Application Form – in confidence

Please note that only the information given in this application form will be considered in determining whether or not you will be called for interview. Please specifically address the criteria detailed in the Job Description & Person Specification.

Post applied for:Family Support Worker

Closing date:Friday 22 July 2016

Please return the completed application form by email: if possible - marked for the attention of Elizabeth Stevenson

Personal Details

Surname:
First Name/s:
Address:
Post code:
Telephone contact number(s):
Home:
Mobile:
Work:
Please indicate if it is acceptable to contact you at work YES / NO
Email:
Date of Birth:
National Insurance No:

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Employment History (most recent First) / Duties and responsibilities

Previous Experience

Please provide an outline of paid and/or non-paid experience, relevant to this application. Please refer to the job description and person specification.

Previous Experience continued

Please tell us about any involvement you have had with voluntary organisations:

Education and training

Please tell us about your education and qualifications relevant to the post, including dates gained:
Please list any training or relevant learning opportunities you have undertaken (certificated or un-certificated) relevant to the post:

Skills and general information

Please tell us about anything else you think maybe relevant. Use as much space as needed.
If appointed, when could you take up the post?
Do you have permission to work in this country YES / NO
Do you hold a clean & current Driving Licence? YES / NO
Are you a member of Protection of Vulnerable Groups (PVG) scheme? YES / NO
If yes, please give Membership No & Expiry Date
Have you any previous contact, or current contact with Signpost? If yes, please give details

References

Please give details of two referees who know you well:
Name:
Address:
Telephone:
Relationship to you:
Name:
Address:
Telephone:
Relationship to you:
Please tick this box if you do not wish us to take up references prior to interview.

Declaration

I declare that the information I have given in the above application is correct and complete. False or misleading statements may be sufficient grounds for cancelling any agreements made, or for disciplinary action to be commenced.

Signature:...... Date:......

Equal Opportunities Monitoring Record

Signpost strives through its policies, practices and procedures to achieve equality of opportunity in recruitment, training, staff development, publicity, organisational structures, access to services, volunteering opportunities, quality arrangements and terms and conditions of employment or engagement.

To help us monitor our equal opportunity policy in recruitment and selection procedures, you are requested to complete the following questionnaire.

The information you provide does not form part of the selection procedures, it is used only for monitoring purposes. This sheet will be separated from your application form before shortlisting. The statistics gathered from the monitoring form will assist us in monitoring our Equal Opportunities Policy.

Post applied for:Family Support Worker

Please tick the relevant boxes which describe you:

Gender:

I identify my gender as ………………………………… Prefer not to say 

Do you consider yourself to have a disability or health condition?

Yes No  Prefer not to say 

(The information in this form is for monitoring purposes only. If you believe you need a ‘reasonable adjustment’, then please discuss this with the manager running the recruitment process if you are a job applicant).

What is your ethnicity?

Ethnic origin is not about nationality, place of birth or citizenship. It is about the group to which you perceive you belong. Please tick the appropriate box Prefer not to say 

White

English  Welsh  Scottish  Northern Irish  Irish 

British  Gypsy or Irish Traveller 

Any other white background, please write in:

Mixed/multiple ethnic groups

White and Black Caribbean White and Black African  White and Asian 

Any other mixed background, please write in:

Asian/Asian British

Indian  Pakistani  Bangladeshi  Chinese 

Any other Asian background, please write in:

Black/ African/ Caribbean/ Black British

African  Caribbean

Any other Black/African/Caribbean background, please write in:

Other ethnic group

Any other ethnic group, please state:-:

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