PERSONAL DETAILS
HISTORY
Which of the following courses / training days have you attended?
EDUCATION AND QUALIFICATIONS
Please provide details of your school leaving qualifications and the grades achieved: (Please include dates and names of establishments in table below)
Please provide details of any post-graduate qualifications: (Training school, hospital, university, post school etc.)
Other courses attended:
EMPLOYMENT HISTORY
A full employment history, together with a satisfactory written explanation of any gaps in employment.
SUPPORTING INFORMATION (PLEASE CONTINUE ON ADDITIONAL SHEETS IF NECESSARY)
In this section please give your reasons for applying for this post and additional information which shows how you match the person specification for the job (you will have been sent this document with this application form). This can include relevant skills, knowledge, experience, voluntary activities and training etc.
REFERENCES (PLEASE CHECK WITH YOUR REFEREES BEFORE SUPPLYING US THEIR DETAILS)
Please give the names of the people who have agreed to supply references. For all positions you must provide 2 references. If you are, or have been, employed these should be your two most recent employers. These may include your line manager or someone in a position of responsibility who can comment on your work experience, competence, personal qualities and suitability for the post. If you are a student please provide contact details of a teacher at your school, college or university. Please note that personal references such as friends and relatives are not acceptable. For all posts, written references obtained must cover the preceding 3 years of employment. All referees will be approached prior to interview unless you indicate otherwise.
Referee 1
Referee 2
Referee 3
HEALTH STATEMENT DECLARATIONS
REQUIREMENTS UNDER THE REHABILITATION OF OFFENDERS ACT 1974
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 Rehabilitation of Offenders Act 1974 (Exceptions) Orders 1975. Applicants are therefore not entitled to withhold information about convictions or police cautions which for other purposes are ‘spent’ under the provisions of the Act and, in the event of employment, any failure to disclose such convictions could result in dismissal or disciplinary action. Any information given will be completely confidential and will be considered only in relation to an application for positions to which the order applies. All offers of employment will be subject to the receipt of a satisfactory CRB/POVA first disclosure and two references.
PASSPORT AND DRIVING LICENCE DETAILS
(You will be required to produce your passport so that we can verify your right to work in the UK)
DECLARATION
Please Read and Sign - Data Protection Act 1984 and 1988 / Declaration
I declare that all the information I have given is correct. I understand that if I knowingly make false statements I could be the subject of Police investigation and prosecution. It may also terminate my employment with Independent Support & Care. I have read, understood and agree to the terms and conditions as laid down in your leaflet, of which I have been given a copy. I understand that my employment is subject to satisfactory references and a satisfactory result after checking with the Development of Health and/or Police records. I undertake to inform you immediately if I am engaged through your introduction, including the offer of permanent employment following temporary assignment. I am aware that personal data (including where relevant, sensitive personal data) relating to myself, whether obtained from myself or from any other source, will be retained by Independent Support & Care indefinitely for the purposes of providing me with employment and/or training. I hereby confirm that my personal details may be held and disclosed in the manner contained herein, and will inform Independent Support & Care of any changes in circumstances which may affect my ability to work in the care profession while registered with Independent Support & Care.
EQUAL OPPORTUNITES MONITORING FORM
Independent Support & Care (ISC) is committed to promoting fairness and eliminating discrimination from recruitment and selection practices. We will ensure that no job applicant or employee received less favourable treatment either directly or indirectly, on the grounds of age, race, disability, gender, marital status, religion or faith or sexual orientation.
To monitor and audit the effective delivery of this commitment, ISC requires all applicants to provide information asked for in this monitoring form. This will only be used for this purpose, will form no part of the interview process and will be treated in strict confidence.
The form will be detached from your application form and transferred to our Human Resources database to help monitor the diversity of applications we receive. This will enable us to develop appropriate policies and procedures in respect of diversity and equal opportunities.
How would you describe your ethnic origin?
Disability is defined by the Disability Discrimination Act as;
A physical or mental impairment, which has a substantial and long-term adverse effect on a person’s ability to carry out normal day-to-day activities. The disability could be physical, sensory or mental and must be expected to last at least 12 months.
