be used. Any data about you will be held in secure conditions, with access restricted to those who need it in connection with dealing with your application and selection processes, but in these circumstances, all data will be anonymous.
I declare the information I have given is, to the best of my knowledge and belief, true and complete. I understand that my application may be rejected or, if I have been appointed, that I may be dismissed for withholding relevant details or giving false information.
SIGNED: DATED:
EQUAL OPPORTUNITIES MONITORING
The Cyrenians is committed to ensuring that applicants and employees from all sections of the community are treated equally and not discriminated against on the grounds of gender, colour, race, nationality, marital status, religion or belief, sexual orientation, disability or age. This form assists us in monitoring who is applying for employment, our adherence to equal opportunities, best practice and our progress towards identifying any barriers to diversity among our workforce. We ask some questions regarding disability which may also assist us in determining whether any reasonable adjustments are necessary to facilitate your interview. This form will be separated from your application on receipt. We would be grateful if you would complete this form and return it with your application. You are not obliged to answer all the questions but the more information you supply, the more effective our monitoring will be. Data Protection Act 1998: Information given on this form will be entered onto a computer database for the purpose of recruitment administration and equal opportunity monitoring and ALL INFORMATION SUPPLIED WILL BE TREATED IN THE STRICTEST CONFIDENCE.
WHAT IS YOUR GENDER? (Please Tick)
Male / Female / Prefer not to say
If you are currently undergoing the process of gender reassignment, please tick your future gender.
HOW WOULD YOU DESCRIBE YOUR ETHNICITY? (Please Tick)
White: / Asian or Asian British / Mixed race:
British - English, Scottish or Welsh / Indian / White and Black Caribbean
Irish / Pakistani / White and Black African
Any other white background / Bangladeshi / White and Asian
Black or Black British: / Any other mixed background / Any other mixed background
Caribbean / Chinese or other ethnic group:
African / Chinese
Any other black background / Any other ethnic group
WHAT IS YOUR DATE OF BIRTH?
HOW WOULD YOU DESCRIBE YOUR SEXUAL ORIENTATION? (Please Tick)
Heterosexual / Bisexual / Lesbian
Gay / Other / Prefer not to say
HOW WOULD YOU DESCRIBE YOUR RELIGION/FAITH?
My religion is:
Prefer not to say / I am not religious
DEPENDANTS
Children / None / Other (parents/relatives/friends)
HEALTH DETAILS
Please give details of any health problems, medications, allergies that we should be be aware of:
I HAVE THE FOLLOWING DISABILITY?
Aspergers Syndrome/Autism / Need Personal Care/Support
Blind/Partially Sighted / Unseen Disability e.g. Asthma, Diabetes, Epilepsy, hepatitis
Deaf/Hearing Impediment / Dyslexia
Wheelchair User/Mobility Difficulties / Mental Health Difficulties
Other (Please State) / I do not have a disability
Prefer not to say
WHERE DID YOU HEAR ABOUT THIS POST? (Please Tick)
Evening Chronicle / JobCentrePlus
Friend/Word of Mouth / The Cyrenians Website

THANK YOU FOR YOUR CO-OPERATION IN COMPLETING THIS FORM.

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To be completed if you consider that you have a disability.

Please attach this form ONLY if completed and return it with your application form.

GUARANTEED INTERVIEW SCHEME
The Cyrenians is committed to the employment and career development of disabled people. To demonstrate our commitment we are working towards the Disability Symbol which is awarded by the Employment Service. We guarantee an interview to anyone with a disability whose application meets the essential criteria for the post.
What do we mean by disability?
To be eligible for the Guaranteed Interview Scheme you must have a disability or long-term health condition which puts you at significant disadvantage in either obtaining or keeping jobs. The disability could be physical, sensory or mental and must be expected to last for at least 12 months.
You do not have to be registered as a disabled person to apply under this scheme.
How do I apply?
Simply complete the declaration below. If you need any help completing this form or would like it in an alternative format e.g. Braille, tape large print etc. please contact HR.
DECLARATION
I consider myself to have a disability as defined above and I would like to apply under the Guaranteed Interview Scheme.
NAME:
SIGNATURE:
DATE:
ASSISTANCE FOR INTERVIEW
To ensure we do not create any barriers in our selection process and to help us implement our equal opportunities policy effectively, please let us know if you would like us to provide any particular assistance for your interview, such as: [please tick]
Induction loop / ¨ / Someone with you at the interview (e.g. speech facilitator) / ¨
Sign language interpreter (type) / ¨ / Assistance in and out of vehicle / ¨
Keyboard for written tests / ¨ / Wheelchair access / ¨
Car parking / ¨ / Accessible toilet facilities / ¨
Other assistance (please specify)

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