Application For Employment

Fields marked * must be completed.

Position Applied For: Community Care and Support Worker Extra Care Housing Care and Support Worker Other

Job Ref:

Please Specify:

PERSONAL DETAILS

Title: Mr. Mrs. Miss

*Full Name:

*Address:

*Postcode:

*Telephone (Home):

*Telephone (Mobile):

*E-Mail:

Date of Birth:

Age:

National Insurance Number:

Do you posess a full driving license? Yes No

Do you have use of a motor vehicle? Yes No

Do you have any endorsements on your license? Yes No

If yes please give details:

Are there any restrictions in the use of your motor vehicle? (for example number of miles driven per year) Yes No

If yes please give details:

Are you involved in any activity that might limit your ability to work or your working hours e.g. Local Government? Yes No

If yes please give details:

Are you subject to any restrictions or covenants that might restrict your working activities? Yes No

If yes please give details:

Have you cautions, convictions or reprimands, including both spent and unspent under the Rehabilitation of Offenders Act 1974? (A copy of Way Ahead's CRB Code of Practice is available of request) Yes No

Are you registered with the Independent Safeguarding Authority (ISA)Yes No

If yes, please give your ISA number:

If offered employment you will be required to complete a Pre-Employment Medical Questionaire. Are you prepard to undergo a medical examination before employment? Yes No

Have you ever worked for Way Ahead before? Yes No

Have you ever applied for employment with Way Ahead before? Yes No

Do you need a work permit to take up employment in the UK? Yes No

Please indicate the periods of the day and which days of the week you are interested in working (All staff is asked to work some part of every other weekend):

This is not a binding commitment but enables us to assess the amount of work we have for you.

Please give details of any hours you would not wish to work:

EDUCATION

One

School or College:

Dates:

Qualifications Gained:

Two

School or College:

Dates:

Qualifications Gained:

Three

School or College:

Dates:

Qualifications Gained:

Further Formal Training:

Do you have a Unique Learners Number? Yes No

If yes, please give your Unique Learners Number:

Job Related Training Courses: (name of organisation and subject)

Please give details of membership of any technical or professional associations:

Please list any foreign languages spoken and the level of competence:

EMPLOYMENT HISTORY

Please give details of all your past employment, excluding your present or last employer, starting the most recent first.

Please give reasons for any gaps in employment.

One

Name and Address of Employer:

Dates:

Position Held/Main Duties:

Reason for Leaving:

Two

Name and Address of Employer:

Dates:

Position Held/Main Duties:

Reason for Leaving:

Three

Name and Address of Employer:

Dates:

Position Held/Main Duties:

Reason for Leaving:

Four

Name and Address of Employer:

Dates:

Position Held/Main Duties:

Reason for Leaving:

Five

Name and Address of Employer:

Dates:

Position Held/Main Duties:

Reason for Leaving:

Six

Name and Address of Employer:

Dates:

Position Held/Main Duties:

Reason for Leaving:

Seven

Name and Address of Employer:

Dates:

Position Held/Main Duties:

Reason for Leaving:

Eight

Name and Address of Employer:

Dates:

Position Held/Main Duties:

Reason for Leaving:

PRESENT OR LAST EMPLOYER

Are you currently employed? Yes No

Name of present employer:

Address:

Telephone Number:

Nature of business:

Job title and brief description of your duties:

Reason for leaving:

Length of service   From: To:

How much notice are you required to give your current employer:

OTHER EMPLOYMENT

Please note any other employment you would continue with if you were successful with the position offered:

EXPERIENCE AND ACHIEVEMENTS

Please give a concise account of relevant experience in support of this application, including leisure interests:

GENERAL COMMENTS

Please detail here your reasons for this application and what do you feel you can bring to the post:

INTERESTS

Interests:

SUPPLEMENTARY INFORMATION

Please provide any other information which you consider would assist us in considering your application:

REFERENCES

Please give the names of two people (one of which should be your present or most recent employer) whom we may approach for a reference.

Can we approach your current employer before an offer of employment is made? Yes No

details of your first reference

Name:

Position:

Address:

Telephone:

details of your second reference

Name:

Position:

Address:

Telephone:

SOURCE OF APPLICATION

How did you hear of this vacancy: Supermarket Receipt Newspaper Advert Flyer Postcard Radio Advertisment Internet Search Recruitment Website Personal Recommendation Other

DISCLOSURES

Given the nature of the job applied for, in the event that I am offered the position, I understand that any offer of employment is subject to information on my criminal record being disclosed to Way Ahead by the Criminal Records Bureau (CRB).

I have been given a copy of Way Ahead's Equal Opportunities Policy, which includes information relating to the recruitment of ex-offenders.

DECLARATION

I declare that the information given in this form is complete and accurate. I understand that any false information or deliberate omissions will disqualify me from employment or may render me liable to summary dismissal. I understand these details will be held in confidence by Way Ahead, for the purposes of assessing this application, ongoing personnel administration and payroll administration (where applicable) in compliance with the Data Protection Act 1998.

If successful in my application I agree that the information I have provided can be shared with Industry Regulators, Commissioners of Contractual Services and Government departments collecting national statistics.

*I agree:

*Date: