CCMS, The Old Smithy

1 North Road, Stokesley

North Yorkshire, TS9 5DU

Tel: 01642 713720

Care and Case Management Services Ltd

APPLICATION FOR EMPLOYMENT

Please complete the application form and email it to . Alternatively you can return to the above address.

FULL NAME (Block Capitals)
POSITION APPLIED FOR
Female Support Worker – York

If you wish to apply for a job with CCMS you must complete this form. The information you give will be treated in confidence and will be seen only by persons employed by the Company who need to use it, in the course of their work. The information is asked for because:

¨  It helps the Company in deciding whether to take your application further.

¨  It will be used as the basis for your employment records should your application be successful and you join the Company

For Office Use Only


PERSONAL DETAILS PLEASE COMPLETE THIS PAGE IN BLOCK CAPITALS

BASIC INFORMATION

Preferred Title Surname

Forenames

Mr / Mrs / Miss / Ms / Other All previous surnames

(please indicate)

Current Address (incl. Postcode) Telephone No: (inc Code)

Mobile No:

E-mail Address:

DRIVING INFORMATION

Do you hold a current UK Driving License? YES NO

Do you own your own vehicle? YES NO

Do you have current endorsements/penalty points? YES NO

(if yes please give details)

OTHER INFORMATION

Have you ever been found guilty by a Court of Court Martial of any offence, which is not treated as spend under the Rehabilitation of Offenders Legislation, or, is any case against you pending?

YES NO (if yes please give details) (unspent convictions will not necessarily bar you from employment).

Have you admitted or committed any offence for which you have been cautioned or convicted by the Police or a Government Body?

YES NO (if yes please give details) (unspent convictions will not necessarily bar you from employment)

Are you, or have you been, on the Protection of Children Act (POCA) List or Protection of Vulnerable Adults (POVA) List? (if yes please give details)

YES NO

Have you been subject to any disciplinary proceedings? (if yes please give details)

YES NO

EDUCATION AND TRAINING

PLEASE INFORM US OF LEARNING ACQUIRED TO DATE

(You are welcome to continue on additional sheets if necessary)

EDUCATION AND QUALIFICATIONS
School / Subject/Qualifications/Level / Date Achieved
FIRST DEGREE COURSE/ HIGHER DEGREES/ POST GRADUATE/PROFESSIONAL QUALIFICATIONS:
Qualification(s) Gained / Main Subjects studied / Full/Part time / From/To / University/
College
TRAINING
Employer / Training Course / From/To
MEMBERSHIP OF PROFESSIONAL ORGANISATION
Organisation / Grade of Membership


EMPLOYMENT – PLEASE PROVIDE DETAILS OF PRESENT/PAST EMPLOYMENT

Are you currently employed YES NO

If “NO”, how long have you been unemployed?

If “YES” – please state

1. Notice required by present employer

2. May we contact your present employer YES NO

3. Current salary / Hourly rate

Please complete the following section in date order beginning with your current/most recent employer.

You must complete details of ALL your employment since leaving full time education including all start and finish dates. Please also account for any gaps in your employment history, e.g. dates of “unemployment “ or “at home with your family”, etc. (You are welcome to continue on additional sheets if necessary)

Dates
From / To / Employers full name, address and
telephone number / Job Title and brief resume of tasks and responsibilities / Reason for leaving
(including dismissal or resignation)
Dates
From / To / Employers full name, address and
telephone number / Job Title and brief resume of tasks and responsibilities / Reason for leaving
(including dismissal or resignation)


THIS IS YOUR OPPORTUNITY TO TELL US MORE ABOUT YOURSELF AND YOUR SUITABILITY FOR THE POST YOU ARE APPLYING FOR

What skills and experience can you bring to the job? What outside interests and activities do you pursue? Please include any other information that you feel is relevant to this application and state why you are applying for this post? (You are welcome to continue on additional sheets if necessary)


REFERENCES

Current Employer:-

Job title
Address
Incl. Postcode
Tel no (incl code)
Email:

Previous Employer:-

NB If no previous employer, please state details of character reference, etc

Job title
Address
Incl. Postcode
Tel no (incl code)
Email:

Employment with the Company is subject to satisfactory written/verbal references being obtained from your current and previous employers. Unless agreed otherwise, the Company may contact your current employer before you have accepted an offer of employment

DECLARATION OF APPLICANT

I understand that giving any incorrect or misleading information, or any omission made with the intention of misleading the Company, could lead to my dismissal

Signature: / Date:


EQUAL OPPORTUNITIES MONITORING

We are committed to ensuring that all job applicants and members of staff are treated equally, without discrimination because of gender, sexual orientation, marital or civil partner status, gender reassignment, race, colour, nationality, ethnic or national origin, religion or belief, disability or age. This form is intended to help us maintain equal opportunities best practice and identify barriers to workforce equality and diversity.

The information on this form will be used for monitoring purposes only and will not be used in any decision affecting you.

All questions are optional. You are not obliged to answer any of these questions. All information supplied will be treated in the strictest confidence.

Thank you for your assistance.

Please state which job you have applied for an the closing date given for applications

Job applied for / Closing Date

Where did you hear about this job?

Newspaper / Job Centre / Friend / Company website / Other
(please specify)

GENDER– what is your gender?

Male / Female / Prefer not to say

ETHNIC GROUP – how would you describe your nationality and/or ethnicity?

A / B / C / D / E
White / Mixed Race / Asian or Asian British / Black or Black British / Chinese and other Groups
British – (English, Scottish, Welsh) / White and Black Caribbean / Indian / Caribbean / Chinese
Irish / White and Black
African / Pakistani / African / Other ethnic group
Other black
Prefer not to say

WHAT IS YOUR AGE?

16-17 / 18-21 / 22-30 / 31-40 / 41-50 / 51-60 / 61-70 / 71+
Prefer not to say

RELIGION OR BELIEF

Please describe your religion or other strongly-held belief:

I would describe my religion as
I have no particular religion or belief
Prefer not to say

DISABILITY

The Equality Act 2010 defines a disability as a “physical or mental impairment which has a substantial and long term adverse effect on a person’s ability to carry out normal day-to-day activities.” An effect is long-term if it has lasted , or is likely to last, more than 12 months.

Do you consider that you have disability under the Equality Act?

Yes / No / Don’t Know / Used to have but have now recovered / Prefer not
to say

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CCMS application for employment