Application for Employment s190

APPLICATION FOR EMPLOYMENT 109 Thorne Road

STRICTLY CONFIDENTIAL Doncaster

DN2 5BE

PLEASE NOTE Tel. 01302 812345

(a) Answer all questions on the form Fax. 01302 812813

(b) Please complete form clearly in BLACK INK

(d) Every applicant will be treated equally, regardless of sex, marital status, sexual orientation, age, disability, race, religious beliefs and ethnic or national origin

(e) Age UK Doncaster meets the requirements in respect of exempted questions under the Rehabilitation of Offenders Act 1974.

(f) A Disclosure will be required for all employees working directly with older people in the community.

(g) Please use supplementary pages where necessary

POST APPLIED FOR: …………COMMUNITY SERVICES MANAGER …..….

PERSONAL INFORMATION

Surname: …………………………………….…. Initials: …………….

Address: ………………………………………..

…………………………………….…. email address: ………………………………

…………………………………….….

Post Code: ……………………….. Telephone No. …………………………………….

(inc STD code)

EDUCATION/TRAINING:

NAME OF ESTABLISHMENT / QUALIFICATIONS

Secondary School

College/
University
Other Training/
Courses

WORK EXPERIENCE:

Present/Most recent employment:

Name of employer: ……………………………………………...….

Address: ……………………………………………

……………………………………………………… Telephone No. (inc STD code)

……………………………………………………… ……………………………….

Position held: …………………………… From: ……………….. To: ………..…...

Salary: ………………….. Brief description of duties: …………………………………………...

………………………………………………………………………………………………………...

How much notice are your required to give? ………………………………

Reason for leaving: ……………………………………………………………………………………

PREVIOUS EMPLOYMENT:

DATE

FROM / TO / NAME & ADDRESS OF EMPLOYER / POSITION HELD / BRIEF DESCRIPTION OF DUTIES / REASON FOR LEAVING

CAR OWNER/DRIVER

Do you possess a full current drivers licence? YES/NO

Have you got access to a car for work? YES/NO

Would you have daily access to a car in relation to your employment? YES/NO

WHERE DID YOU LEARN OF THIS VACANCY?

INTEREST IN POST/SUPPLEMENTARY INFORMATION

(Please state briefly why you are interested in this post and what skills and experience you would bring to it). This is an opportunity for you to draw attention to aspects of your career, interests, voluntary activities, etc relevant to this post and which may give additional weight to your application. Please use continuation sheets if necessary.

REFERENCES:

Please give the names and addresses of two referees. Preferably one should be your present or most recent employer. They should not be relatives. Please also indicate in what capacity they know you.

1 ……………………………………… 2 …………………………………………

Address: ……………………………………. Address: ……………………………………….

……………………………………………… …………………………………………………

Postcode: …………………………………… Postcode: ………………………………………

Capacity known: …………………………… Capacity known: ………………………………

Please mark with a cross in the box if you would wish us not to take up either of your references prior to interview.

Reference 1 } Reference 2 }

DECLARATION

Are you related, by birth or marriage, to any member of the staff of Age UK Doncaster or any member of the Board of Directors?

YES/NO

If Yes, please give details of name and relationship

………………………………………………………………………………………………………………

I declare that the information given on this form is true and correct. I understand that any deception could result disciplinary action being taken which could lead to dismissal.

Signature: ………………………………… Date: ……………………………

AGE UK DONCASTER

GUIDANCE NOTES FOR APPLICANTS

Protection of Vulnerable Persons Pre and Post Appointment Checks

1 Introduction

Age UK Doncaster meets the requirements in respect of exempted questions under the Rehabilitation of Offenders Act 1974 and all applicants whose post will involve regular contact with vulnerable adults, who are offered employment, will be subject to a criminal record check from the Disclosure and Barring Service before the appointment is confirmed. This will include details of cautions, reprimands or final warnings, as well as convictions. The Disclosure and Barring Service will also check for information held on the Care Standards Agency register.

As part of the recruitment process applicants will be asked to complete a declaration for this purpose.

2 Definition

Vulnerable adult/person – a person may be considered vulnerable if they are in receipt of some form of care, has a physical or mental disability or is of such an advanced age that they would be incapable of protecting themselves from assault or physical abuse.

Disclosure information is information:-

¨ Contained in criminal record certificates under Section 113 of the Police Act 1997 (which is referred to as Standard Disclosure)

¨ Contained in enhanced criminal record certificates under Section 115 of the Police Act 1997 (referred to as Enhanced Disclosure)

¨ Provided by the police under Section 115(8) or the Police Act 1997

3 Level of Disclosure

Level 1 Standard Disclosure

Primarily for posts that involve working with or regular contact with vulnerable adults. May also be used for certain people entering positions of trust. Disclosure includes convictions held on Police National Computer (PNC) including spent/current cautions/ convictions/reprimands or final warnings and Care Standards Agency register.

Level 2 Enhanced Disclosure

For posts which involve a greater degree of contact with vulnerable adults. Disclosure will also include check on PNC, local Police records and Care Standards Agency register.

In the event of the Disclosure indicating details of a record, it will then be for the Chief Executive’s judgement as to the suitability of the person, taking into account only those issues which may be relevant to the particular job in question. A person’s suitability as a whole will be considered in the light of the information available.

4 Discrepancies and Disagreements

Where information provided by the Disclosure and Barring Service does not agree with that provided by the applicant, the Chief Executive will discuss the discrepancy with the individual.

5 Failure by an employee to provide accurate and truthful information at the time of applying for a position will be considered a disciplinary matter. Where it is found that an employee intentionally or recklessly provided inaccurate information or withheld information that is relevant to their appointment, the employee will be subject to disciplinary proceedings in accordance with the Disciplinary Policy of Age UK Doncaster.

You must be aware of the above prior to applying for this post.

All potential employees of Age UK Doncaster will be required to apply for an Enhanced Disclosure. Prior to their commencing employment/Induction they should contact the Resource Officer to arrange an appointment to complete the Application Form. Employees will be required to bring in proof of identity documents, guidance on which document can be sought from the Resource Officer, for the Application Form to be countersigned and sent off.

The full charge for an Enhanced Disclosure is £44 (plus ISA Adult First which is £6 if relevant) however Age UK Doncaster will pay half towards the total cost. Payment has to be made at the time of application and potential employees will need to pay £25.00 to include ISA Adult First check when they bring their Application Form in to be countersigned. The employee will receive a copy of the Disclosure direct from the DBS. Age UK Doncaster will also be sent a copy of the Disclosure by the DBS.

AGE UK DONCASTER

Before you can be considered for appointment to the post you have applied, we need to be satisfied about your character and suitability.

Please read the following notes carefully before completing this Declaration Form.

Age UK Doncaster aims to promote equality of opportunity for all with the right mix of talent, skills and potential. Age UK Doncaster welcomes applications from diverse candidates. Criminal records will be taken into account for recruitment purposes only when the conviction is relevant. Unless the nature of the work demands it, you will not be asked to disclose convictions which are ‘spent’ under the Rehabilitation of Offenders Act 1974. Having an ‘unspent’ conviction will not necessarily bar you from employment. This will depend on the circumstances and background to your offence(s). Failure to disclose convictions will mean that your application will be rejected, or, if you are appointed and a conviction subsequently comes to light, you may be dismissed.

Prior to making a final decision concerning your application, we shall discuss with you any information declared by you that we believe has a bearing on your suitability for the position. If we do not raise this information with you this is because we do not believe that it should be taken into account. In that event, you remain free to discuss any of that information or any other matter that you wish to raise. As part of assessing your application, we will only take into account relevant criminal record and other information declared.

The Data Protection Act 1998 requires us to provide you wish certain information and to obtain your consent before processing sensitive data about you. Processing includes: obtaining, recording, holding, disclosing, destruction and retaining information. Sensitive personal data includes any of the following information: criminal offences, criminal convictions, criminal proceedings, disposal or sentence.

The information that you provide on this Declaration Form will be processing in accordance with the Data Protection Act 1998 and will only be used for the purpose of determining your application for this position. Once a decision has been made concerning your appointment, we will not retain this Declaration Form longer than is necessary.

This Declaration Form will be kept securely and in confidence and access to it will be restricted to designated persons who need to see it as part of the selection process and who are authorised to do so.

Please ensure that you read the Guidance Notes for Applicants that accompanied your application form carefully before completing this Declaration Form. They provide you with further and more detailed information concerning how your application will be processed and include details of purposes for which information about you will be processed, the persons to whom it will be disclosed and the checks that will be undertaken to verify the information provided before your appointment is confirmed.

Please answer all questions. If you answer “Yes” to any of the questions, please provide full details in the space provided. Please also use the space below to provide any other information that may have a bearing on your suitability for the position for which you are applying. You may continue on a separate sheet if necessary and you may attach supplementary comments should you wish to do so.

DECLARATION

Answering Yes to any of the questions below will not necessarily bar you from appointment. This will depend on the nature of the position for which you are applying and the particular circumstances.

1 Are you currently bound over or have you ever been convicted of any offence by a Court or Court-Martial in the United Kingdom or in any other country?

Note: You do not need to tell us about parking offences.

NO YES

If YES please include details of the order binding you over and/or the nature of the offence, the penalty, sentence or order of the Court, the date and place of the Court hearing

2 Have you ever received a police caution, reprimand or final warning?

NO YES

If YES please include details of the caution, reprimand or final warning, including the date and reason administered

3 Have you been charged with any offence in the United Kingdom or in any other country that has not yet been disposed of?

Please note: you must inform us immediately if you are charged with any office in the United Kingdom or in any other country after you complete this form and before taking up any position offered to you. You do not need to tell us if you are charged with a parking offence

NO YES

If YES please include details of the nature of the offence with which you are charged, date on which you were charged and details of any on-going proceedings by a prosecuting body

4 Are you aware of any current police investigation in the United Kingdom or in any other country following allegations made about you?

NO YES

If YES please include details of the nature of the allegations made against you and if known to you any action to be taken against you by the police

5 Have you ever been dismissed by reason of misconduct from any employment, office or other position previously held by you?

NO YES

If YES please include details of the employment, office or position held, the date that you were dismissed and the nature of allegations of misconduct made against you

6 Are you subject to any other prohibition, limitation or restriction that means we are unable to consider you for the position for which you are applying?

NO YES

If YES please include details of the nature of the prohibition, restriction, or limitation when and by whom it was made

I have read the “Guidance Notes for Applicants” that accompanied my application form and I consent to the information provided in this Declaration Form being used by Age UK Doncaster for the purpose of assessing my application.

I confirm that the information I have provided in this Declaration Form is correct and complete. I understand and accept that if I withhold information or provide false or misleading information this may result in my application being rejected, or if I am appointed, in my dismissal.

Please sign and date this form

Signature ………………………………….

Name (in block capitals) …………………………………..

Date ……………..

AGE UK DONCASTER

SEX, ETHNIC, AGE AND DISABILITY MONITORING

Applicants are requested to tick the relevant boxes below to enable Age UK Doncaster to monitor its Equality and Diversity Policy and return this form in the envelope provided. Monitoring is recommended by the codes of practice for the elimination of racial discrimination and for the elimination of discrimination on the grounds of sex, age and disability. This information is to be used for no other purpose, will not be available to those short-listing for this post and will be treated as confidential.

Post Applied for: ______

Sex:

Male: Female:

Age:

Under 18 18-25 26-35 36-45 46-55 56-65 over 65

Ethnic Group:

(Please tick √ as appropriate)

White / √ / Mixed / √ / Asian or
Asian British / √ / Black or
Black British / √ / Chinese or
Other Ethnic Group / √
British / White & Black Caribbean / Indian / Caribbean / Chinese
Irish / White & Black African / Pakistani / African
White & Asian / Bangladeshi
Any Other White Background / Any Other Mixed Background / Any Other Asian Background / Any Other Black Background / Any Other

Disability:

Do you consider yourself to have a disability? YES/NO

Day to day activity affected, please specify ……………………………………

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Date: 02.10.06 Revised: 31/08/07 Revised 01/08/08 Revised 25/10/10 Revised 20/05/11 Revised 10/08/11 Revised 03/12/2012