PARAMOUNT CARE AND SAFETY LTD

Part 1 Office 1

The Old Fire Station

Byrom Street

Blackburn. BB2 2LE

01254 661738

APPLICATION FORM

Applications can only be processed if ALL sections are completed.

Please complete the form in BLACK ink or typescript and ensure that you have signed/dated the Declaration

Application for the post of: Social Care Worker
Surname: First Name:
Any other surnames by which you have been known:
Date of Birth:
PERMANENT ADDRESS
Postcode
TEL. NO (Home/Mobile):
EMAIL:
Are you lawfully resident in the UK?
Are there any restrictions on your continued residence or employment in the UK? If yes give details.
National Insurance Number:
Are you medically fit for work, including evenings, nights & weekends, in the course of your duties?
YES NO
How many days sick leave have you taken in the last two years?
Have you ever been declared Bankrupt?
Where did you see the advertisement for our vacancy?
Do you hold a full, current UK driving licence?
Please List Any Endorsements

EMPLOYMENT INFORMATION

CURRENT EMPLOYER

Name and address of employer / Date
from/to (including months) / Main Duties and Responsibilities / Job Title, Grade, Current Salary

PREVIOUS EMPLOYMENT (List the most recent employer first (not including current). Include any periods of unemployment and give explanation of any gaps in employment history.)

Name and address of employer / Date
from/to (including months) / Job Title, Main Duties and Responsibilities, Current Salary / Reason For Leaving

EDUCATION DETAILS

SCHOOL / COLLEGE/ UNIVERSITY / FROM / TO / SUBJECTS / COURSES / QUALIFICATIONS GRADES GAINED
PROFESSIONAL BODIES MEMBERSHIP
Please give details of your membership of any professional body.

CONTINUOUS PROFESSIONAL DEVELOPMENT

Please list training / short courses undertaken/ Mandatory training

DATE / ORGANISING BODY / COURSE OR TRANING TITLE

PERSONAL STATEMENT

Please detail how your application meets the job description/person specification for the position applied for, outlining your knowledge, skills, experience and personal attributes. This would be helpful to do by giving examples of the work you have undertaken, which can be personal or work related.

Name: (Printed) Date:

Signature:

Part 2 REFEREES

(Please note family and friends are not appropriate/acceptable)

Referee 1. Present / most recent employer
NAME.
ADDRESS
Tel No.
Email address / Admin use only
Sent
Chased
Received
Referee 2.
NAME.
ADDRESS
Tel No.
Email address / Admin use only
Sent
Chased
Received
Referee 3.
NAME.
ADDRESS
Tel No.
Email address / Admin use only
Sent
Chased
Received
Can referees be approached prior to interview?
If appointed, when your earliest start date be?
DECLARATION
Please note: This section must be completed in full for your application to be considered. This section of the Application Form will not be taken into consideration when shortlisting processes are being undertaken, but will be looked at prior to interview due to pre checks carried out as per our recruitment policies and procedures.
Before completing this section please read the following carefully:
The post for which you are applying is exempt under the provision of the Rehabilitation of offenders’ Act 1974, (Exception order 1975) (Section 4.2). Ref also Home Office Circular HOC102/88 Protection of children; disclosure of criminal background of those with access to children
This means that you must give full details of any criminal convictions, including any spent convictions, or pending circumstances that might lead to prosecution, conviction, bind-over or caution.
Information, which you give, will be treated in confidence.
Have you ever been either convicted or found guilty by a court of any offence in any country or have you ever been put on probation or absolutely/conditionally discharged, or bound over after being charged with an action pending against you?
YES NO
Have you ever been convicted by a court martial or sentenced to detention or dismissal when serving in the armed forces of the UK or any Commonwealth or Foreign Country?
YES NO
If the answer is yes to either of the above questions, please disclose all convictions including offence, dates and penalty applied.
Are you subject to any current or outstanding disciplinary, suspension/dismissal procedures? Have you ever had any action taken against you by an authority regarding children or young adults? If so please give details.
Applicants should note that a DBS enhanced check will be carried out on the person appointed to this position.
Failure to declare a conviction, caution or bind-over may, however disqualify you from appointment, or result in summary dismissal when the discrepancy comes to light.
Applicants Statement
“I take notice that if I have any convictions and do not declare them or withhold information which is relevant to my application, or if information provided in my application is untrue, I understand that I will be instantly dismissed. I confirm that I have read, understood and truthfully answered the above questions. I confirm that all of the information that I have given in my application for this position is to the best of my knowledge accurate and correct. I confirm that I am not debarred from working with children or young adults. I understand that my application is subject to satisfactory references, DBS checks and interview.”
Signature
Name (printed)
Date

EQUAL OPP0RTUNITIES

The Paramount Group is committed to equality of opportunity in employment.

Are you?
(please tick relevant box) / MALE / FEMALE
Marital status; are you?
(Indicate choice with yes) / Married/ civil partnership
Widowed / Single
Separated / Divorced
Co-habiting
Please enter your Ethnicity: - ……………………………………………..
DO YOU CONSIDER YOURSELF TO HAVE A DISABILITY? Please tick the relevant box.
YES / NO
IF YES PLEASE SPECIFY.
………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
IF YOU ARE REGISTERD DISABLED?
YES / NO
IF YES PLEASE GIVE; REFERANCE NO…………………………………….
REGISTRATION DATE…………/…………/………..
DO YOU REQUIRE ANY SPECIAL FACILITIES / ARRANGEMENTS AT INTEVIEWS?
YES / NO
IF YES PLEASE ADVISE;-

Updated August 2016