APPLICATION FOR EMPLOYMENT (PART 1)

Carers Support Service is working towards Equal Opportunities in employment, which requires fair and equal treatment of all job applicants. The details requested in Part 1 of the Application for Employment will only be used to check whether this policy is working and will in no way affect the consideration of your application.

PLEASE USE BLACK INK OR TYPE

Title (Mr/Mrs/Miss etc)
First name
Surname
Address
Postcode
Date of Birth
Telephone number
Mobile phone
Email address
Gender / Male □ Female □
NI number
Are you disabled? / Yes □ No □
Are you registered disabled? / Yes □ No □
If selected for interview, would you require any special arrangements as a result of your disability?

DECLARATION:

I confirm that the information I have given in support of my application is to the best of my knowledge, correct and complete and that misleading statements may be sufficient for cancelling any agreements made. Because of the sensitive nature of the duties the post holder may be expected to undertake, I understand that the declaration will include details of any criminal convictions, cautions, reprimands, and final warnings and any other information that may have a bearing on my suitability for the post. I also understand that knowingly to give false information may, if I am offered employment, result in dismissal or disciplinary action. I understand too that an Enhanced Disclosure will be sought in the event of a successful application.

Signed
Date

Please return this form to: recruit @carerssupportservice.co.uk or Carers Support Service, Ryton Gardens, Wolston Lane, Ryton-On-Dunsmore, CV8 3ES

For office use only: Application No:


APPLICATION FOR EMPLOYMENT (PART 2)

IN CONFIDENCE

APPLICATION FOR THE POST OF:

WHERE DID YOU SEE THIS POST ADVERTISED?

1.  PLEASE GIVE DETAILS OF YOUR CURRENT OR MOST RECENT EMPLOYMENT:
JOB TITLE /

EMPLOYER

/ DATE
FROM / DATE
TO / BRIEF DESCRIPTION OF ROLE / REASON FOR LEAVING
Notice Required: / Current / last salary:
2.  PLEASE GIVE DETAILS OF YOUR EMPLOYMENT HISTORY
(If you have worked in a non-paid capacity and would like to give us details, please do so)

JOB TITLE

/

EMPLOYER

/ DATES
FROM TO
/ BRIEF DESCRIPTION OF ROLE / REASON FOR LEAVING

Please continue on a separate sheet if necessary:

3.  PLEASE GIVE DETAILS OF YOUR EDUCATION AND QUALIFICATIONS GAINED:

SECONDARY SCHOOL/COLLEGE/

UNIVERSITY

/

DATES

FROM TO
/ QUALIFICATIONS GAINED

4.  PLEASE GIVE DETAILS OF ANY TRAINING COURSES RELEVANT TO THIS POSITION THAT YOU HAVE ATTENDED IN THE LAST 3 YEARS:

NAME OF ESTABLISHMENT/TRAINING CENTRE

/

TRAINING/COURSE DETAILS

/ DATES
FROM TO

5.  PLEASE GIVE DETAILS OF YOUR PERSONAL INTERESTS/HOBBIES/LEISURE PURSUITS:

6.  REFEREES – PLEASE GIVE THE NAMES & ADDRESSES OF TWO REFEREES:

One must be your present or most recent employer. The second should be someone, not a friend or relative, who can give an opinion on your suitability for this post.

CURRENT OR LAST EMPLOYER:
TITLE
FIRST NAME
SURNAME
ADDRESS
POST CODE
TELEPHONE NUMBER
FAX NUMBER
EMAIL ADDRESS
SECOND REFEREE:
TITLE
FIRST NAME
SURNAME
ADDRESS
POST CODE
TELEPHONE NUMBER
FAX NUMBER
EMAIL ADDRESS

We will write for references if you are offered an interview.

If you do not wish your current employer to be approached at this stage please tick here: ¨

7.  PLEASE TELL US HOW YOUR OWN SKILLS, QUALIFICATIONS AND EXPERIENCE MEET THE PERSON SPECIFICATION AND WHY YOU ARE INTERESTED IN THIS POSITION:

8.  Do you possess a full current driving licence? YES ¨ NO ¨
9.  Are you licenced /able to drive a minibus? YES ¨ NO ¨

10.  Do you own a car that you could use and insure for work? YES ¨ NO ¨

11.  Do you speak or read a foreign language? YES ¨ NO ¨

If yes, please give details:

12.  Do you require a Work Permit to work in the United Kingdom? YES ¨ NO ¨

13.  The successful candidate will be required to have a DBS check; please indicate if you would object to this: YES ¨ NO ¨

14.  Do you have a conviction which is not spent under the Rehabilitation of Offenders Act 1974?

YES ¨ NO ¨

If yes, please provide details:

Please either e-mail the completed form to:

Or post to:

Carers Support Service

Ryton Gardens

Wolston Lane

Ryton-On-Dunsmore

CV8 3ES

For office use only: Application No:


Equal Opportunities Monitoring Form

Carers Support Service aims to be an Equal Opportunities employer. In order to monitor the effectiveness of our equal opportunities policy and procedures, all applicants are asked to complete the following questions. Human Resources staff will remove this form before your application is sent for short listing. It is important that you complete this form and return it with your application.

Please tick the relevant boxes.

Gender

Male
Female

Age range

Under 25
25 – 34
35 – 44
45 – 54
55 – 64
65 or over

Ethnicity

White / Black / Black British
British / Caribbean
Irish / African
Other White / Other Black background
Asian / Asian British / Mixed race
Indian / White & Black Caribbean
Pakistani / White & Black African
Bangladeshi / White & Asian
Other Asian background / Other mixed background
Chinese / Other
Chinese / Other ethnic group

Disability

The Disability Discrimination Act defines disability as follows: Someone who has a physical or mental impairment that has a substantial and long term adverse effect on his or her ability to carry out normal day-to-day activities (at work on a regular basis).

I consider myself disabled
I do not consider myself disabled

Please return this form with your application form. Thank you.

Please note: This form will be separated from your application form and will not be copied or passed on to the shortlisting panel. It will be used for statistical purposes only.

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