THE NORFOLK AND NORWICH ASSOCIATION FOR THE BLIND

Magpie Road Norwich NR3 1JH

T: 01603 629558

F: 01603 766682

E:

W:

CONFIDENTIAL APPLICATION FOR EMPLOYMENT

For: Senior Care Assistant

If you require, for the reason of a disability, for this form to be resent to you so that you can fill it in more easily, or for it to be submitted in a different format, please contact Julie Lythgoe. Examples are a format in Braille, large print or submission via tape recording. This will in no way be detrimental to your application.

1. Personal Details

Name………………………………………

Address......

......

......

Post code......

Telephone Numbers:

Home...... ………..Work...... …………..Mobile……………………………

E-mail…………………………………..

Are there any disabilities that may affect your application? YES/NO

If yes, describe disabilities and:

a) any reasonable adjustments which you feel should be made to the recruitment process to assist you in your application for the job

b) any reasonable adjustments which you feel should be made to the job itself which would enable you to carry out the job

1

2. Education and Training
Name of School, College etc.,
attended / Dates / Examinations
(subjects/results)
Schools (after age 11)
Further Education and training
Professional or other training

1

3. EMPLOYMENT
Present/last employer………………………………………………………………
Address………………………………………………………………………………
………………………………………………………………………………………...
Job Title………………………………………………………………………………
What are/were you required to do?
Reason for leaving & when did you leave?
Finishing pay £ Per wk/mth/annum
Other most recent employer……………………………………………………….
Address………………………………………………………………………………
………………………………………………………………………………………...
What were you required to do?
Reason for leaving & when did you leave?
Finishing pay £ Per wk/mth/annum
Other most recent employer……………………………………………………
Address…………………………………………………………………………….
………………………………………………………………………………………
What were you required to do?
Reason for leaving & when did you leave?
Finishing pay £ per wk/mth/annum

4. General Information:

Why are you applying for this post and what special qualities will you be bringing to the post (Continue on a separate sheet if you wish).

Other Information

Do you hold a clean current driving licence? Yes/No

Do you have your own transport? Yes/No

How did you find out about this vacancy?......

What are your interests and hobbies?......

......

......

Any other information about yourself

When could you start?……………………………

5. WORK PERMITS

Are there any restrictions to your residence in the UK that might affect your right to take

up employment in the UK? Yes  No 

If you are successful in your application would you require a work permit to work in the

UK? Yes  No 

6. HEALTH

Are you in good health Yes  No 

7. REFEREES

Please indicate clearly if you do not wish them to be contacted prior to interview. Wherever possible one referee should be your present or most recent employer; (if not possible please state why not) Employment will not be offered unless satisfactory references are received.

Work reference – not members of your own family
Name…………………………………………………………………………………………………
Address………………………………………………………………………………………………
………………………………………………………………………………………………………..
Organisation…………………………………………………………………………………………
Occupation…………………………………………………………………………………………..
Telephone number………………………………………………………………………………….
Email:…………………………………………………………………………………………………
Work reference – not members of your own family
Name………………………………………………………………………………………………… / Telephone / Telephone
Address………………………………………………………………………………………………
………………………………………………………………………………………………………..
Organisation…………………………………………………………………………………………
Occupation………………………………………………………………………………………….
Telephone number…………………………………………………………………………………
Email:………………………………………………………………………………………………..
Personal reference – not members of your own family
Name…………………………………………………………………………………………………
Address………………………………………………………………………………………………
…………………………………………………………………………………………………………
Telephone number………………………………………………………………………………….
Email:…………………………………………………………………………………………………

8. Residential Home only

Because of the nature of the work for which you are applying, this post is exempt from the provisions of Section 4 (2) of the Rehabilitation of Offenders Act 1974 by virtue of the Exemption Order for 1975. Applicants are, therefore, not entitled to withhold information about convictions which for other purposes are ‘spent’ under the provisions of the Act.

Please give information about convictions or, if you are in doubt as to the implications of the act, please specify your queries on a separate sheet, which may be enclosed in a sealed envelope. Failure to disclose appropriate information may lead, pending investigation, to dismissal.

9. Recruitment Policy

It is the Association's policy to employ the best qualified personnel and provide equal opportunity for the advancement of employees including promotion and training and not to discriminate against any person because of race, colour, national origin, sex, sexual orientation, religion or belief or marital status or disability.

______

I authorise the Association to obtain references to support this application once an offer has been made and accepted and release the Association and referees from any liability caused by giving and receiving information.

Please Note: This position will require a Criminal Records Bureau (CRB) check. Attached is a copy of the Association’s policy on Disclosures.

Declaration: I confirm that the information given on this form is, to the best of my knowledge, true and complete. Any false statement may be sufficient cause for rejection or, if employed, dismissal. I understand that the appointment may be subject to a satisfactory medical examination.

Signature...... Date......

Application to be returned to: Closing Date:

Mrs J Lythgoe

Senior Executive Officer

Norfolk & Norwich Association for the Blind

Magpie Road Interviews: TBA

Norwich NR3 1JH

1