Bromley Dementia Support Hub
APPLICATION FOR EMPLOYMENT
PLEASE COMPLETE IN BLACK INK OR TYPE
Please note that this application form must be completed in full. Curriculum Vitae will not be accepted.
Forms should be returned to: Bromley & Lewisham Mind, 20b Hayne Road, Beckenham, Kent BR3 4HY or by email to
Post for which you are applyingJob reference number
1.PERSONAL DETAILS
Title: Mr/Mrs/Miss/Ms… First Name:
Surname:
Home Address:
Post Code:
Home Tel No:
Mobile Tel No:
Work Telephone No:
May we contact you there? YES NO
Email Address:
Do you have any special needs that we should be aware of?YES NO
If yes, please give details and let us know of any special requirements you would have if selected for interview:
The ‘Person Specification’ for this role will say whether a driving licence is needed for this post.
If a driving licence is required,
a)Have you a current full driving licence?YES NO
b)Type of licence:
Please give details of any endorsements
d)Do you have use of your own transport?YES NO
2.EMPLOYMENT DETAILS
Do you have the right to work in the UK? YES NO
(All employees are obliged to provide original documentary evidence of theirright to work in the UK, prior to commencing employment.)
Current or Most Recent EmploymentPosition Held:
/ Starting Date: / Notice Required or Date Left:Current Salary
£ / Reason for leaving:
Employer's Name: Address:
Main Duties and Responsibilities
PREVIOUS EMPLOYMENT
Please use a separate row for each role.
Please provide reasons for any gaps in your employment history, using a separate sheet if necessary
From: To: / Employer'sName & Address: / Job Title: / Duties/ Responsibilities: / Reason for leaving:
3.EDUCATION
Qualifications will only be taken into account where they are strictly required for the post
Schools, Colleges, Universities or Institutes of Further Education attended (including part-time) /Dates:
/ Qualifications gained including subjects, grades or results expectedFrom: / To:
Name of Professional or Technical Association: / Status:
Any Other relevant qualifications or records of achievement (e.g. courses attended)
4.GENERAL EXPERIENCE AND FURTHER INFORMATION
(Please append and number up to 2 additional sheets as necessary)
Describe how your skills, past achievements, qualifications, experience and personal qualities make you suited for this job. This could include voluntary work, leisure interests and any other activities you consider relevant to this position. Please refer to the person specification and give specific examples wherever possible.
5.REFERENCES
If you are selected for an interview we will wish to take up references. You must give the name of your present or last employer as one referee. If you are a School, College or University leaver, you should give your head teacher or tutor.
1.Referee’s Name: Referee’s position:
Name & Address
of Company:
Position you held: From: To:
Telephone No: Email:
2.Referee’s Name: Referee’s position:
Name & Address
of Company:
Position you held: From: To:
Telephone No: Email:
6.DECLARATION
I confirm that the information I have given is correct and complete and that false or misleading statements may be sufficient to cause Bromley & Lewisham Mind or Age UK Bromley & Greenwichto withdraw any offer of employment made.
I understand that, in the event of being short listed for interview, I may be required to complete a confidential declaration relating to criminal convictions, cautions, reprimands and final warnings that are not ‘protected’ as defined by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (as amended in 2013) by SI 2013 1198. I may also be required to provide any other information that may have a bearing on my suitability for the post.
I also understand that a DBS Disclosure will be sought in the event of a successful application, where this is a requirement for the position applied for.
Falsification of qualifications or information which are a statutory and essential requirement of employment or which result in additional remuneration may lead to dismissal without notice.
I give explicit consent that the information which I give on this form may be processed in accordance with Bromley & Lewisham Mind or Age UK Bromley & Greenwich’s registration under the Data Protection Act 1998. The information provided may also be used in the prevention of crime and fraud or shared with other bodies administering public funds solely for this purpose.
Signed: Date:
Canvassing of members or the Board of Trustees of Bromley & Lewisham Mind or Age UK Bromley & Greenwich, either directly or indirectly, for appointment by Bromley & Lewisham Mind or Age UK Bromley & Greenwich shall disqualify the candidate concerned for that appointment.
EQUALITY AND DIVERSITY POLICY STATEMENT
Bromley Dementia Support Hub is committed to equality of opportunity and the elimination of discriminationin all its forms. We seek to create productive environments, representative of different cultures and groups, which reflect the diversity of the communities we serve.
What is Equality?
Equality is focused on enabling everyone to participate and fulfil their potential. It does not mean treating everyone exactly the same, but rather treating people as individuals and accounting for inequalities and disadvantages.
It addresses unfair discrimination based on the membership of a particular group. For example, age, disability (physical or mental ability), race, gender, sexuality, religion, etc. It is also supported by legislation.
Equal opportunities is about:
- Good management practice in order to maximise employee and volunteer potential and create a framework ensuring all employees, volunteers and job applicants receive equal access in relation to employment, terms and conditions, training, promotion and services, and are able to maximise their potential.
- Providing services that maximise opportunities for service users and ensure equal access services that are relevant and accessible to all sectors of the communities we serve.
- Ensuring all employees, volunteers and service users are free from harassment and bullying of any description, or any other form of unwanted behaviour, based on their identity or membership of a particular group.
What is Diversity?
Diversity is about recognising, respecting and valuing the differences between individual employees, volunteers and service users. Diversity values individuals because of their differences, not in spite of them. For example their cultural, educational and life experiences etc.
Diversity helps to establish an environment that harnesses differences for the benefit of the individual and the organisation.
Equality and Diversity in Bromley Dementia Support Hub
This service exists to enhance and enrich the quality of life of people with mental health needs and dementia. It serves a diverse community and believes that diversity enriches our society and that individual differences should be respected.
Bromley Dementia Support Hub believes there is a direct link between discrimination and oppression and mental distress, because of the effect it has on identity, self-esteem and opportunities to achieve self-fulfilment.
Commitment to Equality and Diversity is everyone’s responsibility and everyone has a role to play, no matter how big or small. Bromley Dementia Support Hub staff not only believe in equality but demonstrate this on a daily basis with their interaction with service users, volunteers, visitors and each other.
Bromley Dementia Support Hub provides guidance to ensure that no job applicant, employee, volunteer, carer or service user is discriminated against, either directly or indirectly, on the grounds of their race, colour, religion or belief, ethnic or national origin, gender, marital status, sexuality, physical or sensory disability, age, mental disability, mental health need, HIV status, or transgender status.
Breaches of this policy will lead to disciplinary proceedings.
EQUAL OPPORTUNTIES MONITORING INFORMATION
Bromley & Lewisham Mind and Age UK Bromley & Greenwichbelieve in the equality of opportunity and access for all, and take care to ensure that all our services are inclusive and accessible to all. We are committed to ensuring that no job applicant receives less favourable treatment on the grounds of race, colour, religion, gender, class, age, health or disability, sexual orientation, political activities, because they have dependents, or because they have been, or are in contact with, mental health services.
The purpose of this confidential form is to ensure Bromley & Lewisham Mind and Age UK Bromley & Greenwich have a clear overview of how effective we, as organisations, are in outreaching to diverse communities.
Post Applied for: Date:
Full name: Mr/Mrs/Miss/Ms/Dr
1. Female Male Transgender (Please tick appropriate box)
2. Are you married or in a civil partnership? Yes No
3. Age 16-24 25-29 30-34 35-39 40-44 45-49
50-54 55-59 60-64 65+
4. Ethnic Origin - please tick only one box below
(Ethnic origin categories are not about nationality, place of birth or citizenship. They are about the group to which you as an individual perceive you belong.)
White
White British White Irish
Any other white background
Black/African/Caribbean/Black British
Black CaribbeanBlack African
Any other Black background
Mixed/multiple ethnic groups
White and Black Caribbean White and Black African
White and Asian Any other mixed background
Asian/Asian British
Indian Pakistani Bangladeshi
Any other Asian background
Other Ethnic Group
Chinese Gypsy or traveller
Any other ethnic group (please state)
Prefer not to say
(Cont)
- Do you consider yourself to have any of the following health conditions or disabilities?
(The Equality Act defines a person as disabled if he/she has a physical or mental impairment, which has a substantial and long-term adverse effect on his/her ability to carry out normal day-to-day activities.)
Yes No If Yes…
Physical impairment Long term illness or condition
Visual or hearing impairment Mental health condition
Learning difficulty Other
- Are you registered disabled?
Yes No
- What is your sexual orientation?
Lesbian Gay Bisexual Heterosexual/Straight
Asexual Other Prefer not to say
- What is your religion or belief?
Buddhist Christian Hindu Jewish Muslim Sikh
Baha’i Catholic Jain Pagan Other
No religion/belief Prefer not to say
9. Do you have personal experience of mental health problems?
Yes No Prefer not to say
10. Where did you hear about this job opportunity?
Bromley & Lewisham Mind websiteAge UK Bromley & Greenwich website
National Mind website Guardian jobs websiteCharityjob website
Local Council websiteWorking Mums Website Internal vacancyFriend/colleague other (please specify)
Thank you for taking the time to complete this form.
April 2016
RECRUITMENT OF EX-OFFENDERS AND STAFF WORKING WITH VULNERABLE ADULTS
As organisations using the Disclosure & Barring Service (DBS) to assess applicants’ suitability for positions of trust, Bromley & Lewisham Mind and Age UK Bromley & Greenwich comply fully with the DBS Code of Practice and undertake to treat all applicants for positions fairly. We undertake not to discriminate unfairly against any subject of a DBS check on the basis of a conviction or other information revealed.
We actively promote equality of opportunity for all with the right mix of talent, skills and potential and welcome applications from a wide range of candidates, including those with criminal records. We select all candidates for interview based on their skills, qualifications and experience.
A DBS check is only requested after a thorough risk assessment has indicated that one is both proportionate and relevant to the position concerned. For those positions where a DBS check is required, all application forms, job adverts and person specifications contain a statement that a DBS check will be requested in the event of the individual being offered the position.
Where a DBS check is to form part of the recruitment process, we encourage all applicants called for interview to provide details of their criminal record at an early stage in the application process. We request that this information is sent under separate, confidential, cover, to a designated person within Bromley Dementia Support Hub and we guarantee that this information will only be seen by those who need to see it as part of the recruitment process.
Unless the nature of the position allows Bromley Dementia Support Hub to ask questions about your entire criminal record, we only ask about ‘unspent’ convictions as defined in the Rehabilitation of Offenders Act 1974.
We ensure that all those in Bromley Dementia Support Hub who are involved in the recruitment process have been suitably trained to identify and assess the relevance and circumstances of offences. We also ensure that they have received appropriate guidance and training in the relevant legislation relating to the employment of ex-offenders, e.g. the Rehabilitation of Offenders Act 1974.
At interview, or in a separate discussion, we ensure that an open and measured discussion takes place on the subject of any offences or other matter that might be relevant to the position. Failure to reveal information that is directly relevant to the position sought could lead to withdrawal of an offer of employment.
We make every subject of a DBS Check aware of the existence of the DBS Code of Practice and make a copy available on request.
We undertake to discuss any matter revealed in a DBS check with the person seeking the position before withdrawing a conditional offer of employment.
Bromley & Lewisham Mind and Age UK Bromley & Greenwich have policies on Handling of DBS certificate information, which is available to see on request.
In the event of you becoming an employee in Bromley Dementia Support Hub, any failure to disclose such convictions could result in dismissal. Any information given will be kept completely confidential in line with the Data Protection Act and will be processed fairly and lawfully and only disclosed in appropriate circumstances. The information we may hold on you will be accurate, relevant, kept securely and not held longer than is necessary.
Having a criminal record will not necessarily bar you from working with us. This will depend on the nature of the position and the circumstances and background of your offences.