CONFIDENTIAL

APPLICATION FORM

Important Note: This form can be either typed or clearly hand written. Please read all accompanying information before completion. CV’s will not be accepted as part of the application process.

VACANCY: Carer Recruitment Officer (Part time)
LOCATION/DEPT: Belfast / CLOSING DATE: 7th January 2013
CANDIDATE PERSONAL DETAILS
TITLE:______SURNAME: ______
FIRST NAMES:______

Have you ever used any other names? Yes No
If YES, please state: ______
ADDRESS IN FULL:
Postcode: ______/ Please only give numbers/addresses on which you are willing to be contacted.
TELEPHONE (Home): ______
MOBILE TELEPHONE:______
PERSONAL FAX: ______
EMAIL (Home): ______
TELEPHONE (Work): ______
EMAIL (Work): ______
National Insurance No:

DRIVING AND TRANSPORT

Do you hold a valid driving licence for use in the UK?Yes No
Type:ProvisionalFullOther (please specify) ______

Do you have use of a car to carry out duties of the post if required? Yes No
Do you have any current endorsements?
If YES, please give details: Yes No
You will be asked to bring your driving licence to interview should driving form part of your role
ASYLUM AND IMMIGRATION ACT 1996

Do you have any restrictions in taking up employment in the UK?YesNo
If YES, please supply details

Do you require a Work Permit or Certificate of Sponsorship?YesNo
DECLARATION OF OTHER INTERESTS
Are you currently a foster carer, or waiting for approval as a foster carer, with CFFA, a local authority or any other agency or have previously been a foster carer?

If YES, please give details and dates: Yes No
Are you related to a current employee of CFFA? If yes please give details YesNo

If appointed would you continue to hold other paid or unpaid/voluntary positions? YesNo
Please give details:

Have you previously worked for CFFA in any capacity? Yes No
HOME BASED POSITIONS ONLY
Do you have sufficient space to allow you to work from home? Yes No

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EMPLOYMENT HISTORY

CURRENT OR MOST RECENT EMPLOYER
Your Employer’s name, Address and phone number and type of Business / Dates of Employment
From To / Reason for Leaving / Current Salary / Notice Required
Job Title:
Duties and Responsibilities:
Briefly describe current, or most recent employment, highlighting duties, responsibilities, skills and experience gained that are relevant to the post for which you are applying.
BREAKS IN EMPLOYMENT
If you have had any breaks in employment since leaving full-time education, please give dates and details of your activities during these times.
PREVIOUS EMPLOYMENT
Please list all employment, in date sequence, since leaving full-time education. Excluding your current employer, please begin with your most recent previous employer. Voluntary, home-based and part-time work should be included. Please continue on a separate sheet if necessary, and attach to the application form.
Dates
FromTo / Employer’s Name and Address / Job title, main responsibilities, reason for leaving and final salary

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EDUCATIONAL AND PROFESSIONAL QUALIFICATIONS AND TRAINING
(Where applicable please give details of all professional qualificationsgained or about to be gainedfor which results are not available)
Name/Address of Institutions attended (most recent first) / Dates
FromTo / Qualifications gained, with dates, level grades or predicted grades indicated
Other relevant training courses (including in-house) completed or personal development which are relevant to the post
Organising Body/Course Title / Brief Description of content or activity
MEMBERSHIP OF OR REGISTRATION WITH PROFESSIONAL BODIES
Name of Professional Body / Level/Type of Membership / Registration No: / Renewal Date

Important Note: Please attach copies of certificates of relevant qualifications and registration to this form.

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SUPPORTING INFORMATION
Please use this section to tell us a little about yourself and why you are interested in the position. With reference to any information contained in the recruitment pack, please advise why you consider yourself to be suitable for the post, giving details of relevant skills and experience, indicating how you would contribute to the role if appointed. If necessary, you may attach separate sheets.
REFERENCES
Please give the names and addresses of two referees who have known you in a professional capacity. One must be your current, or most recent, employer. The second if not a previous employer must have known you for at least twoyears. If you give a home address for a referee, please indicate which employer or institution they represent. References cannot be accepted from friends or relatives. An offer of employment is conditional upon satisfactory references. Further references may be requested if necessary.
Referee 1
Position Held:______
Telephone No:______
How do they know you? ______
May we contact the above without further reference
to you: YesNo / Referee 2
Position Held:______
Telephone No:______
How do they know you? ______
May we contact the above without further reference
to you: YesNo

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DISCLOSURE OF CRIMINAL CONVICTIONS AND REHABILITATION OF OFFENDERS ACT 1974
The appointment of any staff member who may have contact with or access to children or vulnerable adults will be subject to the receipt of a satisfactory enhanced disclosure from the Criminal Records Bureau (or equivalent)
Because of the nature of the work this post is exempted from the Rehabilitation of Offenders Act 1974 and all convictions both spent and unspent must be disclosed.

Have you ever been convicted of a criminal offence?YesNo
Are there any alleged offences outstanding against you?YesNo
If you have answered YES to any of the above please attach details in a sealed envelope marked ‘STRICTLY CONFIDENTIAL’. CFFA believes that having a criminal record will not necessarily bar a candidate from working for us. Employment will depend upon the role, circumstances and nature of the offence.
Are you currently, or have you previously been barred from working with vulnerable groups or subject to sanctions by a regulatory body? Yes No
All employees will be subject to registration with the ISA Vetting and Barring Scheme.
DATA PROTECTION
Information given in connection with this application will be controlled under data protection legislation and will be used for the purposes of recruitment within CFFA. Should your application be successful, the information will be used for your personnel records and payroll purposes. The information will be processed both manually and automatically for these purposes.
DECLARATION
Before signing this declaration, please read the following:
Candidates who omit information that has been requested may not be considered for the post they wish to apply for. Please check that you have correctly supplied all information that has been asked for. If you are appointed to the post any serious omission or inaccuracy relevant to your application could lead to disciplinary and in some circumstances legal action against you.
I declare that the information given by me is true and accurate. I understand that if it is subsequently discovered that any statement is false or misleading CFFAreserves the right to withdraw an offer or terminate employment without notice.
I accept the conditions as given in the Data Protection section above. I understand that any job offer is conditional upon satisfactory references, criminal records checks and medical checks.
Signature:______Date:______
Note:If you have returned this form electronically you will be required to sign it should you attend an interview. Copies of certificates should still be forwarded by post.
Applications may be returned by post to: Human Resources, Frays Court, 71 Cowley Road, Uxbridge,
Middlesex, UB8 2AE
or by email attachment to: .

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RECRUITMENT MONITORING FORM

The information of this form is strictly confidential and does not form part of the application. Information provided will be handled and stored in line with the provisions and requirements of the Data Protection Act 1998.

CFFA aims to promote equality of opportunity for all and welcomes applications from all sections. It is a fundamental principle of our policies that all people are valued equally regardless of their gender, age disability, race, ethnic origin, language, religion or sexual orientation.

To help us ensure that our Equal Opportunity Policy is fully and fairly implemented (and for no other reason) we hope that you will assist us by completing this form.

The form will not be seen by those involved in the selection process. Only through collecting information can we assess our performance and identify where improvements should be made.

Thank you.

POST APPLIED FOR:______JOB REFERENCE NO: ______

SURNAME: ______
NATIONALITY: ______/ FIRST NAMES: ______
GENDER:MF
DATE OF BIRTH (DD/MM/YYYY):
VACANCY
Where did you find out about this vacancy?

InternetTitle or Source: ______

NewspaperTitle or Source: ______

Professional/Trade JournalTitle or Source: ______

Internal BulletinTitle or Source: ______

Friend/ColleagueTitle or Source: ______

OtherTitle or Source: ______
RELIGION:
Please select one of the choices below. If they do not provide a suitable option, please specify how you would describe your religion.

I do not wish to specifyJewishBuddhist

ChristianMuslimNone

SikhHinduOther
ETHNIC ORIGIN:
The following categories are recommended by the Commission of Racial Equality. If the choices do not provide a suitable option for you, please specify how you would describe your ethnic origin.

I do not wish to specify
ASIAN OR ASIAN BRITISH / BLACK OR BLACK BRITISH / CHINESE OR OTHER ETHNIC GROUP / MIXED / WHITE

Indian

Pakistani
Bangladeshi
Any other /
Caribbean

African
Any Other /
Chinese

Any Other /
White & Black Caribbean

White & Black African

White & Asian

Any Other /
British

Irish
Any Other
If you have ticked any of the boxes marked “ANY OTHER”, please give details below:-
The Disability Discrimination Act 1995 states that “a person has a disability for the purposes of this Act if they have a physical or mental impairment which has a substantial and long-term adverse effect on their ability to carry out normal day-to-day activities”.

Do you meet the above definition?YesNo
If YES, please specify:
How, if at all, does it affect you at work?

Signature: ______Date: ______

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