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Section 1: Personal Information
Applicant 1 (Proposed main carer) / Applicant 2 (Spouse/partner)
Surname:
Previous Family Name (If Applicable):
First name:
Other names known as:
Place, date of birth & age:
Legal status of residence within the UK for all household members:
Home no:
Mobile no:
Email address:
Address:
Post code:
Length of time at address:
Is the property (please specify)
Please note: If the property is rented or leased, written permission of the landlord will be required. / Mortgaged: / Rented/Leased:
Owned: / Letter Attached:
Identity
Applicant 1 *(Proposed main carer) / Applicant 2 *(Spouse/partner)
Gender:
Sexual Orientation:
Nationality:
Ethnic origin:
Religious persuasion or faith
Primary language spoken:
Other languages spoken:
Are you registered disabled?
If yes please provide brief details:
National Insurance No.
Occupation and hours worked:
Planned hours of work when you become an approved foster carer?
Marital Status
Marital status:
Length of relationship: Do you and your partner live together? If no please provide the following: Permanent address. How often do you see one another?
If you have a registered civil partnership, give date and place of registration:
If you live with a partner, date on which you set up a household together:
If you are separated/divorced or have dissolved a civil partnership, give date & name of partner:
If you previously set up a household with a partner give date when this ended and name of partner:
Household Information
Number of household members:
Number of bedrooms:
Number of spare bedrooms: / Please note that if you do not have a spare bedroom then you may only be considered for babies.
Name & Ages of children living at home:
Name & Ages of children living independently:
If you have birth children have they been in care? If yes when and which Local Authority:
Do you have pets? If yes, please give details:
Does anyone in the household smoke?
Do you hold a driving licence?
Do you have any driving convictions?
Do you have regular use of a car?
Birth Children of the Applicant/s
Family Name:
Forename:
Gender:
DOB/ Death:
Ethnicity:
Relationship to Applicant:
Address:
Family Name:
Forename:
Gender:
DOB/ Death:
Ethnicity:
Relationship to Applicant:
Address:
Family Name:
Forename:
Gender:
DOB/ Death:
Ethnicity:
Relationship to Applicant:
Address:
Additional Information
What age-range are you interested in fostering? Please give reason:
Would you consider supporting any of the following? Sibling groups of children?
Parent and child?
Children and young people on remand?
Children with disabilities? If yes, please detail which disabilities you could work with.
Have you previously fostered?
If yes, please provide dates and name of Local Authority/ Fostering Agency.
Have you previously been in Foster Care?
SECTION 2: Medical Information
A. Has either applicant suffered or is suffering a serious medical condition or injury?
If yes please give details below. / Yes:
No:
B. Has either applicant at any time, required medical attention for a mental health problem e.g. stress or depression etc.
If yes please give details below. / Yes:
No:
C. Has any member of the applicants’ immediate or extended family, suffered from a mental health problem?
If yes please give details below. / Yes:
No:
When was the last time you visited your GP and what was the nature of your visit?
Any surgery undertaken in the last 5 years? If yes please specify. Do you currently take any regular medication? If so please specify the name of the medication and the condition it treats.
General Practitioner
Applicant 1 *(Proposed main carer) / Applicant 2 *(Spouse/partner)
Name of GP:
Address:
Telephone number:
National Health No:
SECTION 3: Housing
If you have lived at your current address for less than 10 years, please give previous addresses:
Address:
Local Authority:
Dates From:
To:
Address:
Local Authority:
Dates From:
To:
Have you or any other member of the household previously applied to become a foster carer, adopter or childminder? / Yes:
No:
Are you currently registered as a foster carer with another agency/organisation? / Yes:
No:
If YES please state name of agency/organisation and give date of approval:
Approval Type:
Other people Living in the Household
Family name:
Forename(s):
Gender:
Age & Date of Birth:
Ethnic descent:
Relationship to applicants:
Family name:
Forename(s):
Gender:
Age & Date of Birth:
Ethnic descent:
Relationship to applicants:
Please tick and complete the following:
Home owner: / Mortgaged: / Estimated House Value:
Rented: Private: / Rented Housing Association: / Rented Local Authority:
SECTION 4: Employment & Education
Please provide your full employment & education to Secondary School, do not include in-house training.
Please explain any gaps in employment.
Applicant 1 – Most recent first. / Applicant 2
Employment & Education History (please specify dates and course name.)
Dates: / Company Name/Contact / Job Title/ Duties or Course Name / Dates: / Company Name/Contact / Job Title/ Duties or Course Name
CV Included: / CV Included:
SECTION 5: Motivations to foster
What is your motivation to foster?
Please express your preference to age or gender and explain the reason why.
SECTION 6: Convictions/Court Proceedings
Have you ever had a county court judgement made against you or have you ever been declared bankrupt?
If YES please give date(s), court and brief details below. / Yes:
No:
Have you ever been convicted or cautioned for a criminal offence?
Any conviction or ‘caution’ considered to be “spent” under The Rehabilitation of Offenders Act 1974 must be disclosed*
Date / Offence(s) / Penalty
Applicant 1 *(Proposed main carer)
Applicant 2 *(Spouse/partner)
Other household members:
* Disclosure & Baring Service (DBS) & other checks will be made on all members of the household over the age of 16yrs, in accordance with fostering regulations and best practice.

Declaration

I confirm that the information I have given on this form is correct and complete, and that untrue or misleading statements may be sufficient for canceling this application. I understand that my declaration will include details of any criminal convictions, cautions, reprimands and final warnings and any other information that may have a bearing on my suitability for the post. I understand that an Enhanced Disclosure & Baring checkwill be sought in support of this application.

Declaration of Criminal Record

As stated on the application form, because of the sensitive nature of the duties the foster carerwill be expected to undertake, you are required to disclose details of any criminal record. Only relevant convictions and other information will be taken into account so disclosure need not necessarily be a bar to obtaining this position or undertaking the role of a foster carer.
Have you ever been convicted by the courts or cautioned, reprimanded or given a final warning by the police? (Note that the post you have applied for is excepted from the Rehabilitation of Offenders Act 1974, which means that all convictions, cautions, reprimands and final warnings on your criminal record need to be disclosed.) If yes, please give details of offences, penalties and dates. / Yes:
No:
Date / Offence(s) / Penalty
Applicant 1 *(Proposed main carer)
Applicant 2 *(Spouse/partner)
Other household members:
Are you aware of any police enquiries undertaken following allegations made against you, which may have a bearing on your suitability for this post?
Are you aware of any police enquiries undertaken following allegations made against you, which may have a bearing on your suitability for this post? If yes, please give details. / Yes:
No:
Print Name:
Signed:
Date:
SECTION 7: Referees and Support
*Note: one person will be required to be available at home during the day whilst fostering. You will also be required to attend monthly Support Group Meetings and training.
Please give the names and addressed of six people, four who are not family members, 2 which are family members who know you well and would be prepared to be interviewed about your parenting/caring capacity and other issues relevant to this application.
These are minimum requirements and the agency may also require additional references.
1st Referee / 2nd Referee / 3rd Referee
Name:
Address:
Tel No:
E-mail:
Relationship to you:
Numbers of years known:
Does this referee know you as a couple? (where this is a joint application) Or one of you (please state which)
4th Referee / 5th Referee / 6th Referee
Name:
Address:
Tel No:
E-mail:
Relationship to you:
Numbers of years known:
Does this referee know you as a couple? (where this is a joint application) Or one of you (please state which)
Additional Checks are also completed: Where relevant and applicable, references will also be required from the following.
(Tick to confirm applicants are aware where references will be sought, please supply name and address where relevant).
Names and addresses:
1. Health visitor: / 2. School/s: / 3. Employer/s: / 4. Other (please specify):
1. Name: / 2. Name: / 3. Name: / 4. Name:
1. Address: / 2. Address: / 3. Address: / 4. Address:
Have you identified a back up carer?
A back up carer is someone who could provide support for you and the fostered child ie: if you were unavailable and the child needed collecting from school, or if you were away for the weekend, someone who could move into your home and look after the fostered child).
If yes please provide details, the Back Up Carer/s will need to have a DBS check completed and be prepared to be interviewed by the social worker, this person can be a family member or friend, but should not be a referee.
Name:
Address:
Telephone Number:
E-mail Address:
SECTION 8: Consent and Data Protection
DECLARATION
I certify that, to the best of my knowledge and belief, the details supplied in this application are correct. I understand that NRS Foster Care Recruitment Service or its appointed agencies may seek verification of any of the facts supplied. I understand that if any of this information is found to be false or misleading this may result in NRS Foster Care Recruitment Service rejecting my application. I understand that it is important not to withhold any information about factors that may influence my capacity to care for a child. If I have any uncertainty about this, then I will discuss the details during the assessment.
I give my consent to NRS Foster Care Recruitment Service asking for information (written or verbal) from individuals, agencies or organisations identified by me to the agency in support of this application. I understand that any information obtained will only be used in processing my application. This includes a written report from my registered medical practitioner about my health. I understand that I may not be entitled to see some of this information where it has been supplied confidentially.
I understand that the agency may ask me to supply further information in order to assess my application.
I understand that any information supplied by me in respect of this application may be held and/or processed in an electronic form and is subject to the relevant provisions in the Data Protection Act 1998 and other relevant statutes. I understand that any information supplied will form part of the agency’s case record in respect of my application.
I understand that this form is the property of the agency to whom I have applied. I agree not to copy this document (other than for my own personal records) or disclose its contents in full or in part, to any other person, agency or authority without the agency’s permission.
Applicant 1 / Applicant 2
Name:
Signature:
Date:
Data Protection Act
Applicant 1 / Applicant 2
Name:
Signature:
Date of Birth:
Please note that the information you supply to NRS Foster Care Recruitment Service will be recorded on a computer database. Under the terms of the Data Protection Act 1998 you are required to give your consent to this information being electronically stored. You are also entitled to see such information as is held.
SECTION 9: Ethnicity The below classifications are as recommended by the Commission for Equality and Human Rights
What is your ethnic group? Choose only one selection from A to E. Then tick the appropriate box within that section to indicated your ethnic group. You should use this questionnaire to identify your ethnic group but record the answer in the relevant section of the application form.
A. White / British: / Scottish: / Welsh:
Irish: / Other (specify): / Any other white background (specify):
B. Mixed / White & Black Caribbean: / White & Black African: / White & Asian:
Any other mixed background (specify):
C.
Asian / Asian British: / Asian English: / Asian Scottish:
Asian Welsh: / Indian: / Pakistani:
Bangladeshi: / Any other Asian background (specify):
D.
Black / Black British: / Black English: / Black Scottish:
Caribbean: / African: / Any other background (specify):
E.
Chinese / Chinese British: / Chinese English: / Chinese Scottish:
Chinese Welsh: / Any other background (specify):
Other: / (Please use if you cannot identify yourself from the groups above):