Lewisham Nexus Service

Application for Employment

Please complete in black ink or type. To be completed by the applicant only.

A.GENERAL
POST APPLIED FOR:
Bank Support Worker / CLOSING DATE:
SURNAME: / TITLE (Mr/Mrs/Ms/Other):
FIRST NAME(S):
ADDRESS:
POST CODE: / CONTACT NOS:
E-MAIL ADDRESS:
B.REFERENCES

At least one should be your current or last employer

NAME: / COMPANY NAME:
JOB TITLE:
TEL NO (Work):
TEL NO (Home): / ADDRESS:
POST CODE:
NAME: / COMPANY NAME:
JOB TITLE:
TEL NO (Work):
TEL NO (Home): / ADDRESS:
POST CODE:

Please note that in obtaining references we will specifically enquire about any disciplinary offences and reserve the right to contact any of your previous employers for a reference at any time.

C.CURRENT OR LAST EMPLOYMENT
POST HELD: / FROM / TO / BRIEF NATURE OF DUTIES
EMPLOYERS NAME, ADDRESS AND TEL NO.

D.EMPLOYMENT HISTORY (Starting with the most recent)

Please include any periods when not working and any relevant Voluntary or Work Experience

POST HELD: / FROM / TO / BRIEF NATURE OF DUTIES
EMPLOYERS NAME, ADDRESS AND TEL NO
POST HELD: / FROM / TO / BRIEF NATURE OF DUTIES
EMPLOYERS NAME, ADDRESS AND TEL NO
POST HELD: / FROM / TO / BRIEF NATURE OF DUTIES
EMPLOYERS NAME, ADDRESS AND TEL NO
POST HELD: / FROM / TO / BRIEF NATURE OF DUTIES
EMPLOYERS NAME, ADDRESS AND TEL NO
POST HELD: / FROM / TO / BRIEF NATURE OF DUTIES
EMPLOYERS NAME, ADDRESS AND TEL NO

E.EDUCATION AND TRAINING

Formal Qualifications Obtained (including Schools, Colleges, Professional Bodies
Pleasegive Detailsof any Training Relevant to the Post that You have Undertaken During the last Five Years
F.ADDITIONAL INFORMATION

Our Projects provide 24 hour support, 7 days a week and we require staff cover at all times. Are you fully aware that you will be required to:

Work a Shift Pattern, cover Sleep-in Duties (on a rota basis), work some Weekends/Bank Holidays (on a rota basis) Yes/No

Please list any restrictions you may have, which could prevent you from carrying out all the above over a 36 hour week

Do you consider yourself as disabled?Yes/No

If you consider yourself as disabled person and are unable to meet some of the job requirements specifically because of your disability, please address this in your application. If you meet all other criteria, you will be shortlisted and we will explore jointly with you if there are ways in which the job can be changed to enable you to meet the requirements. This could include adjustment to premises and equipment or job duties

Lewisham Nexus Service

Support Worker

Supporting Information

Name of Applicant:______

Completion of this section is essential. Before completing this Section, please ensure you read the Person Specification.

Please detail your suitability for this position under the relevant headings as outlined in the Person Specification for this post

G.DISCLOSURE OF INFORMATION
(A) / ARE YOU RELATED TO OR KNOW A MEMBER OR EMPLOYEE OF LNS?
(IF YES, PLEASE GIVE DETAILS): / YES/NO
(B) / BECAUSE OF THE NATURE OF THE WORK CONCERNED, THIS POST IS EXEMPT FROM THE PROVISION OF SECTION 4(2) OF THE REHABILITATION OF OFFENDERS ACT, 1974. YOU ARE NOT ENTITLED TO WITHHOLD INFORMATION ABOUT CONVICTIONS WHICH FOR OTHER PURPOSES ARE 'SPENT' UNDER THE PROVISIONS OF THE ACT. ANY SUCH INFORMATION GIVEN WILL BE COMPLETELY CONFIDENTIAL AND WILL BE CONSIDERED ONLY IN RELATION TO YOUR APPLICATION FOR THE POST.
HAVE YOU EVERY HAD ANY CONVICTIONS AGAINST YOU?
(IF YES, PLEASE STATE FULL DETAILS OF CONVICTIONS): / YES/NO
(C) / HAVE YOU EVER BEEN DISMISSED FROM A JOB OR HAD DISCIPLINARY ACTION TAKEN AGAINST YOU? (IF YES, PLEASE GIVE DETAILS) / YES/NO
(D) / IS THERE ANY DISCIPLINARY ACTION CURRENTLY PENDING AGAINST YOU?
(IF YES , PLEASE GIVE DETAILS) / YES/NO
(E) / DO YOU HAVE THE RIGHT TO WORK IN THE UK?
LEWISHAM NEXUS SERVICE WILL REQUIRE PROOF OF THIS RIGHT BEFORE AN OFFER OF EMPLOYMENT CAN BE CONFIRMED, EG, BIRTH CERTIFICATE AND /ORANY OTHER APPROPRIATE DOCUMENT REQUIRED TO CONFIRM YOUR RIGHT TO WORK IN THE UK AS REQUIRED BY THE ASYLUM AND IMMIGRATION ACT 1996 / YES/NO
(F) / ANY JOB OFFER WILL BE SUBJECT TO SATISFACTORY HEALTH CLEARANCE, CRIMINAL RECORDS BUREAU CHECK, REFERENCES AND VERIFICATION OF YOUR APPLICATION AND ELIGIBILITY FOR EMPLOYMENT.
(G) / DO YOU CURRENTLY HOLD A FULL UK DRIVING LICENCE
IF YOU HAVE ANSWERED YES TO THE ABOVE QUESTION, DO YOU HAVE ANY POINTS FOR DRIVING OFFENCES: / YES/NO
IT IS NECESSARY TO ASK QUESTIONS OF A PERSONAL AND CONFIDENTIAL NATURE BECAUSE OF THE VULNERABILITY OF THE SERVICE USER GROUP WE SUPPORT
I CERTIFY THAT ALL INFORMATION WHICH I HAVE PROVIDED IS CORRECT. I UNDERSTANDTHATANYFALSEINFORMATIONGIVEN MAY RESULT IN A JOB OFFER BEING WITHDRAWN.
NAME
SIGNATURE ______
DATE:______