APPLICANT CODE
Section 1.Personal Information
Information to applicants:Section 1 of this form will be separated from Section 2 and will only be seen by Human Resources. The application form will then be coded to ensure confidentiality, and none of the information provided in Section 1 will be seen by the recruitment panel. This system helps to ensure that applicants are shortlisted only against the requirements for the role.
We are committed to monitoring the effectiveness of our employment policies. All stages of the recruitment process are monitored to check that unfair discrimination is not taking place. The information you provide below will be treated in strict confidence and will only be used for statistical purposes.
Title: Surname: Forenames:
Gender: male female Date of birth:
Where did you see the post advertised?
The Guardian Online
CharityJob
Totaljobs
Other – (please specify):
1 * I would describe my ethnic origin as:
Asian or Asian British
Bangladeshi
Indian
Pakistani
Any other Asian background (details):
Black or Black British
African
Caribbean
Any other Black background (details): / Mixed or Mixed British
White & Asian
White & Black African
White & Black Caribbean
Any other mixed background (details):
White
British
Irish
European (details):
Any other White background (details):
/ Other Ethnic Group
Chinese
Any other ethnic group (details):
I do not wish to disclose this information
2* Please select the option which best describes your sexuality
Gay Woman / Lesbian
Gay Man
Bisexual
Heterosexual
Other
I do not wish to disclose this information
3 * Please indicate your religion or belief
No Religion
Bahai
Buddhist
Christian
Jain / Jewish
Hindu
Muslim
Rastafarian
Sikh / Other (details):
I do not wish to disclose this information
4 The Disability Discrimination Act defines disability as follows: a person has a disability if he/she has a physical or mental impairment, which has a substantial and long-term adverse effect on his/her ability to carry out normal day-to-day activities.
* Do you consider yourself to have a disability? / Yes (please provide details below)
No
I do not wish to disclose this information
Physical impairment
(such as difficulty using arms or mobility which means using a wheelchair or crutches) / Sensory impairment
(such as being blind, having a serious visual impairment, being deaf or having a serious hearing impairment) / Mental health condition
(such as depression or schizophrenia) / Learning disability
(Such as Downs Syndrome, dyslexia or cognitive impairment such as autism or head injury) / Longstanding illness or health condition
(such as cancer, HIV, diabetes, chronic heart disease or epilepsy)
5. Please describe any personal experience you have had as a service user in the care system or living away from home in any of the settings where Coram Voice works (e.g. experience of foster care, adoption, residential children’s home, secure units, secure training centres or YOIs):
APPLICANT CODE
Section 2.Application Form
Position applying for:Surname: / Forenames:
Postal address including postcode:
Email address:
Telephone numbers:
Home Mobile Work (if convenient)
Are there any restrictions to you taking up employment in the UK? Yes No
(If yes, please provide details)
Education and qualifications
Any public examinations (such as GCSE’s, CSE, O and A levels:
Dates:
/ Subject: / Level: (GCSE, CSE, or A)
/ Grade obtained:
Name of any colleges/universities attended:
Dates: / Name: / Subject: / Course/ qualification:
Any other qualifications (including professional qualifications and details of software packages used:
Qualification/course details: / Dates:
Other relevant training courses attended (with dates). Please use a separate sheet if required.
Course details: / Dates:
Employment history
Please give details of your working experience, starting with your present or most recent employer and working backwards.
Current or most recent Employer
Name, address and business of employer: / Date employed:
From From-To / Job title, purpose and main duties: / Final salary: / Reason for leaving:
Previous employers (including home-based, freelance or part-time work) Use additional sheets if necessary
Name, address and business of employer: / Date employed:
From To / Job title, purpose and main duties: / Final salary: / Reason for leaving:
Please account for any gaps in your work record:
Voluntary work
Name, address and business of employer: / Duration / Job title, purpose and main duties: / Reason for leaving:
Supporting statement
Please say why you think you are suitable for this work. You should use each element of the person specification as a heading in the supporting statement of your application, explaining clearly and with examples how you meet the criteria.
Other information
Have you a current full driving licence?
Yes No / If yes, please give details of any endorsements.
Have you applied to Coram Voice for a job before?
Yes No / If so, for which post and when?
If appointed, when could you start?
Please note the dates for interview in the information pack and indicate if you are not available for interview on these dates. It may not be possible to offer alternative dates.
Rehabilitation of offenders
The post for which you are applying is exempt from the provisions of the Rehabilitation of Offenders Act (1974). When answering the following questions you must therefore disclose any criminal convictions, even those that may be considered ‘spent’ for other purposes.
Rehabilitation of Offenders Act 1974 (Exceptions Order 1975).
Have you ever been found guilty of committing an offence or of having done the act or made the omission with which you were charged in any proceedings bought by a local authority in relation to the care of a person under 18 years old? /
Yes No
Have you ever been convicted of an offence in any criminal proceeding in any court in any country?
(for motoring offences, please answer ‘yes’ only if it resulted in disqualification). / Yes No
Have you ever been found guilty of violent, cruel, indecent or dishonest behaviour in any service disciplinary proceedings? / Yes No
Have you ever been convicted of any offences under the 1958 Adoption Act as amended by the 1975 and 1989 Children Act? /
Yes No
Are you aware that there are any current police enquiries or pending prosecutions in relation to you? /
Yes No
If you have answered ‘yes’ to any of these questions please give details, continuing on a separate sheet if necessary:
Applicants for all Coram Voice posts will be asked to complete a DBS form at interview. In the event that you are successful in your application, Coram Voice will apply for an Enhanced DBS check. This will include details of cautions, reprimands or final warnings as well as convictions.
Failure to disclose any criminal conviction will automatically disqualify you from the recruitment process. However, a previous criminal conviction which you have declared will not necessarily be a bar to obtaining the position applied for.
Are you on the POCA (Protection of Children Act) list? Yes No
References
Please give names and addresses of 3 people we may approach for a reference. One of them should be your present or most recent employer. If in employment less than one year, please also give details of your employee before last. Please note that referees must not be related to you.
Coram Voice reserves the right to contact any previous employer. We may make contact by telephone with any of your referees. In any event, we will not make an appointment until satisfactory references have been received.
Please indicate the earliest stage we may contact your referees. Please provide an email address for each referee where possible.
First referee
Name
Address
Postcode
Telephone number Email
How do you know him/her?
May we take up the reference before interview?
Second referee
Name
Address
Postcode
Telephone number Email
How do you know him/her?
May we take up the reference before interview?
Third referee
Name
Address
Postcode
Telephone number Email
How do you know him/her?
May we take up the reference before interview?
Declaration
I confirm that the above information is complete and correct and that any untrue or misleading information will give my employer the right to terminate any employment contract offered.
I agree that the organisation reserves the right to require me to undergo a medical examination. (Should we require further information and wish to contact your doctor with a view to obtaining a medical report, the law requires us to inform you of our intention and obtain your permission prior to contacting your doctor). I agree that this information will be retained in my personnel file during employment and for up to six years thereafter and understand that information will be processed in accordance with the Data Protection Act.
Signed: Date:
Please return your completed form to
Coram Voice is the working name of Voice for the Child in Care
Registered Charity Number 1046207 Company Reg. No. 3050826