Please Complete Application Form in BLACK Pen If You Are Handwriting It

Application for Employment

Post applied for

Reference code (for official use only)

Please complete application form in BLACK pen if you are handwriting it

Education and Qualifications

Please give details of the date and name of the awarding body of any Professional qualification. (Candidates will be asked to

produce evidence of their professional qualifications at interview).

Name of School, College, University / Full or
Part-time / Examinations passed
HCPC Social Work registration date/number: (if applicable)
………………………………………………

Employment History:

Membership of Professional bodies

Details of present/most recent employment:

Name and Address of Employer
Position held: / From: / To:
Details of Responsibilities:
Reason for leaving/wishing to leave:
Current salary:

Employment prior to above (record all posts you have held starting with the first)

Name and Address of Employer / From / To / Position Held / Reason for leaving
What is the earliest date you could commence employment with us?

Health:

Disclosure: This position will require an Enhanced Disclosure

I understand that I will be asked to provide proof of my identity and that appointment to this post is subject to a satisfactory Disclosure & Barring Service Enhanced Disclosure and/or Enhanced Disclosure with Barred List check. I also understand that I am required to disclose any record I may have of criminal convictions, cautions, reprimands or final warnings that are not ‘protected’ as defined by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (as amended in 2013).
Do you have any convictions, cautions, reprimands or final warnings that are not ‘protected’ as defined by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (as amended in 2013)? The amendments to the Exceptions Order 1975 (2013) provide that certain spent convictions and cautions are “protected” and are not subject to disclosure to employers, and cannot be taken into account. Guidance and criteria on the filtering of these cautions and convictions can be found on the Disclosure and Barring Service Website.
(Declaration subject to the Rehabilitation of Offenders Act 1974)
Yes (please provide details and attach) No

Other details:

Where driving is a requirement do you have a current full driving licence? / Yes / No
Times and/or Dates when not available for interview?
Where did you see post advertised? / The Guardian Charity Job Website Local press Other

References:

Please give the name, full address, e-mail & telephone number of 3 persons to whom references can be made. Two should be professional references one of which should be your most recent employer. If possible one referee must have known you for 5 years or more. Welcare will seek references on shortlisted candidates and may approach previous employers for information to verify particular experience of qualifications, before interview. If you do not want your current employer approached at this stage please indicate. Wherever possible we will e-mail referees.

Do not approach my current employer(please put a cross in the box)
Name / Full Address (including full postcode) & Telephone Number / Relationship to applicant / How long has referee known you?
Postcode
E-mail address
Telephone number:
Postcode
E-mail address:
Telephone number:
Postcode
E-mail address:
Telephone number:

Interests and Voluntary Activities

Experience and Relevant skills

You must assess your self against all of the criteria on the person specification and give specific examples of how your skills, knowledge and experience meet these criteria. Evidence must be concise and relevant. Please ensure that the evidence is presented in the same format as the selection criteria. DO NOT ATTACH A CV
/ Please continue on a separate sheet.
Why do you want to work for an organisation like Welcare?
Apart from your skills, what else will you bring to Welcare?
Finally, are there any reasons why you cannot fulfill all the duties/tasks in the job description? / Yes / No
I certify that all information given by me on each section of this form, as Additional Information,and in supporting documents is correct to the best of my knowledge and belief, that all questions have been fully and accurately answered, and that I possess all qualifications which I claim to hold and will produce evidence of the same.
I understand that my name will be withdrawn from the list of candidates if, prior to appointment, I am found knowingly to have omitted or concealed any relevant fact, and I acknowledge that such discovery subsequent to appointment is likely to lead to my dismissal without notice and, where appropriate, referral to the police.
I hereby consent to the processing of sensitive personal data, as defined by the Data Protection Act 1998, involved in the consideration of this application.
Signed: / Date:

Southwark Diocesan Welcare

EQUAL OPPORTUNITIES EMPLOYMENT MONITORING FORM

For the purposes of implementing & monitoring Welcare's Equal Opportunities Policy, it would be helpful to know the following. This information will not be made available to the short-listing panel.

Date of birth: ……………………………… Previous names: ………………………………………

Gender: Female Male

Disability: I consider myself to be disabled I do not consider myself to be disabled

Ethnicity: please chose from one of the following categories & tick the box that you feel most appropriately represents your cultural background:

1. White
British
Irish
Traveller of Irish Heritage
Gypsy/Roma
European: (Country ……………….………)
Any other White background
(Please state ………………………….………..) / 6. Mixed
White & Black Caribbean
White & Black African
White & Asian
Any other mixed background
(please state …………………………….)
2. Asian or Asian British

Indian
Pakistani
Bangladeshi
Any other Asian background
(Please state …………………………………..) / 7. Black or Black British
Caribbean
African
Any other Black background
(Please state …………………….……………..)
3. Chinese or other ethnic group
Chinese 
4. Other ethnic background not listed on the
Monitoring Form 
(Please state …………………………………………….)
5. No ethnic background category to be recorded
I do not wish an ethnic background category
to be recorded.  / 8. Sexual Orientation* (Optional)
Bisexual
Lesbian
Homosexual
Heterosexual
9. Religious belief* (Optional)
…………………………………………………..

*To ensure compliance with the Employment Equality (Sexual Orientation) Regulations 2003 & Employment Equality (Religion & Belief) Regulations 2003 we ask questions 8 & 9 however your response to these two questions is optional.

All Information provided will be treated as confidential

Please return this form, together with your application form, to:

Welcare in East Surrey,

24 Warwick Road, Redhill Surrey RH1 1BU

Notes for applicants

General information:

Before signing this form please check that every section has been completed.

The form should be returned as instructed in the details of the post(if you are returning it in a large envelope please use the correct postage for a larger letter – if in doubt check with your post office).

This is an application for a post in Welcare, which is an independent Charity with links to the Diocese of Southwark. As such you will be required to adhere to Welcare's Value Base, details of which are on the welcare.org website.

The closing date for receipt of this application is:

…12 noon on Friday 20th February 2015…

Please remember to put your National Insurance number on page one. If you are required to have a work permit please enclose copies of your Home Office documentation with the application.

Complete all sections of the application form, even if you will be attaching your CV.

If shortlisted, you will be required to bring your passport or a valid ID card with you to the interview as photo identificationand to confirm your right to work in the UK.

Details of referees: Please note that it is necessary to enter the full postcodes of references.

One reference should be your current or most recent employer. If you are not currently working but have done so in the past, a reference will be required from the employer by whom you were most recently employed.

Welcare will seek references on shortlisted candidates and may approach previous employers for information to verify particular experience of qualifications before the interview.

If you are currently working, on a paid or voluntary basis, your current employer will be asked about disciplinary offences (this includes any penalty that is time expired).

Please be aware that if you have not heard from us within 4 weeks of the closing date, you should assume that your application has not been successful on this occasion; as a Charity Welcare has an obligation to keep its administrative costs as low as possible and we do not write to applicants that have not been invited to interview.

Finally, should any information on the application form knowingly be falsified, it may result in an offer of a job being withdrawn.