CARIS Haringey

Tel 020 8800 5300 Fax 020 8800 5430

St. Ann’s Church Hall. Avenue Road. London N15 5JH, Reg. Charity No. 1061577

APPLICATION FOR EMPLOYMENT
Post:
Family Support Worker / Closing date:
28th March @ 2pm
BACKGROUND INFORMATION
Surname / First name
Address (please include post code)
Telephone numbers
Day / Evening
Age / Date of birth
Are you a member of a Christian Church? YES/ NO We welcome members of staff, people of many faiths and beliefs. We do, however, ask thatall staff should support the values, ethos and philosophy of a Christian based organisation; and we would expect staff to make a positive contribution to the development of that Christian ethos
If so, which one?
Do you hold a current clean driving licence?
Do you have the use of a car during the day?
Do you need a work permit to work in the United Kingdom?
If you do need a work permit, do you have one already?
Where did you see the advert for this vacancy? (if a newspaper, please give the title)
If you did not see the advert, how did you hear of the vacancy?
PRESENT OR MOST RECENT EMPLOYMENT
Name of Employer / Business of Employer
Address
Post held
Salary / What is your notice period?
Reasons for leaving
Please describe your current duties
PREVIOUS EMPLOYMENT
Please give details of your previous employment, both paid and unpaid (most recent first). Continue on another sheet if necessary.
Date From / Date To / Employer's Name
and Address / Job Title and Main Duties / Salary and Reasons for Leaving
HEALTH
How many days off have you had due to illness in the last 2 years?
Do you have any serious health problems?
If yes, please specify

N.B. Having a physical disbility does not preclude someone being appointed.

EDUCATION
Please give your education and qualifications. List them in order with most recent first and include any being currently studied for.
Dates / University/ College/School / Subject studied and level obtained / Results
MEMBERSHIP OF PROFESSIONAL ORGANISATIONS
Organisation name and address / Date of joining / Status
OTHER TRAINING UNDERTAKEN
Course attended / Course location / Dates / Level
REFERENCES
Please give details of three referees, none of whom should be related to you. One must be your present employer, or most recent employer if you are presently unemployed. One should be able to comment on your Christian understanding. These referees will normally only be approached once you have been offered the job.
Referee / Your most recent employer / Other relevant referee / Other relevant referee (should be able to comment on your Christian understanding)
Name
Address
Tel no.
Occupation
May we approach? / yes 
no  / yes 
no  / yes 
no 
CRIMINAL CONVICTIONS
Because of the nature of the work for which you are applying, this post is exempt from the provisions of Section 4(2) of the Rehabilitation of Offenders Act 1974 by virtue of the Rehabilitation of Offenders Act 1974 (Exemptions) Order 1975. You are, therefore, not entitled to withhold information about convictions which for other purposes are 'spent' under the provisions of the Act. In the event of employment, any failure to disclose such convictions could result in dismissal or disciplinary action by us.
Any information given will be completely confidential, and will be considered only in relation to an application for positions to which the Order applies. In order to fulfil this requirement would you please complete the details below.
Have you ever had or do you have any pending prosecuations, cautions or criminal convictions? yes  no 
If yes, when did this take place? / What was the charge?
RELEVANT EXPERIENCE/FURTHER INFORMATION
Please give a concise account of any relevant experiences/activities, whether from work or non-work situations, and any further information that you feel supports your application. You are advised to relate this account to the person specification attached to the job description for the post for which you are applying. Please state why you are applying for this job and what you feel you will bring to CARIS Haringey. You can continue on a separate sheet if necessary – please attach it firmly to the application form and put your name at the top of the page(s).
DECLARATION
I declare that the information that I have given here is correct to the best of my knowledge and I understand that any appointment offered may be retracted should this information prove to be false. I also understand that all posts will be subject to CRB checks and that canvassing will disqualify me.
Full name
Signed / Date