Vacancy Applied For: Team Leader (Rochdale)

Vacancy Applied for: Team Leader (Rochdale)

Full Name / Mr/Mrs/Miss/Ms
Address for correspondence:
Post Code:
Tel No. / Mobile: / Home: / Work:
Email: / National Insurance No.


Are you applying for this position on a job share basis?YESNO
Calico is committed to employing a workforce that is inclusive and diverse by removing any barriers and tackling discrimination.
INTERVIEW GUARANTEE SCHEME FOR DISABLED APPLICANTS
If you are a disabled person and you fulfil all the essential criteria on the enclosed person specification to the satisfaction of the selection panel, you are guaranteed an interview. If you wish to be included in this scheme, please indicate in the box below.

I am disabled and would like to take part in this scheme ( please tick)
Adjustments For Selection Purposes
Please contact us if you need the application form in an alternative format or of you need any adjustments for the interview.
Please note that this information does not form part of the selection process.
Do you have any relationship with a Board Member, member of staff, resident, tenant or client of the Calico Group? Yes/No
If yes, please state their name and the nature of your relationship:
Name: ______Nature of relationship: ______
Signed: ______Dated: ______
I declare that the information provided in my application is correct and understand that if appointed, I will be liable to disciplinary action including dismissal should I knowingly give false information.
Signed: Dated: ______
The information given above may be processed and used for recruitment, selection, statistics and monitoring purposes. If you join the Company, the information will form the basis of your personal file. The data will then be processed for any purpose in connection with your employment relationship; training and development; remuneration; or the effective management of the organisation.
Signed: ______Dated: ______

Calico is committed to providing equal opportunities for everyone, regardless of ethnic origin, gender, disability, age, transgender, religion or sexual orientation and in accordance with the 9 protected characteristics of the Equality Act 2010. We therefore ask you to provide us with the information requested on this form. Please be assured that this information is used for monitoring purposes only in order to comply with current employment legislation and to promote equality of opportunity throughout the company. By monitoring this information for job applicants we are able to identify and remove any barriers that may exist for any groups or individuals. This form will be kept separately from your application form and has no part in the selection process

1. Vacancy applied for: Team Leader (Rochdale)
2. Ethnic origin: (*To which group would you say you belong? Please tick one box.)

WHITEINDIANIRISHBLACK CARIBBEANBANGLADESHI
BLACKPAKISTANICHINESEBLACK – OTHER (PLEASE DESCRIBE) ______AFRICAN
OTHER – (PLEASE DESCRIBE) ______
*These categories are approved by the Equality and Human Rights Commission
3. Gender

ARE YOU: MALE FEMALE

If you are permanently living in the gender not of your birth please tick
4. Disability
ARE YOU DISABLEDNO YES (please refer to Personal Information Form)

1. Age – Please tick the category to which you belong

UNDER 2525-3435-5455-64>64

6. Religion/Faith (Please tick the category to which you belong)

AtheistBuddhistChristianHinduJewishMuslim

Sikh Other Prefer not to say
7. Sexual Orientation (Please tick the category to which you belong)

Heterosexual LesbianGayBi-SexualPrefer Not to Say

8. Where did you INITIALLY see the advert – please tick appropriate box.

JOB CENTRE PROFESSIONAL JOURNALINTERNAL ADVERTISEMENT

CALICO WEBSITEEQUALITY BRITAIN WEB SITE
OTHER WEBSITE (which site) ______
PRESS ADVERTISEMENT (which publication) ______
Application For Employment /
Vacancy Applied for: Team Leader (Rochdale)
Present or most recent employment
Job Title / Date of Employment
Employer / Notice Required
Reason for leaving
(if applicable) / Salary
Brief description of duties
Previous Employment / Please give details of past work you have undertaken. This can include paid work, unpaid or voluntary work, self employment or work at home.
Job / Employer / From / To / Reason for Leaving
Gaps In Employment / Please provide a brief explanation below of any gaps in your employment history

______

Qualifications

Qualifications and/or examinations passed Grade

______

______

______

______

Special Training / (include any relevant short courses and development activities you have undertaken)

DetailsDuration of course/activity

______

______

______

______

Driving Licence

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

Please provide details of how you are suitable for the position and meet the person specification. Please include qualifications, experience, skills, knowledge and any other information which you feel may be helpful to your application (continue on a separate sheet if necessary). CV’s will not be accepted.

______

Please return this form to: Human Resources, Calico, Centenary Court, Croft Street, Burnley, BB11 2ED

CANDIDATE NAME: ______

POSITION APPLIED FOR: ______

Please give details of your referees. These should include all employment references covering the last three years, including your present or most recent employer. In all cases a minimum of two referees must be provided.
If you are applying for a role involving client care at Whitworth Care Trust or Acorn Recovery Projects you must provide details of your last CQC registered / care employer regardless of when you left.
If your first referee covers the last three years of your employment, you will still need to provide a second referee. This should be a person who has knowledge of your skills and would be able to comment on your ability to do the job you are applying for, for example: a Club or Charity for whom you work voluntarily; or School or College
If you have been self-employed for the last three years, or have never been employed, you should still provide the names of two people who can comment on your suitability for this post.

2

Name: / Name:
Address: / Address:
Telephone No: / Telephone No:
Fax No: / Fax No:
E mail: / E mail
Relationship: / Relationship:
Dates Employed / From: / To: / Dates Employed / From: / To:
Name: / Name:
Address: / Address:
Telephone No: / Telephone No:
Fax No: / Fax No:
E mail: / E mail
Relationship: / Relationship:
Dates Employed / From: / To: / Dates Employed / From: / To:
WE WILL NOT CONTACT A REFEREE UNLESS A JOB OFFER IS MADE
Please note, it is the requirement of the Company’s Insurance Policy that satisfactory written references are obtained direct from former employers covering the previous 3 years. Therefore, an offer of employment will be subject to the receipt of satisfactory references

The disclosure of a criminal record will not debar your appointment unless the selection panel considers that the conviction renders you unsuitable for appointment. In making this decision the panel will consider the nature of the offence(s), how long ago and what age you were and any other factors which may be relevant.

Failure to declare a conviction may, however, disqualify you from an appointment, or result in the termination of your contract if the discrepancy comes to light.

1. DISCLOSURE OF CRIMINAL RECORD

The post you have applied for is excluded from the provisions of the Rehabilitation of Offenders Act 1974 as amended by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975. You must therefore disclose details of convictions, cautions and bind over orders, whether spent or not, and whether imposed when you were an adult or a juvenile. The amendments to the Exceptions Order 1975 (2013) provide though that certain spent convictions and cautions are “protected” and are not subject to disclosure to employers, and cannot be taken into account. Guidance and criteria on the filtering of these cautions and convictions can be found on the Disclosure and Barring Service website. You must also disclose details if you are currently the subject of a police investigation/proceedings which could result in a conviction, caution or bind over order.

Criminal Convictions
Have you ever been convicted of any criminal offence received a police caution or bind over orders ? / Yes: No:
Are you currently the subject of any police investigation and/or prosecution, in the UK or abroad ? / Yes: No:
If you have answered “yes” to either of the above please set out details below or continue on a separate sheet

2. DISCLOSURE OF PROFESSIONAL/REGULATORY INVESTIGATIONS

Investigations
Are you currently the subject of any investigation or proceedings by any body having regulatory functions in relation to health/social care professionals, including such a regulatory body in another country? / Yes: No:
Have you EVER been disqualified from the practice of a profession or required to practice it subject to specified limitations following a fitness to practice investigation by a regulatory body in the UK or another country? / Yes: No:
If yes set out details below or continue on a separate sheet

I understand that failure to disclose fully any spent criminal conviction, caution or bind over order may lead to any job offer being withdrawn, or to disciplinary action up to and including dismissal.

Signature:

Print Name:

Date: