Please Complete This Form in BLOCK Capitals - All Information Will Be Treated As Confidential

JOB APPLICATION FORM

Please complete this form in BLOCK capitals - all information will be treated as confidential

Name:

Address:

Post Code:

Home Telephone Number:

E-mail Address:

Mobile number:

National Insurance Number:

Contact details of next of kin: (emergency use only – name and phone number)

Position Applied for:

Do you own/have use of a car?

If so, does your licence permit you to drive a 16 person mini bus?

Where did you hear about this vacancy?

Please give details of any qualifications you have (GCSEs, A Levels, Degree, Training, vocational)

Please give details of any other relevant experience you have:(including voluntary work)

Work History, starting with most recent dates and reasons for leaving:

What skills and personal qualities do you have which you think may be useful for the role:

SAFETYCHECKS

WorkingforReadingMencapinvolvessupportingpeoplewithlearningdifficultiestodo/tryavarietyofactivities. Thiscanbedoneeitheronaone-to-oneorinagroupsetting. Wethereforeneedtoensurethatthepersonusingtheserviceisplacedinassafeanenvironmentaspossible.Wearecommittedtobestpracticeinrecruitmentandwillensurethatthosedirectlyworkingwithpeopleareappropriatelyscreened.

All posts at Reading Mencap are exempt from the Rehabilitation of Offenders Act 1974 and we therefore ask you to declare you have any convictions, cautions or bind-overs, including any that would normally be regarded as ‘spent’.

HAVEYOUEVERBEENCONVICTEDOFANYCRIMINALOFFENCEBYACOURTOFLAW? Yes/No

Ifyouhaveanswered ‘yes’,pleasegivedetailsbelow:

(Pleasenotethatacriminalrecordwillnotnecessarilypreventyoufromworking. However,becauseofthevulnerabilityofsomeofthepeoplewithwhomwework,wereservetherighttoconductchecksasdeemednecessary.)

Providing false information is an offence and could result in the application being rejected or summary dismissal if the applicant has been selected and possible referral to the police and/or ISA.

HEALTH DECLARATION:

Please declare whether you consider you have any health or disability conditions that may impact on your abilities to carry out the job. This will not necessarily prevent you from working with us but it will allow us to anticipate whether any reasonable adjustments might be made. Yes/No

DO YOU NEED A WORK PERMIT TO WORK IN THE UK? Yes / No

In line with the Asylum and Immigration Act 1996 we have to ask you for proof of your eligibility to work in the UK. If you have answered yes to the above, and are invited to interview, please bring original documentary evidence of your right to work in the UK.

IconfirmthatIamnotdisqualifiedfromworkwithchildren or vulnerable adults,orsubjecttosanctionsimposedbyaregulatoryorprofessionalbodyandthattheinformationprovidedontheformiscompleteandaccurate.

Signed:______

AllsuccessfulapplicantswillberequiredtocompleteanenhancedDisclosure and Barring Service (DBS)application.

REFEREES:

Pleasegivethenamesandaddressesoftwopeoplewhocangiveareferenceregardingyoursuitabilityfor this post. One shouldbeyourcurrentormostrecentemployer.Ifyouhavehadexperienceworkingwithchildrenorvulnerableadultsthenitwouldalsobeusefultousethatemployerasareferee.Ifyouhavenotbeenemployed,youmayprovideotherreferees,preferablyinaprofessionalcapacity(e.g.teacher,tutor, or personyoureportedtoforvoluntarywork). Family or friends cannot be given as Referees.

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Reading Mencap Job Application Form Form – May 2017

Source: Reading Mencap, Owner: Office Manager

Registered Charity: 1118287, Company Number: 05976118

NAME:

ADDRESS:

TEL.NO:

POSITON:

EMAIL:

NAME:

ADDRESS:

TEL.NO

POSITON:

EMAIL:

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Reading Mencap Job Application Form Form – May 2017

Source: Reading Mencap, Owner: Office Manager

Registered Charity: 1118287, Company Number: 05976118

DECLARATION:

Ideclaretothebestofmyknowledge,theinformationIhaveprovidedinthisapplicationiscorrectandtrue.IrealizethatifitisfoundthatIhavedeliberatelygivenfalseormisleadinginformation,Iwillnolongerbeabletocarryon as an employee of Reading Mencap. IfIamconvictedofanycrimesubsequenttothisapplication,thenIwillinformReadingMencapimmediately.

Signed:______Date: ______

As required by the Data Protection Act 1998 your information will be securely stored in accordance with our Data Protection Policy. It will not be shared outside of Reading Mencap without your specific permission.

Returnto:ReadingMencap,21AlexandraRoad,Reading,RG15PE

Email:

Page1 | 4

Reading Mencap Job Application Form Form – May 2017

Source: Reading Mencap, Owner: Office Manager

Registered Charity: 1118287, Company Number: 05976118