St Joseph S Service

Application form for Support Worker

Position: / Full time/Part time/Sessional
SURNAME: / FIRST NAMES:
ADDRESS: / Contacts details:
Home no:
Work no:
Mobile no:
Email:
POST CODE: / DRIVING LICENCE:
YES/NO Full/Provisional

QUALIFICATION LEVEL

/ /

SUBJECT AREA

None / No formal qualification
“O” Grade / Standard Grade/SVQ 2
Higher / HNC / SVQ 3
HND / SVQ 4
Degree
Post Graduate / Master /

Health & Social Care

Social Work
Nursing
Early Years & Education
Community Education
Other

PROFESSIONAL QUALIFICATIONS

Registration Body / Registration No/ Pin No. / Renewal Date

EMPLOYMENT: PRESENT / MOST RECENT POSITION

Name of Employer: / Address:
Title of post held:
/ Salary:
Date appointed: / Notice required:
Key Duties of this post:

EXPERIENCE: PREVIOUS POSTS WITH MOST RECENT SHOWN FIRST

Where employed / Position held / From / To

STATEMENT IN SUPPORT OF APPLICATION:

Please refer to the guidance notes, job description and person specification for assistance in completing this section
Please tell us about skills you used and/or learned in your previous work or at home
Please tell us why you think you are suitable for the job.
Please tell us in your own words what you think are the most important parts of the job.
Please continue on a separate sheet of paper if necessary

REHABILITATION OF OFFENDERS

Because this position involves the care of vulnerable adults employment is dependent on the following:

Your written consent to obtaining an Enhanced Disclosure and PVG Scheme Membership Certificate from Disclosure Scotland or an approved umbrella body
Such disclosure being acceptable to us.
Proof of identity – birth or marriage certificate (where appropriate) and passport (if available).
Two satisfactory written references.
That you will supply a photograph of yourself for retention in your records.
Evidence of physical or mental suitability for your work.

1.The Rehabilitation of Offenders Act 1974 allows people who have been convicted of certain criminal offences to regard their convictions as “spent” after the lapse of a period of years. This means that no reference need be made to the convictions or any circumstances relating to it.

2.Due to the sensitive nature of the duties you will be expected to undertake, you will be required to disclose details of any criminal record.

a)Have you ever been convicted by the courts or cautioned, reprimanded or given a final warning by the police? (Note that the post you have applied for is excepted from the Rehabilitation of Offenders Act 1974, which means that all convictions, cautions, reprimands and final warnings on your criminal record need to be disclosed).

i) I have a previous criminal record: YES/NO (delete as appropriate)

If you have answered ‘YES’ to the above question please complete the following section

b)I have previous convictions. These are as follows:

OffenceSentenceDates

Please continue on a separate sheet of paper if necessary

I understand that an application for membership / confirmation of membership of the Protecting Vulnerable Groups Scheme will be sought in the event of a conditional job offer.

Signature of candidate………………………………………Date …………………….

REFEREES

Referees should be people who can speak to your experience and character. The most appropriate referees are usually your most recent employers. Present and previous employer should be named.

NAME: NAME:

ADDRESS:ADDRESS:

POSITION:POSITION:

TEL NO:TEL NO:

NOTES FOR APPLICANTS:

It will be assumed, unless here stated otherwise that these referees may approached now.

Please tick here if you do not wish your present employer to be consulted.

DISABILITY

If you have a disability please tell us about any adjustments we may need to make to assist you at interview

I declare that the information I have given is correct to the best of my knowledge.

Signature: ………………………………………………………… Date: ………………………

Please return to:

Applications

St Joseph’s Services

72 Carnethie Street,

Rosewell, Midlothian,

EH24 9AW

Email:

1 SWSJHR003 v1 13/08/15