Age UK Staffordshire JOB DESCRIPTION I East Staffs PCN...Hospice, Support Staffordshire and South...

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Age UK Staffordshire JOB DESCRIPTION I Job Title: Social prescriber / community connector East Staffs PCN Responsible to: Head of Wellbeing & Prevention, Age UK Staffordshire Clinical oversight named GP/practice Working alongside: Social prescriber/community connectors working for St Giles Hospice, Support Staffordshire and South Staffordshire Network for Mental Health. This role stems from a collaboration and true partnership with the NHS. We are working with East Staffs PCN and other local organisations in the development of a local approach to social prescribing. Social prescribing is a new role delivered through the NHS which empowers people to take control of their health and wellbeing through referral to non-medical ‘link workers’ who give time, focus on ‘what matters to me’ and take a holistic approach, connecting people to community groups and statutory services for practical and emotional support. Link workers support existing groups to be accessible and sustainable and help people to start new community groups, working collaboratively with all local partners. Social prescribing can help to strengthen community resilience and personal resilience, and reduces health inequalities by addressing the wider determinants of health, such as debt, poor housing and physical inactivity, by increasing people’s active involvement with their local communities. Social Prescribing particularly works for people with long-term conditions (including support for mental health), for people who are lonely or isolated, or have complex social needs which affect their wellbeing. Age UK Staffordshire is an independent local charity whose aim is to make a positive difference to the lives of people aged 50 and over, their families and carers. Our 200 staff and 150 volunteers provide a range of person-centred services and activities to enhance people’s quality of life, wellbeing and independence and to reduce social isolation and loneliness. Our services operate in the community across the whole of Staffordshire and include Day Opportunities for people living with dementia and/or complex needs, Help at Home, companionship, exercise, walking and falls prevention programmes, social activities, lunch club and services which work with health, social care and voluntary organisations to ensure people are able to access the services they need in their local community. Information about our project partners, St Giles Hospice, Support Staffordshire and South Staffordshire Network for Mental health is enclosed. II Job Purpose The social prescriber / community connector worker will be directly linked to GP practices within the Primary Care Network. Access to clinical guidance will be provided through these GP practices. They will work collaboratively within an integrated model of care to support the health

Transcript of Age UK Staffordshire JOB DESCRIPTION I East Staffs PCN...Hospice, Support Staffordshire and South...

Page 1: Age UK Staffordshire JOB DESCRIPTION I East Staffs PCN...Hospice, Support Staffordshire and South Staffor dshire Network for Mental Health. This role stems from a collaboration and

Age UK Staffordshire

JOB DESCRIPTION

I

Job Title: Social prescriber / community connector – East Staffs PCN

Responsible to: Head of Wellbeing & Prevention, Age UK Staffordshire

Clinical oversight named GP/practice

Working alongside: Social prescriber/community connectors working for St Giles

Hospice, Support Staffordshire and South Staffordshire Network for Mental Health.

This role stems from a collaboration and true partnership with the NHS. We are working with

East Staffs PCN and other local organisations in the development of a local approach to social

prescribing. Social prescribing is a new role delivered through the NHS which empowers people

to take control of their health and wellbeing through referral to non-medical ‘link workers’ who

give time, focus on ‘what matters to me’ and take a holistic approach, connecting people to

community groups and statutory services for practical and emotional support. Link workers

support existing groups to be accessible and sustainable and help people to start new

community groups, working collaboratively with all local partners.

Social prescribing can help to strengthen community resilience and personal resilience, and

reduces health inequalities by addressing the wider determinants of health, such as debt, poor

housing and physical inactivity, by increasing people’s active involvement with their local

communities. Social Prescribing particularly works for people with long-term conditions

(including support for mental health), for people who are lonely or isolated, or have complex

social needs which affect their wellbeing.

Age UK Staffordshire is an independent local charity whose aim is to make a positive

difference to the lives of people aged 50 and over, their families and carers. Our 200 staff and

150 volunteers provide a range of person-centred services and activities to enhance people’s

quality of life, wellbeing and independence and to reduce social isolation and loneliness. Our

services operate in the community across the whole of Staffordshire and include Day

Opportunities for people living with dementia and/or complex needs, Help at Home,

companionship, exercise, walking and falls prevention programmes, social activities, lunch club

and services which work with health, social care and voluntary organisations to ensure people

are able to access the services they need in their local community.

Information about our project partners, St Giles Hospice, Support Staffordshire and South

Staffordshire Network for Mental health is enclosed.

II Job Purpose

The social prescriber / community connector worker will be directly linked to GP practices within

the Primary Care Network. Access to clinical guidance will be provided through these GP

practices. They will work collaboratively within an integrated model of care to support the health

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and wellbeing of patients and local people working closely with GP’s, key stakeholders, local

statutory, and non-statutory groups including voluntary and community groups.

They will undertake collaborative working amongst all local partners at a ‘place-based’ local level,

to recognise the value of community groups and assets and to enable people to build or rebuild

friendships, community connections and a sense of belonging, as well as accessing existing

services.

They will meet individuals on a face to face basis to help them identify their health and wellbeing

needs and to help them to locate local resources in the community that can help them to achieve

those identified needs

They will work with other social prescribers / community connector workers across the Primary

Care Network to gather information (mapping) about local groups, services, activities which

individuals can be signposted to

They will support existing groups to be accessible and sustainable and help people to start new community groups, working collaboratively with all local partners.

III

Responsibilities

1. To provide a service to individuals who are often experiencing complex social circumstances, using agreed, person-centred based principles. Building trusting relationships by giving people time and focus on ‘what matters to me’ and providing personalised support to individuals, their families and carers to take control of their health and wellbeing, to live independently and improve their health outcomes,

2. To support people to navigate existing complex pathways to support better self-management 3. To negotiate and support access for individuals to community-based services and activities

that will support them to live well. 4. To work autonomously and manage workload, appointments etc. 5. To have an awareness and understanding of when it is appropriate or necessary to refer

people back to other health professionals / agencies, when what the person needs is beyond the scope of their role.

6. To maintain accurate records at the pre-intervention, progress and post-intervention stages. 7. To fulfil data collection and collation responsibilities as necessary. Ensuring confidentiality is

maintained. 8. To build and maintain a comprehensive knowledge of services and activities within the local

community which can be utilised in the best interests of other local people. 9. To liaise with public sector teams, service providers, and programme management team as

required. 10. Draw on and increase the strengths and capacities of local communities, enabling local VCSE

organisations and community groups to receive referrals, working together to build community capacity through the sharing of local assets

11. To build community connectedness and capacity within the local community through engagement with local networks of social prescribers / community connectors and other local organisations.

IV Key Tasks

1. Referrals

• Promoting social prescribing, its role in self-management, and the wider determinants of

health.

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• Build relationships with key staff in GP practices within the local Primary Care Network (PCN),

attending relevant meetings, becoming part of the wider network team, giving information and

feedback on social prescribing.

• Be proactive in developing strong links with all local agencies to encourage referrals,

recognising what they need to be confident in the service to make appropriate referrals.

• Work in partnership with all local agencies to raise awareness of social prescribing and how

partnership working can reduce pressure on statutory services, improve health outcomes and

enable a holistic approach to care.

• Provide referral agencies with regular updates about social prescribing, including training for

their staff and how to access information to encourage appropriate referrals.

• Seek regular feedback about the quality of service and impact of social prescribing on referral

agencies.

• Be proactive in encouraging self-referrals and connecting with all local communities,

particularly those communities that statutory agencies may find hard to reach.

2. Provide personalised support

• Meet people on a one-to-one basis, making home visits where appropriate within

organisations’ policies and procedures. Give people time to tell their stories and focus on ‘what

matters to me’. Build trust with the person, providing non-judgemental support, respecting

diversity and lifestyle choices. Work from a strength-based approach focusing on a person’s

assets.

• Be a friendly source of information about wellbeing and prevention approaches.

• Help people identify the wider issues that impact on their health and wellbeing, such as debt,

poor housing, being unemployed, loneliness and caring responsibilities.

• Work with the person, their families and carers and consider how they can all be supported

through social prescribing.

• Help people maintain or regain independence through living skills, adaptations, enablement

approaches and simple safeguards.

• Work with individuals to co-produce a simple personalised support plan – based on the

person’s priorities, interests, values and motivations – including what they can expect from the

groups, activities and services they are being connected to and what the person can do for

themselves to improve their health and wellbeing.

• Where appropriate, physically introduce people to community groups, activities and statutory

services, ensuring they are comfortable. Follow up to ensure they are happy, able to engage,

included and receiving good support.

• Where people may be eligible for a personal health budget, help them to explore this option as

a way of providing funded, personalised support to be independent, including helping people to

gain skills for meaningful employment, where appropriate.

3. Support community groups and VCSE organisations to receive referrals

• Forge strong links with local VCSE organisations, community and neighbourhood level groups,

utilising their networks and building on what’s already available to create a map or menu of

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community groups and assets. Use these opportunities to promote micro-commissioning or

small grants if available.

• Develop supportive relationships with local VCSE organisations, community groups and

statutory services, to make timely, appropriate and supported referrals for the person being

introduced.

• Ensure that local community groups and VCSE organisations being referred to have basic

procedures in place for ensuring that vulnerable individuals are safe and, where there are

safeguarding concerns, work with all partners to deal appropriately with issues. Where such

policies and procedures are not in place, support groups to work towards this standard before

referrals are made to them.

• Check that community groups and VCSE organisations meet in insured premises and that

health and safety requirements are in place. Where such policies and procedures are not in

place, support groups to work towards this standard before referrals are made to them.

• Support local groups to act in accordance with information governance policies and

procedures, ensuring compliance with the Data Protection Act.

4. Work collectively with all local partners to ensure community groups are strong and

sustainable

• Work with commissioners and local partners to identify unmet needs within the community and

gaps in community provision.

• Support local partners and commissioners to develop new groups and services where needed,

through small grants for community groups, micro-commissioning and development support.

• Encourage people who have been connected to community support through social prescribing

to volunteer and give their time freely to others, in order to build their skills and confidence, and

strengthen community resilience.

• Develop a team of volunteers within your service to provide ‘buddying support’ for people,

starting new groups and finding creative community solutions to local issues.

• Encourage people, their families and carers to provide peer support and to do things together,

such as setting up new community groups or volunteering.

• Provide a regular ‘confidence survey’ to community groups receiving referrals, to ensure that

they are strong, sustained and have the support they need to be part of social prescribing.

5. Data capture

• Work sensitively with people, their families and carers to capture key information, enabling

tracking of the impact of social prescribing on their health and wellbeing.

• Encourage people, their families and carers to provide feedback and to share their stories

about the impact of social prescribing on their lives.

• Support referral agencies to provide appropriate information about the person they are

referring. Use the case management system to track the person’s progress. Provide appropriate

feedback to referral agencies about the people they referred.

• Work closely with GP practices within the PCN to ensure that social prescribing referral codes

are inputted to EMIS/SystmOne/Vision and that the person’s use of the NHS can be tracked,

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adhering to data protection legislation and data sharing agreements with the clinical

commissioning group (CCG).

6. Professional development

• Work with your line manager to undertake continual personal and professional development,

taking an active part in reviewing and developing the roles and responsibilities.

• Adhere to organisational policies and procedures, including confidentiality, safeguarding, lone

working, information governance, and health and safety.

• Work with your line manager to access regular ‘supervision’, to enable you to deal effectively

with the difficult issues that people present.

7. Miscellaneous

• Work as part of the team to seek feedback, continually improve the service and contribute to

business planning.

• Undertake any tasks consistent with the level of the post and the scope of the role, ensuring

that work is delivered in a timely and effective manner.

• Duties may vary from time to time, without changing the general character of the post

IV

Terms and Conditions of Employment

Scale of Pay: £24200 (includes £1200 travel allowance as mileage is not payable with this role).

Tenure: 37 hours Full-time over 5 days

Holiday Entitlement: To be confirmed

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V Person specification Essential /

Desirable

Assessed by

Application /

Interview /

Personal

qualities and

attributes

Ability to actively listen, empathise with people and provide person-centred support in a non-judgemental way.

Able to get along with people from all backgrounds and communities, respecting lifestyles and diversity.

Commitment to reducing health inequalities and proactively working to reach people from all communities.

Able to support people in a way that inspires trust and confidence, motivating others to reach their potential.

Ability to communicate effectively, both verbally and in writing, with people, their families, carers, community groups, partner agencies and stakeholders.

Ability to identify risk and assess/manage risk when working with individuals.

Have a strong awareness and understanding of when it is appropriate or necessary to refer people back to other health professionals/agencies, when what the person needs is beyond the scope of the link worker role – e.g. when there is a mental health need requiring a qualified practitioner.

Able to work from an asset-based approach, building on existing community and personal assets.

Ability to maintain effective working relationships and to promote collaborative practice with all colleagues.

Commitment to collaborative working with all local agencies (including VCSE organisations and community groups). Able to work with others to reduce hierarchies and find creative solutions to community issues

Can demonstrate personal accountability, emotional resilience and ability to work well under pressure

E

E

E

E

E

E

E

E

E

E

E

A AND I

A AND I

I

I

A AND I

I

I

A AND I

A AND I

I

I

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Ability to organise, plan and prioritise on own initiative, including when under pressure and meeting deadlines

Ability to work flexibly and enthusiastically within a team or on own initiative Understanding of the needs of small volunteer-led community groups and ability to support their development

Able to provide motivational coaching to support people’s behaviour change

Knowledge of, and ability to work to, policies and procedures, including confidentiality, safeguarding, lone working, information governance, and health and safety

E

E

E

E

E

A AND I

I

I

I

I

Qualifications & training

NVQ Level 3, Advanced level or equivalent qualifications or working towards

Demonstrable commitment to professional and personal development

Training in motivational coaching and interviewing or equivalent experience

E

E

D

A

A

A and I

Experience

Experience of working directly in a community development context, adult health and social care, learning support or public health/health improvement (including unpaid work)

Experience of supporting people, their families and carers in a related role (including unpaid work)

Experience of supporting people with their mental health, either in a paid, unpaid or informal capacity

Experience of working with the VCSE sector (in a paid or unpaid capacity), including with volunteers and small community groups

Experience of data collection and using tools to measure the impact of services

E

E

E

E

D

A and I

A and I

A and I

A and I

I

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Skills and knowledge

Knowledge of the personalised care approach

Understanding of the wider determinants of health, including social, economic and environmental factors and their impact on communities, individuals, their families and carers

Knowledge of community development approaches

Knowledge of IT systems, including ability to use word processing skills, emails and the internet to create simple plans and reports

Local knowledge of VCSE and community services in the locality

Knowledge of how the NHS works, including primary care

E

E

E

E

D

D

I

I

A and I

A and I

I

I

Other

Meets DBS reference standards and criminal record checks

Willingness to work flexible hours when required to meet work demands

Access to own transport and ability to travel across the locality on a regular basis, including to visit people in their own homes

E

E

E

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Information about the partner organisations

St. Giles Hospice provides high-quality, individual care for local people living with cancer

and other serious illnesses, as well as support for their families and helpers. Care is offered

in a variety of ways according to the individual’s needs. Services are offered from three sites

at Whittington, Sutton Coldfield and Walsall. Services include community-based Clinical

Nurse Specialists, in-patient care, day hospice, hospice at home, bereavement and family

support, and an internationally renowned Lymphoedema Clinic. There is no charge to

patients for the specialist services we offer. We receive funding from the NHS but primarily

we rely on fundraising activities and legacies to support our work. St Giles employs

approximately 270 paid staff and over 1000 volunteers.

Age UK Staffordshire is an independent local charity whose aim is to make a positive difference to the lives of people aged 50 and over, their families and carers. Our 200 staff and 150 volunteers provide a range of person-centred services and activities to enhance people’s quality of life, wellbeing and independence and to reduce social isolation and loneliness. Our services operate in the community across the whole of Staffordshire and include Day Opportunities for people living with dementia and/or complex needs, Help at Home, companionship, exercise, walking and falls prevention programmes, social activities, lunch club and services which work with health, social care and voluntary organisations to ensure people are able to access the services they need in their local community.

Support Staffordshire was established on 12 January 2015 following the historic merger of

six CVS partners across Staffordshire. This saw the creation of six Support Staffordshire

offices across the county. At Support Staffordshire we believe that an effective and influential

Voluntary, Community and Social Enterprise (VCSE) sector in Staffordshire enriches the

lives of local people and communities. Our services aim to increase skills and knowledge,

harness the drive, enthusiasm and energy of people, to enhance individual and family

livelihoods, to build capacity in neighbourhoods & communities and to improve the

relationships and resilience of organisations and individuals. It can be helpful to think of

Support Staffordshire as acting like the ‘nuts and bolts’ or the ‘glue’ that holds our sector

together, although often our role is much less explicit even than this, rather acting like the

microscopic organisms that ensure any ecosystem is able to function healthily.

The South Staffordshire Network for Mental Health (SSNMH) is a charitable organisation

dedicated to the prevention of mental health issues and the improvement of service user

voice since 2003. The organisation helps to empower the communities within the 6 districts

of South Staffordshire to take action regarding their emotional wellbeing, by building

management plans and helping them to identify the gaps that may be preventing them from

becoming more emotionally well. SSNMH also at every stage of a person’s social

involvement tackles Stigma and discrimination within the communities through talks and

educational workshops. We hope through our talks and workshops we can end Mental

Health stigma and help build an emotionally healthier society.

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APPLICATION FORM (STRICTLY CONFIDENTIAL)

Application for Employment with Age UK Staffordshire

Please Note: a) Please complete clearly in black ink or type

b) CV’s are not acceptable, and will be discounted

c) Please ensure that you address all points on the person specification

and show how you meet them.

For which post are you applying –

1. PREVIOUS WORK EXPERIENCE Please list your employers in date order, starting with your current or most recent employer and ending with your first employer. Please include part time and unpaid work.

Dates From To

Name and Address of Employers

Title of post held and brief description of duties

If applicable what notice are you required to give?

Present position held Salary

Document No. HR12 Issue 11 – 25 May 2018

Candidate No.

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2. EXPERIENCE AND SKILLS Please state how your experience and skills, gained both inside and outside paid work, or through study and training, meet the requirements for the post described in the personal specification. Continue on a separate sheet if necessary.

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3. EDUCATION AND TRAINING Please list the qualifications that you have obtained in secondary school, further education and professional and technical institutes. Also list any relevant non-qualification courses that you have attended.

Dates From To

Secondary School/College Training Organisation

Name of course and Qualification where appropriate

4. FURTHER INFORMATION Is there any other information relevant to your application for this post which has not been covered elsewhere on the form e.g. Public duties?

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5. REFERENCES

Please give the names and addresses of two referees, indicating in what capacity you know them. One of these should be your present or most recent employer. Please tick the box if you do not wish referees to be contacted prior to interview.

Name Address

Post code Tel. Nos. Home Work Email Address In what capacity is the referee known to you

Name Address

Post code Tel. Nos. Home Work Email Address In what capacity is the referee known to you

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6. PERSONAL DETAILS

Title Surname Forenames

Address

Post Code NI No

Tel. Home Tel. Work

Nationality May we contact you at work? Yes/No

I declare that to the best of my knowledge the information on this form is true and correct. Signature of Applicant …………………………………… Date …………………………..

Consent Statement

In order to process your application to Age UK Staffordshire we need to store data about you. The law says that we must obtain your consent to do this. Everything you tell us will be treated confidentially and your personal details will be processed in accordance with current Data Protection Law, as set out in our applicant privacy notice. We will need to share some details with the recruitment panel and if successful, liaise with other organisations in order to appoint you as an employee. Please read the sentence below and, if you consent, please sign and date. I consent to the processing of my personal data by Age UK Staffordshire. I understand that my data may be securely shared with other organisations in order to comply with relevant legislation. I understand I can withdraw consent at any time by contacting the Charity Administrator Tel: 01785 788470 Name of applicant: ________________________________________________________ Signature: ________________________________ Date: ______________________

We will never pass your personal details onto any third parties without your consent.

Full details of our Data Protection policy are available on our website or upon request. ________________________________________________________________________

Please return to: [email protected]

Lisa Barlow Age UK Staffordshire The Roller Mill Teddesley Road Penkridge ST19 5BD

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Oct 17 HR32 Equality & Diversity Monitoring Form

Equality & Diversity Monitoring Form

Age UK Staffordshire (AUKS) wants to meet the aims and commitments set out in its

Equality and Diversity Policy. This includes not discriminating under the Equality Act

2010. This form is intended to help us maintain equal opportunities best practice and

identify barriers to workforce equality and diversity.

The organisation needs your help and co-operation to enable it to do this, but filling

in this form is voluntary. The form will be separated from your application on receipt.

The information on this form will be used for monitoring purposes only to ensure we

are meeting our Equality & Diversity Policy and will play no part in the recruitment

process.

All questions are optional. You are not obliged to answer any of these

questions but the more information you supply, the more effective our

monitoring will be. All information supplied will be treated in the strictest

confidence. It will not be placed on your personnel file.

Thank you for your assistance.

Job/Role Vacancy

Where did you hear about the job/role (please tick)?

Newspaper

(please

specify)

…………

[ ] Friend [ ] Recruitment

company

[ ]

AUKS

website

[ ] Other

website

(please

specify)

[ ] Other

(please

specify)

[ ]

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Oct 17 HR32 Equality & Diversity Monitoring Form

Gender

What is your gender (please tick)?

Male [ ]

Female [ ]

Prefer not to say [ ]

(If you are undergoing gender reassignment, please use the gender you identify with.)

Ethnic group

Ethnic origin is not about nationality, place of birth or citizenship. It is about the group to

which you perceive you belong (please tick)

White: Mixed race: Asian or

Asian

British:

British -

English,

Scottish or

Welsh

[ ] White and

Black

Caribbean

[ ] Indian [ ]

Irish [ ] White and

Black

African

[ ] Pakistani [ ]

Other White

background

[ ] White and

Asian

[ ] Bangladeshi [ ]

Other Mixed

background

[ ] Other Asian

background

[ ]

Black or

Black

British:

Chinese

and other

groups:

Caribbean [ ] Chinese [ ] Prefer not to

say

[ ]

African [ ] Other ethnic

group

[ ]

Other Black

background

[ ]

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Oct 17 HR32 Equality & Diversity Monitoring Form

Age

What is your age (please tick)?

16–17 [ ] 18–21 [ ] 22–30 [ ] 31–40 [ ] 41–50 [ ]

51–60 [ ] 61–65 [ ] 66–70 [ ] 71+ [ ] Prefer

not to

say

[ ]

Sexual orientation

How would you describe your sexual orientation (please tick)?

Heterosexual

/ straight

[ ] Bisexual [ ] Prefer not to

say

[ ]

Gay man [ ] Gay woman

/ lesbian

[ ] Other [ ]

Religion or belief

Please describe your religion or other strongly-held belief.

I would describe my religion or belief as: .................................................

I have no particular religion or belief [ ]

Prefer not to say [ ]

Disability

The Equality Act 2010 defines a disability 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". An effect is long-term if it has lasted, or is likely to last, more than 12 months.

Do you consider that you have a disability under the Equality Act (please tick)?

Yes [ ] No [ ]

Used to have a

disability but have

now recovered

[ ] Don't know [ ]

Prefer not to say [ ]

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Doc No HR 39 March 2018

Rehabilitation of Offenders Act 1974. Exceptions Order 1975

This Act regulates the treatment and rehabilitation of offenders in relation to employment they may apply for following conviction. The Act allows that certain convictions can be treated as ‘Spent’ after a given period of time. The individual is treated as having been rehabilitated and does not need to disclose the conviction. For more serious cases where the sentence exceeds four years’ imprisonment there is no rehabilitation period and the conviction will never be treated as ‘spent’. However, the Act is subject to the Exceptions Order 1975 which aims to protect individuals considered vulnerable, including vulnerable adults and children. We consider that the role for which you are applying falls within the Exceptions Order. When completing this section of the form you are therefore obliged to declare all convictions, including any which in other circumstances would be considered spent. Have you ever been convicted of any criminal offence by a court of law? Yes / No If yes, please complete the section below.

Date Place (Where sentence was

handed down) Offence Sentence

It is Age UK South Staffordshire’s policy to obtain a criminal record check for all new employees who are subject to the Exceptions Order through the Disclosure and Barring Service.

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Age UK Staffordshire August 2019

East Staffordshire Office: Voluntary Services Centre, Union Street, Burton-on-Trent, Staffordshire, DE14 1AA

APPLICANT CONSENT STATEMENT – APPLICATION FORM

In order to process your application to Age UK Staffordshire we need to store data about you. The law says that we must obtain your consent to do this. Everything you tell us will be treated confidentially and your personal details will be processed in accordance with current Data Protection Law, as set out in our applicant privacy notice. We will need to share some details with the recruitment panel and if successful, liaise with other organisations in order to appoint you as an employee. Please read the sentence below and, if you consent, please sign and date. I consent to the processing of my personal data by Age UK Staffordshire. I understand that my data may be securely shared with other organisations in order to comply with relevant legislation. I understand I can withdraw consent at any time. Name of applicant: ______________________________________________________________ Signature: ___________________________________ Date: ______________________

We will never pass your personal details onto any third parties without your consent.

Full details of our Data Protection policy are available on our website or upon request.