Sense Application Form

Sense Application Form

Job Title and Location / Ref No.
Where did you see job advert?
Section 1. Personal Details
First Name(s) / Family Name
Have you ever been known by any other names? If so, please give details
Home Address
Home telephone
Mobile / textphone / fax number
Email address
Preferred method of contact?
Do you hold a valid driving licence? / Yes / No
Do you have the use of a car? / Yes / No
Are you eligible to work in UK? / Yes / No
Do you hold BSL Level 1? / Yes / No
Do you hold BSL Level 2? / Yes / No
Are you eligible to work in the UK?
Current / most recent salary
Have you previously worked for Sense? If so, please give details / Yes / No
Do you currently work for the organisation Sense as a casual worker or an employee? If so, please give details / Yes / No
Positive about disabled people

Sense is proud to hold the Positive about disabled people accreditation. We will guarantee an interview to all candidates with a disability who meet the minimum criteria for a particular job.

The definition of ‘disability’ under the Equality Act 2010:

In the Act, a person has a disability if:

• they have a physical or mental impairment
• the impairment has a substantial and long-term adverse effect on their ability to perform normal day-to-day activities

For the purposes of the Act, these words have the following meanings:

• 'substantial' means more than minor or trivial
• 'long-term' means that the effect of the impairment has lasted or is likely to last for at least twelve months (there are special rules covering recurring or fluctuating conditions)
• 'normal day-to-day activities' include everyday things like eating, washing, walking and going shopping

Please let us know if you qualify for this scheme by checking this box.

Please note that all information received will be held in the strictest confidence and we will only use this information to ensure we comply with our obligations under this accreditation.

Positive about disabled people

The following information will help us make adequate arrangement if you are selected for interview and will only be shared with the interview panel if your application is successful

Should you be invited to interview, would the interviewer(s) need an interpreter to meet with you? Yes No

Which mode/method of communication would you wish to use during an interview, e.g. BSL, SSE, speech to text?

Are there any other ways Sense could support you during your interview, e.g. book a room with a loop, book a room which is wheelchair accessible, copy interview materials on to yellow paper? If so, please give details

Do you need information in an alternative format? If so, which would you prefer

Large Print

Braille

Audio Tape

If you would prefer a different font size, please specify which

Have you ever received support through Access to Work?Yes No

If 'Yes' did you receive equipment?Yes No

If so, please advise what equipment

Did you have a support worker?

Did you have interpreter / notetaker / lipspeaker support?

If you were successful at interview, would you like to discuss your support needs further?Yes No

Positive about disabled people

Education & Employment History

Sense make detailed checks on the background of all new staff and it is a requirement for this role that we hold a full working life history that begins from the date you left school or full time education to present day.

Please state the date that you left full time school of full time education

Please provide details of any relevant education and training achievements, starting with the most recent

Date / General / Further Education subjects studied / Qualification obtained

Please give details of any technical or professional organisations to which you belong

Please provide a full working life history from the date that you left school until the present day. You should include your full education and work history and also indicate any gaps in employment and your activity during this time.

Start / end date / Employer / Education establishment name, address and telephone number / Job title and brief description of duties (or title of course) / Reason for leaving

Please detail any gaps in employment

Start / end date / Reason for gap in employment?
Meeting the requirements of the role

Please read the candidate guidelines, Job Description & refer to the I Statements.

Please provide information to support evidence of your suitability for the advertised role. Details of the type of evidence required for this section are provided in the Candidate Guidelines. Candidates should, therefore, consult this before completing the section.

Supporting Statement
Other information
If you are related to or in a relationship with anyone who currently works for Sense please check the box below to confirm this
If so, please give details of who this person is and where they work
References References

All offers of employment are subject to receipt of satisfactory written references. Please provide details of a minimum of two referees, one of whom should be your present or most recent employer, or an academic referee if more appropriate. It may also be necessary to contact any of your previous employers for a reference.

We will require at least two references that covers the past two years as a minimum, please ensure that the referee details given fall within this time period.

For further information please refer to the candidate guidelines.

If your previous employer no longer exists, or if there are breaks in your employment over the last three years, please give the name of a responsible person to act as a personal referee. Your personal referee must not be related to you and must have known you for at least three years.

May we contact your referees prior to a job offer? / Yes / No
Referee 1
(Current or most recent employer) / Referee 2
(Recent employer)
Name
Job Title
Company Name
Address
Telephone Number
Email Address
Do the reference details provided cover the past two years (from today) with no gaps? / Yes No
If no, please provide further referee contact details including the dates for which this covers.

Declaration

I understand that if I have deliberately used misleading information to gain employment within Sense then I may be instantly dismissed at a later date. The information contained in this application form is, to the best of my knowledge, correct. I authorise Sense to process this application in line with the Data Protection Act 1998.

Signed / Date
Diversity Monitoring

Sense has instituted a policy of monitoring our Equal Opportunity Policy by collecting information about staff. In order to assist us with this, it would be helpful if you could answer the questions below. All information received will be held in the strictest confidence.

Name / Job Applied For
Gender (please tick) / Male / Female
Do you consider that you have a disability under the Equalities Act 2010 definition?
(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) / Yes
No
Prefer not to say
If you have answered Yes, please select the definition/s from the list below that best describes your disability/disabilities:
Deafblindness (A combined sight and visual impairment causing difficulties with communication, access to information and mobility)
Hearing (Such as deaf, partially deaf or hard of hearing)
Vision (Such as blind/partial sight)
Speech (Such as impairments that can cause communication problems)
Mobility (Such as wheelchair user, artificial lower limb(s), walking aids, rheumatism or arthritis)
Reduced physical capacity (Such as inability to lift, carry or otherwise move everyday objects. Debilitating pain or lack of strength, breath, energy or stamina, asthma, angina or diabetes)
Physical coordination (Such as manual dexterity, muscular control, cerebral palsy)
Learning difficulties (Such as dyslexia
Mental Illness (Substantial and lasting more than a year, such as severe depression or psychosis)
Other Disability (please specify)
Sexuality
Lesbian Gay Bisexual Heterosexual Other Prefer not to say
Ethnic Origin
This section uses the same categories as the latest government census. Sense is, therefore, able to monitor whether the ethnicity of staff reflects the local population. What do you regard as your ethnic origin?
White: British Another white background
Mixed: White & Black Caribbean White & Black African
White & Asian Another mixed background
Asian or Indian Pakistani
Asian British: Bangladeshi Another Asian background
Black or Caribbean African
Black British: Another Black background
Chinese or other Chinese background
Other:(please specify)
I do not wish to give this information
Religion/Belief:
Atheism Buddhism Roman Catholic
Hinduism Islam Protestant
Judaism Sikhism Other Christian denominations
Other (Please specify) Prefer not to say