Thornage Hall Employment Application Form
Any technical problems in completing this form, please ring our office on 01263 860 305.
Post applied for:If you are applying for a Support worker role are you interested in sleep in shifts / ☐Yes ☐No☐not applicable
Please complete this form electronically for submissions by email or in Black Ink if being completed by hand.
Applications must be completed using this form, CV’s will not be accepted.
All sections must be completed, incomplete applications will not be accepted
Copies of this application form can be downloaded from our website at or by emailing
Returning the application form
By post to: / Thornage Hall
Thornage
Holt
NR25 7QH
Electronically to: /
Section A: Vacancy Details
Where did you see the position advertised? / ☐EDP / ☐Jobs24 online
☐Camphill.org.uk / ☐
Other:
Section B: Personal Details
Title: / forename / surname
Address:
Postcode:
Email address:
Home telephone: / Mobile telephone:
Work telephone: / May we contact you on this number? / ☐Yes☐No
Do you need a permit to work in the UK? / ☐Yes ☐No
Do you hold a full driving license that entitles you to drive in the UK? / ☐Yes ☐No / Car owner? / ☐Yes ☐No
Any driving convictions? / ☐Yes☐No / Current endorsements? / ☐Yes ☐No
Please give details of any endorsements or convictions
Section C:Current Employment
Current Employer: / Job title:
Start date:
Salary:
Reason for leaving
Main duties and responsibilities
Section D: Previous Employment
Please show most recent first, accounting for any breaks in employment.
Please continue on a separate sheet if necessary
Date from month/yr / Date to month/yr / Name and address of employer / Job title
& main duties / Salary details / Reason for leaving
Section E: Education & Training
Please give details of all education and courses taken, from age 15 onwards
Dates attended / Name and address of Educational establishment / Qualifications and grade/level obtained / Dates obtained
From / To
Other Training attended
Please give details of any relevant short courses or specialist training
Date attended / Duration / Course title/subject covered / Grade/level attained where relevant
Section F: Membership of Professional bodies/associations
Where appropriate
Name of professional or technical association/body / Membership status / Membership number
Section G: Interests & Community/voluntary work
Please give details of any interests and hobbies or voluntary/ community based work. Continue on a separate sheet if necessary
Dates / details
Section G: Supporting Statement
Please tell us how your previous experience, knowledge and skills match the job description and person specification. Please refer to both your employment history as well as interests and any voluntary work where relevant.
Section H: Referees
Please give the names of two referees who are able to comment on your suitability as a candidate for this post, but who are not closely related to you.
Referee 1 must be from your present or most recent employer.
Referee 1
Name: / Job title:
Address of organisation: / Relationship to you:
May we contact them now? / ☐Yes
☐No
Work phone / Mobile:
email:
Referee 2
Name: / Job title:
Address of organisation: / Relationship to you:
May we contact them now? / ☐Yes
☐No
Work phone / Mobile:
email:
Section I: Health
Please complete the total number of absences through illness
Number of days / Number of occasions
Current year
Previous year
Are there any problems with your health that would prevent or restrict you in carrying out the duties for the position that you are applying for? / ☐Yes
☐No
Please give details
Name and address of your GP
Fitness declaration
I have read the job description and person specification. I have considered the duties and responsibilities of the position I am applying for.
Please tick the most appropriate response
☐ / I believe I am physically fit and mentally fit to carry out the work involved in this position
☐ / I would like to share with you now the following information about my medical history or the following details of my current physical and mental condition or general difficulties with my health. I am doing this so we can discuss them and can reassure you that I am physically fit and mentally fit to carry out the work involved in this position.
We may wish to discuss the information you give us with you. If we do not, it is because we have taken the view that it is not relevant to your suitability for the position. If we have any concerns about your ability to fulfil the requirements of the role we may involve your GP and/or occupational health services, but we will not do this without discussing with you first.
Any offer of employment is conditional on the information given being correct.
Section J: Equal Opportunities
Thornage Hall is committed to Equal Opportunities and ensuring that people with disabilities receive fair treatment. If you consider yourself to be a person with a disability, please give information about the nature of your disability and also give information about arrangements Thornage Hall might make to give you a fair interview. We may need to contact you for further information.
Do you consider yourself to have a disability? / ☐Yes ☐No
Nature of disability
Section K: Disclosure of convictions/cautions/warnings
Under the Rehabilitation of Offenders Act (Exceptions Order) 1975 you are required to declare all criminal convictions which you have, irrespective of the nature of the offence/s and how long ago the offence/s was, or were, committed. A criminal conviction itself may not necessarily lead to refusal of your application, however, a failure to disclose any conviction you have could lead to your application being refused, or if your application is successful, your placement with Thornage Hall being immediately terminated if it is subsequently discovered you have a criminal record.
Have you ever been convicted of a criminal offence? / ☐Yes ☐No
If yes, please provide the following details
Offence / Date of conviction / Sentence/punishment
Police investigations not leading to prosecution
Have you ever been charged with a criminal offence? / ☐Yes ☐No
Have you ever been subject to police investigation not resulting in a criminal conviction? / ☐Yes
☐No
Are you currently subject to police investigation for any matter? / ☐Yes
☐No
If yes to any of the above please provide the following details
The alleged offence(s) / Date(s)
Section L: Employment related investigations
Have you ever been subject to any employment related disciplinary investigation, suspension, formal warning and/or dismissal? / Yes No
If yes, please provide the following details
The nature and outcome of the disciplinary action / Dates
Section M: Declarations
☐ / By ticking this box I confirm that the information given in this application form is true and correct and I understand that any misrepresentation will invalidate my application and, if employed, could lead to dismissal.
Signed: / Date:
Print name:
If this form is completed electronically, the tick in the box and entering your name in the box, is considered to be a statement confirming the accuracy of this application form and taken as an electronic signature.
Recruitment Monitoring Form
Thornage Hall recruits employees for a variety of roles, it is important to everyone concerned that the way in which applicants are selected is fair and does not contravene current legislation. We welcome applications for employment from all sections of the community and believe that everyone should be equally valued regardless of gender, age, disability, race, ethnic origin, language, religion or sexual orientation.To help us monitor our recruitment and selection processes, we would ask that you provide the following additional information about yourself.
The details you supply will be used for the purpose of monitoring our workforce. Analysis of the information will not be in a form that identifies you, nor will it be used in selecting or not selecting you for an interview, or a job.
1.1.1.1.Please fill in all sections
Post TitleWhere did you hear about the vacancy?
EDP / Jobs24 / Jobs Centre / Freebridge / Voluntary Norfolk
Other please state
Are you / Male / Female
Age / Under 21 / 21-30 / 31-40 / 41-50 / 51-60 / 61-64 / 65 or over
Religion(If you feel the choices below do not provide a suitable option, please write how you would describe your religion)
Christian / Sikh / Hindu / Judaism
Muslim / Buddhist / None / Other*
*Please specify
Ethnic origin
The following categories are recommended by the Commission for Racial Equality. If you feel the choices do not provide a suitable option, please write how you would describe your ethnic origin.
(a) White / (b) Mixed / (c) Asian or Asian British
British / White and Black Caribbean / Indian
Irish / White and Black African / Pakistani
Any other white background / White and Asian / Bangladeshi
Any other mixed background / Any other Asian background
(d) Black or black British / (e) Chinese or other ethnic group
Caribbean / Chinese
African / Any Other
Any other black background
If you have ticked one of the ‘any other’ boxes, please describe your ethnic origin
Disability
Do you have a disability? / Yes / No
Definition of Disability
The Disability Discrimination Act 1995 defines disability as follows:
A person has a disability if he/she has a physical or mental impairment which has a substantial and long term effect on his/her ability to carry out normal day to day activities.
According to the Act, a disabled person is currently someone who:
- Has a physical or mental impairment
- The impairment has an adverse and substantial effect on his or her ability to carry out normal day to day activities
- The effect of the impairment is long term
- Physical impairments: diabetes; epilepsy; multiple sclerosis; cancer; cerebral palsy; heart disease
- Mental impairments: schizophrenia; dyslexia; bi-polar disorder; learning difficulties
- Progressive conditions: cancer; multiple sclerosis; muscular dystrophy; HIV infection
Signature / Date