Applicant Details

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Position applied for: Title: Mr Mrs Miss Ms. Dr Rev Other Forename: Surname: Any other names you have been known by: Date of Birth: Address: Postcode: Telephone: Work Telephone: Mobile Telephone: National Insurance Number:

Qualifications and Training

Schools Attended	Qualification Gained	Year Obtained

Colleges Attended	Qualification Gained	Year Obtained

Other Employment

Please note any other employment you would continue with if you were to be successful in obtaining this position.

Employment History

Date from	Date to	Job Title and Duties	Name and address of employer	Reason for leaving

Period of notice required: Are you legally eligible for employment in the UK? Date available for work: Do you hold a current driving licence? Do you require a work permit? Do you own a car?

References

Please provide details of two referees who can provide information relating to your competency for this role, one of whom must be your current or latest employer. If you are a student, please give an academic referee. As this is an application for a post which requires unsupervised access to vulnerable adults, we reserve the right to approach any past employer for a reference.

General Comments

Please detail here your reasons for this application, your main achievements to date and the strengths you would bring to this post. Specifically, please detail how your knowledge, skills and experience meet the requirements of this role (as summarised in the job description and person specification).

CAUTIONS, REHABILITATION AND CRIMINAL RECORDS

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 Exceptions Order 1975 as amended by the Exceptions (Amendment) Order 1986, which means that convictions that are spent under the terms of the Rehabilitation of Offenders Act 1974 must be disclosed, and will be taken into account in deciding whether to make an appointment. Any information will be completely confidential and will be considered only in relation to this application.

In addition, you are required to submit to a Disclosure and Barring Service (DBS) check. Any standard or enhanced disclosure made by the DBS will remain strictly confidential.

Have you ever been convicted in a Court of Law and/or cautioned in respect of any offence? If YES, please give details:

HEALTH SCREENING

The role of support worker can be demanding, and at times, stressful. Please could you declare any medical conditions that you suffer or are prone to which may impede your ability to carry out the role. Do you consider yourself to have a disability? Please provide the name and address of your General Practitioner:

SPECIAL REQUIREMENTS

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

1. Your consent to obtaining a standard/enhanced disclosure certificate from the Disclosure and Barring service or an approved umbrella body
2. Such disclosure being acceptable to us
3. Proof of identity – birth or marriage certificate (where appropriate) and passport (if available).
4. Two satisfactory written references.
5. That you will supply a photograph of yourself for retention in your records.
6. Proof of status to work in the UK (where appropriate).

NOTIFICATION OF DISCIPLINARIES / ALLEGATIONS

Home Focus pride themselves on maintaining and adhering to guidelines and legislations with regard to the recruitment of their staff.

As such – all employees and prospective employees are requested to declare their participation in any known disciplinarians / allegations of abuse that have been made against them.

Employees and prospective employees should be aware that Disclosure and Barring Service checks are carried out following an initial offer of employment and status checks will be done at regular intervals thereafter.

An offer of employment may be withdrawn if it transpires that information regarding the above was undisclosed at the time of offer of employment.

Have you knowingly been subject to any disciplinary action / allegations of abuse at any time in your previous places of employment.

PERSON SPECIFICATION

FLEXIBILITY – Support is required 24 hours a day, 7 days a week including Christmas and other bank holidays. Will you be able to provide flexibility when the role demands it? TEAMWORK – Do you have the skills that it takes to work with a variety of people? The role may also require lone working at times. Do you have the initiative to take responsibility to take and make decisions? Do you have an awareness of risk and the ability to identify areas of risk and factors to risk? COMMUNICATION – Are you able to communicate effectively both verbally and in writing and with a variety of people? Are you prepared to undertake communication training to enable you to communicate effectively in other forms, e.g. through sign language? Sometimes, supporting people can be difficult and repetitive. Do you have the self-motivation and conscientiousness to provide an ongoing high standard of support? Most of all – are you patient, non-judgemental and open minded? Can you acknowledge other people’s points of view and remain calm in sometimes pressured situations?

EQUAL OPPORTUNITIES

Please complete this form as part of the application process. It is solely used for monitoring purposes and to develop our Equal Opportunities Policy.

It will be separated from the application upon receipt and not available to those interviewing prospective employees.

Please choose the answer that best describes you (please circle):

Are you Male or Female? Please choose Male Female Are you Married? Please choose Married Single How would you describe your ethnic origin? Please choose Black – Caribbean Black – African Black – Other White Indian Pakistani Bangladeshi Chinese Other What is your age? Please choose 18-25 26-35 36-45 46-55 55 plus Are you registered disabled Have you been absent from work through sickness for more than 14 days in the last 12 months? Notes Are you prepared to undertake training? Appreciating the physical demands of the job; do you have any health conditions which may limit your ability to carry out duties? Are you aware that all information with regards to service users is confidential and must not be disclosed? Are you aware that you will paid monthly by BACS?

All offers of employment will be subject to references being received and a suitable check being completed with the Disclosure and Barring Service.

Declaration

• I confirm that the above information is complete and correct and that any untrue or misleading information will give my employer the right to terminate any employment contract offered.
• Should we require further information and wish to contact your doctor with a view to obtaining a medical report, the law requires us to inform you of our intention and obtain your permission prior to contacting your doctor. I agree that the organisation reserves the right to require me to undergo a medical examination. In addition, I agree that this information will be retained in my personnel file during employment and for up to six years thereafter and understand that information will be processed in accordance with the Data Protection Act.
• I agree that should I be successful in this application I will apply to the Disclosure and Barring Service for an enhanced disclosure. I agree to sign up to, maintain and pay for my continued registration with the DBS update service whilst in this service’s employ. I understand that should I fail to do so or should the disclosure not be to the satisfaction of the company any offer of employment may be withdrawn or my employment terminated.
• I give ongoing consent to Home Focus to carry out status checks with the DBS, as they deem necessary, if I am successful in this application (whilst in Home Focus’ employ).