ESAS Caseworker

Application form

Closingdate for applications: 20th May 2018

Please send us this form to or post it to Vacancies, deafPLUS, Trinity Centre, Key Close, Whitechapel, London, E1 4HG.

The size of the boxes below do not indicate how much we expect you to write. As you type in the boxes they will expand as you need more space. If you are completing a printed copy please use extra sheets as appropriate.

If you need a large print or different format, please contact Mary Hicks on the above email address.

1. Your details

First name
Last name
Address
Home Telephone
Mobile Telephone
Email
Do you have a UK or EU passport?
If No, please explain your entitlement to work in the UK
Languages spoken (other than English) - indicate to what standard
Do you currently hold a DBSor CRB check issued within the last 3 years?

2. Details of current (or if not currently employed, most recent) employment

Name of employer and location
Position
Main duties
Salary
Date started
Notice required (if still working there)
Date left (if applicable)
Reason for leaving
3. Previous employment/roles

Please give brief details of your previous employment history and work experience, either paid or voluntary

Dates

From To /

Employer and location

/ Job title and brief description / Reason for leaving

4. Education and qualifications

Please give details of your education and training (add extra rows if necessary)

Dates

From To /

Course

/ Place of education /

Qualification

obtained

5. Work-related training

Please give details of any other specialised training or qualifications not covered in 4, such as CPD, short courses and on-the-job training.

Dates

From To /

Course title

/ Training provider

6. Why you would be good at this role

6.1 Please read each section of the job description and then describe any relevant experience (paid or unpaid) you have that demonstrates your ability to perform each requirement. Please give examples that demonstrate why you would be good at this job.

6.2 Please explain how you meet each point on the person specification,using examples to demonstrate how you meet each criteria. You shoulddescribeany qualifications, experience, skills and knowledge you have as evidence. This section is scored.

6.3 Why are you interested in this position?

7. Preferred start date

If appointed, what date would you be able to start work?

8. Availability for interviews

We have a tight schedule for this recruitment process. Please indicate if you are NOT available for interview at any times (between 9am and 7pm) on these dates. We will offer you an interview in a time slot that you will be available based on this information. We can’t promise to provide you with an alternative opportunity if you are no longer available.

Thursday 17th May

9. Access needs

Do you need support to take part in the interviews (e.g. special equipment, extra time, BSL/English Interpreter, Lipspeaker, Speech to text, or large print materials)?

10. References

Please can you give the names and contact details of two referees. One must be your current or most recent employer. The second referee should be another employer if possible. If not, please think of someone who can comment on your abilities but would still be impartial.Ideally they will have known you for more than 12 months.

Referee 1 / Referee 2
Title (Mr/Mrs/Ms, etc):
Full name:
Job Title:
Address:
Post Code:
Telephone Number:
E-mail address
How long have you known this person?
How do you know them (e.g. manager, colleague)?
Is it OK to contact them prior to interview?

11. Our advertising

How did you find out about this role?

Website (please say which one)
Other (please say)

12. Disclosure and barring checks

This post is exempt from the provisions of section 4(2) of the Rehabilitation of Offenders Act 1974, by virtue of the Rehabilitation of Offenders Act 1974 (Exemptions) Order 1975.

This means that you must tell us about convictions which for other purposes are `spent' under the provision of this Act, and so must disclose them below.

A criminal record will not necessarily exclude you from possible employment. Information given will be strictly confidential and will only be taken into account for the purpose of this application.

Have you ever been convicted of any criminal offence, whether ‘spent’ or ‘unspent’, as defined in the Rehabilitation of Offenders Act 1974 or do you have any charges pending? (Please tick or cross)

Yes / No

If yes, please give details

13. Declaration

DATA PROTECTION ACT 1998

deafPLUS will use the information provided by you only to assess the merits of your application. deafPLUS retains information about job applicants for 12 months, after which, all applications are destroyed. Application Forms for successful candidates are retained on their personal file.

By submitting this Application Form you are indicating your understanding and acceptance of the following conditions:

  • To the best of your knowledge the information you have given on this form is correct and will be used as part of your contract of employment.
  • Canvassing of officers or members of deafPLUS or any committee, directly or indirectly, for any appointment will disqualify your application.
  • The provision of false information may result in disqualification or termination of your employment.
  • Under the Rehabilitation of Offenders Act 1974 (if it applies to the post for which you are applying) failure to disclose any convictions may result in dismissal or disciplinary action by deafPLUS).
  • Under legislation for the protection of children (if the post for which you are applying will have access to children) you will be asked to agree to a check being made through the DBS about the existence and content of a criminal record.
  • You consent to the processing of your data for the purposes described in the ‘Data Protection’ section of this Application.
  • By submitting your Application by e-mail you agree that your submission of this Application gives the same affirmation as a signature

Signature
Date

Equality and Diversity information

deafPLUS collects equalities monitoring information so that we can make sure that we are reaching all sections of our community in our recruitment activities, and to help ensure that we recruit a diverse and representative workforce. After a recruitment exercise we analyse this information at an aggregate level for these purposes. This information is only used for these purposes.

The information is collected separately from your application form and will not be used as part of the selection process. You can either return it with your application form, or if you prefer you can return it in a separate envelope to ensure complete anonymity.

Role applied for:…………………......

Disability or health condition
Sensory Impairment / Mental health condition
Physical Impairment / Long standing health condition
Learning disability / I have no disability or long-standing health condition
Other (specify below) / Prefer not to say
Age
16-20 / 21-30
31-40 / 41-50
51-60 / 61-70
71+ / Prefer not to say
Relationship status
Married / Divorced
Civil partnership / Cohabitating
Single / Widowed
Other / Prefer not to say
Ethnicity
Asian or Asian British: Bangladeshi / Mixed: White & Black African
Asian or Asian British: Indian / Mixed: White & Black Asian
Asian or Asian British: Pakistani / Mixed: White & Black Caribbean
Asian or Asian British: Other / Mixed: Any Other Mixed
Black or Black British: African / Vietnamese
Black or Black British: Caribbean / White: British
Black or Black British: Somali / White: Irish
Black or Black British: Other / White: Traveller of Irish heritage
Chinese / White: Gypsy/Roma
Other Ethnic Group: Other background / Prefer not to say
Gender
Male / Female
Other / Prefer not to say
Gender identity/re-assignment / * If yes, is current gender different to that assigned at birth?
Yes * / Yes
No / No
Prefer not to say / Prefer not to say
Religion and belief
Atheist / Sikh
Agnostic/No religion / Hindu
Muslim / Humanist
Christian / Buddhist
Jewish / Prefer not to say
Other religion (specify below)
Sexual orientation
Bisexual / Heterosexual / straight
Homosexual/gay man / Other
Lesbian/gay woman / Prefer not to say

If you want to return this form separately to your application form, please post it to:

Head of Services

deafPLUS
Trinity Centre

Key Close

Whitechapel

London
E1 4HG