Three Cs Application Form
Post Applied for / Redbridge Support Worker and Flexible Support Worker April 2016
What hours do you wish to work? (Please tick)
1. Permanent Full-time (36 Hour per week contract)
2. Permanent Part-time (please state how many hours per week you would want to work)
3. Flexible Support Worker (Non-fixed , floating hours, Bank Staff)
Personal Details
Last Name / Title
First Name
Address
Postcode
Telephone Home / Mobile
Email Address
Do you have a National Insurance Number –( You will be required to produce details if successful ) / Yes / No
Do you hold a valid UK driving licence
Are you willing to drive the vehicles of people we support? / Yes
Yes / No
No
Are you eligible to work in the UK?
( You will be required to bring along the evidence at the time of the interview if shortlisted)
No / Yes - Permanent Resident / EU Passport Holder
Yes - Spousal Visa / Yes - Long Term Work Permit ( min 3 yrs at present)
Yes - Ancestral Visa / Yes- Youth Mobility Scheme / Working Holiday Visa
Yes – Other- If you have any other visa or permit please provide details:
Education and Qualifications
Give us details of the most relevant education and qualifications
Name of University, college or school / Course and qualifications achieved / Dates
From / To
Professional Development
Include any courses, membership, voluntary work or other responsibilities you consider relevant with outcomes where applicable
What languages can you speak fluently? (Please list below)
Employment History
Please give details of all jobs held including part time and unpaid work, starting with your current or most recent employer. (Continue on a separate sheet if required.)
Employer ( Name and address) / Job Details (What were your key tasks?) / Employment dates (From - Till) / Reason for leaving
Your References
Please provide two references, one of which must be from your present or most recent employer. Referees should not be friends, relatives or immediate colleagues. If this is your first job, one reference must be from your head teacher or lecturer. All appointments are subject to the receipt of at least two satisfactory references, which cover the last five years of employment/study. If you have had more than two employers in the last three years, please provide details and attach to your application. We reserve the right to take up references from any previous employer.
1st Referee / 2nd Referee
Name
Job Title
Relationship to you
Company Name
Address
Postcode
Email address
Tel No
We are Positive about Disability:
If you have a disability which you would like us to know about please give details. It is our objective to ensure that people with disabilities receive fair treatment and is considered solely on their ability to do the job. If you are disabled you are guaranteed an interview if you meet the minimum requirements for the post. (The definition of ‘disability’ under the Equality Act 2010, states a person has a disability if they have a physical or mental impairment, and the impairment has a substantial and long-term adverse effect on their ability to perform normal day to day activities.) We are an equal opportunities employer and are glad to receive applications from anyone, regardless of sexual orientation, sex, race, age, gender or disability.
Are there any reasonable adjustments that may be required to be made should you be invited for interview? If yes please state the same:
Disclosure of Information
Rehabilitation of Offenders Act 1974
I confirm that to the best of my knowledge the details given are correct. I understand that the post applied for is NOT protected by the Rehabilitation of Offenders Act 1974 and that I must disclose information about all criminal convictions (if any), no matter when they occurred. In the event of employment, failure to disclose all previous convictions, even if they are ‘spent’ could result in disciplinary action, including dismissal by Three Cs. (All information is confidential and will be considered only if relevant to the post you have applied for)
Have you ever been convicted of a criminal Offence or received a caution or bind-over?
No / Yes
If Yes, please provide details of convictions, sentence, cautions or bind over on a separate sheet
Are you related to any members of the board of Trustees or to any employees of Three Cs?
No / Yes / Name:
Professional Registration Declaration:
Have you been or are you currently subject to any fitness to practice proceedings by an appropriate licensing or regulatory body in the UK or any other country? If yes, please provide on a separate sheet details of the nature of proceedings undertaken, or contemplated, including dates of proceedings, country where proceedings were undertaken and the name and address of the licensing or regulatory body concerned.
Important Note Declaration I declare that the information given on this form is true and complete. I understand that providing misleading or false information will disqualify me form appointment will disqualify me from the appointment OR, if appointed, may result in my dismissal.
Signed / Date
If Online application please put a cross in the relevant box to agree with the declaration
Yes / No
Where did you hear you first hear about this position: Please put a cross against it
Three Cs staff referral
Three Cs Website
Other Website / If yes which one:
Other than above / If Other please explain:
PLEASE COMPLETE THE SUPPORTING STATEMENT IN THE NEXT SECTION.
IT IS IMPORTANT THAT YOU FULLY COMPLETE ALL SECTIONS OR THIS APPLICATION MAY MOT BE CONSIDERED BY THE RECRUITMENT PANEL.
RETURN YOUR COMPLETED APPLICATION FORM TO
Supporting Statement(Please do not use more than two sides of a A4 paper with font size of 10 or above)
This is your chance to sell yourself! Please tell us why you are the best person to get this job with Three Cs
At Three Cs we want a Support Worker who is able to improve and maintain independence, rather than care, for a person with learning disabilities and/or mental health challenges. With this in mind please answer the following questions.
Top tip: Don’t forget the job description and person specification that came with this job.
1. Tell us about your views on independence for people we support (Word limit: 250 Words)
2. Tell us what you understand by social inclusion (Word limit: 250 Words)
3. Tell us what safeguarding means to you for people we support. (Word limit: 250 Words)
4. Tell us why you would be a good team member. (Word limit: 250 Words)
Three Cs values diversity in service delivery and employment.
If you need any assistance, please contact