Kingdom Support & Care Cic

CONFIDENTIAL

KINGDOM SUPPORT & CARE CIC

APPLICATION FOR EMPLOYMENT

POST(S) APPLIED FOR: / Support Worker – Falkirk/Slamannan Service

Part 1 – Not shared with the Recruiting Department

1. Personal Details

Surname / Forename(s)
Home Tel No / Mobile No
Home Address / Email Address
(If you provide us with your email address we will normally contact you this way)
Post Code / Email:

2. Police Check / PVG Scheme

It is a requirement of this post that you are eligible to register with the Nursing & Midwifery Council or the Scottish Social Services Council and either hold or be willing to work towards qualifications that will help you to maintain your registration.

Before confirming appointment, you will be required to obtain Protection of Vulnerable Groups (PVG) scheme membership through Disclosure Scotland and become a member of the relevant PVG scheme.

You are required to disclose any unspent convictions or cautions and any spent convictions for offences included in Schedule A1, ‘OFFENCES WHICH MUST ALWAYS BE DISCLOSED’ of the Rehabilitation of Offenders Act (Exclusions and Exceptions) (Scotland) Amendment Order 2015 No.2.

Candidates are not required to disclose spent convictions for offences included in Schedule B1, ‘OFFENCES WHICH ARE TO BE DISCLOSED SUBJECT TO RULES’ until such time as they are included in a higher level disclosure issued by Disclosure Scotland.”

These lists of offences are available on the Disclosure Scotland website or at www.legislation.gov.uk.

Do you have any unspent convictions? / Yes / No
Do you have any spent convictions that you are required to disclose? / Yes / No
Are you registered with the PVG Scheme to work with Protected Adults & Children? / Yes / No
If yes, please provide your PVG Member Number

3. Referees

One must be your present or most recent employer or school/college. We will not normally accept references from relatives/friends. We reserve the right to request more than 2 references

Name / Name
Position / Position
Company
(if applicable) / Company
(if applicable)
Relationship to You / Relationship to You
Address
Post Code / Address
Post Code
Telephone No / Telephone No
Email Address / Email Address

We will assume you are happy for us to contact your referees if you are provisionally offered and accept employment/work with us

Are you available for Interview at any time? / Yes / No
If “No”, please provide details of non-availability:

4. Granting of Benefits to Close Relatives / Family Members

Are you closely connected to a current employee or Member of the Board of Kingdom Housing
Association ? (Definition of this is available in our Entitlements, Payments & Benefits Policy under
Section 3 on our website) / Yes / No
If “Yes”, their name:…………………………………. Relationship:………………………………………

5. Equality and Diversity Monitorin To which ethnic group do you belong?

White: / Asian, Asian Scottish or Asian British:
Scottish / Indian
Other British / Pakistani
Irish / Bangladeshi
Gypsy / Traveller / Chinese
Polish / Any Other Asian Background
Any Other White Background
Mixed or Multiple Ethnic Background:
Black, Black Scottish or Black British:
Caribbean / Other Ethnic Background:
African / Arab, Arab Scottish or Arab British
Any Other Black Background / Any Other Group
Do you give us permission to check your eligibility to work in the UK from the Home Office if required? / Yes / No
Are you? / Male / Female
Do you consider yourself disabled, as defined by the Equalities Act 2010 / Yes / No
If yes, please specify the nature of your disability:

To which age group do you belong?

Under 16 / 16-19 / 20-29 / 30-39 / 40-49 / 50-59 / Over 60

How were you first made aware of this post?

Indeed / Kingdom Website / Recruitment Event / Job Centre
Other (Please Specify)

6. Declaration

I declare that the information given in Parts 1 and 2 of this application for employment is true and complete to the best of my knowledge. If any of this information given by me in this form or in support of my application is untrue, I recognise that any offer of employment/work may be withdrawn, or my employment with Kingdom ended.

Signed: / Date:
/ Post Ref / OPREC2 / Applicant Ref No / CONFIDENTIAL
POST(S) APPLIED FOR: / Support Worker - Falkirk/Slamannan Service

Part 2 – Assessed by the Recruiting Department

1. Qualifications / Memberships

Please indicate below qualifications gained at School, College or University. You need only provide the date awarded for College or University qualifications or time served apprenticeships.

Subject / Detail / Qualification and Status of Membership (if applicable) / Grade / Date Awarded

2. Courses Attended / Other Relevant Specialised Training / Knowledge

3. Employment History

This is your present or most recent employment, voluntary work or work experience.

Name and Address
of Employer
Nature of Business
Post Held
Dates of Employment / From / To
Salary / Current / Expected
Notice Required
Duties and Responsibilities
Reason(s) for leaving or wishing to leave

Page 7 Revised: May 2016

4. Previous Employment

Please start with most recent and include any periods not in paid employment, voluntary work or work experience. Continue on an additional sheet, if necessary.

Name and Address of Employer
Position Held
Dates (Month/Year) / From: / To:
Reason(s) for Leaving
Description of Duties and Responsibilities
Name and Address of Employer
Position Held
Dates (Month/Year) / From: / To:
Reason(s) for Leaving
Description of Duties and Responsibilities
Name and Address of Employer
Position Held
Dates (Month/Year) / From: / To:
Reason(s) for Leaving
Description of Duties and Responsibilities
Name and Address of Employer
Position Held
Dates (Month/Year) / From: / To:
Reason(s) for Leaving
Description of Duties and Responsibilities

5. Suitability for the Post

Please refer to the person specification below and demonstrate how you meet the criteria (continue on a separate sheet, if necessary).

Essential Criteria / Please give examples on how your skills, qualities and experience meet each of the following criteria
E 1 Previous experience or interest in supporting adults to live an independent life in the community.
E 2 The ability to develop professional working relationships with supported individuals and colleagues.
E 3 The ability to work with people with challenging behaviour in a positive and person centred way.
E 4 Experience of helping an individual to achieve their personal goals.
E 5 The ability to provide personal care in a positive and person centred way.
E 6 The ability to understand and promote confidentiality.
E 7 The ability to cope with the physical and emotional demands of a Support and Care setting.
E 8 The ability to work flexible hours; i.e. shift working will be required and, to meet the needs of the individual services, split-shift working; sleep in and waking night duties may be required.
E 9 SVQ 2 in Social Care or commitment to gain this qualification.
Desirable Criteria / Please provide examples on how your skills, qualities and experience meet each of the person specification criteria
D 1 A current full UK driving licence and use of car for work purposes.
D 2 Knowledge/experience of autism.

6. Further Information

Please use the space below to tell us why you are applying for this position and any other relevant information you would like us to know.

DATA PROTECTION STATEMENT

We will use the information you give in Parts 1 and 2 of this form, and in any supporting evidence you send us, to process your application for employment. We may pass the information to other agencies or organisations as allowed by the law and in accordance with our Registration with the Information Commissioner. Kingdom is registered as the Data Controller under the Data Protection Act with the office of the Information Commissioner. As the Data Subject you have the right to access the information we hold on you. If you wish to access this right please contact our office and ask for a Data Subject Access Request Form.

Completed application forms should be sent (or emailed) to Kingdom Support & Care CIC, Support & Care Admin Team, James Bank, James Street, Dunfermline, Fife, KY12 7QE. Email or telephone (01383) 741220

Web: www.kingdomhousing.org.uk

Registered in Scotland: SC545491

Page 7 Revised: May 2016