APPLICATION FORM - Newcastle Carers€¦ · Web viewFriend/Word of Mouth Newcastle Carers Website...

For Office Use OnlyDate r’vd:Application No:APPLICATION FOR

EMPLOYMENT

Please return your completed application form by the closing date to:

Newcastle Carers135-139 Shields RoadBykerNewcastle upon TyneNE6 1DN

Or via email: [email protected]

Please note that CV’s will not be accepted in support of or as a substitute for a completed application form.

PART 1: PERSONAL INFORMATIONVacancy Title:

Title: Last Name:

First Name[s]:

NI Number:

Address:

Post Code:

Home Telephone:

Mobile Telephone:

Work Telephone:

Email Address:

Date[s] unavailable to attend interview:

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mailto:[email protected]


EMPLOYMENT

THIS PAGE IS INTENTIONALLY BLANK – DO NOT USE OR

DELETE

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PART 2: KNOWLEDGE, SKILLS AND EXPERIENCE

PROFESSIONAL MEMBERSHIP / REGISTRATION:Name of Body: Renewal Date:

Registration No: Class/grade of membership

CURRENT OR LAST EMPLOYMENT:

Employer’s name::Employer’s address:Telephone number:Position held:Date started: Date left:

Brief outline of duties, responsibilities etc:

Salary / wage:Reason for leaving or wishing to leave:Notice of period required:

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OTHER WORK EXPERIENCE (paid or unpaid) – please list most recent firstFrom To Name &

Address of employer

Position held Salary/Wage Reason for leaving

EDUCATION, QUALIFICATIONS & VOCATIONAL TRAINING – please list the most recent firstIf you are invited to interview please bring the original documents with youFrom To Establishment (school / college /

university)Exam, Qualification, Grades

CANVESSING:If you are related to, or know any member of Newcastle Carers staff, please give details(canvassing panel members and / or staff for preferential treatment will disqualify applicants)

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FURTHER DETAILS IN SUPPORT OF YOUR APPLICATION:Please state your reasons for applying, full details of your relevant work experience, skills and achievements. Please use the person specification as a guide.If necessary, continue on a separate sheet no more than 2 sides of A4 in total please, using minimum font 11

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DISCLOSURE OF CRIMINAL CONVICTIONS (OR ANY DISCIPLINARY ACTION)Newcastle Carers meets the requirement in respect of exempted questions under the Rehabilitation of Offenders Act 1974, all applicants who are offered employment will be subject to a Disclosure and Barring Service check, before appointment is confirmed. This will include details of cautions, reprimands or final warnings, as well as convictions. Applicants are therefore not entitled to withhold information about convictions which for other purposes are "spent" under the result in provisions of the Act, and, in the event of employment, any failure to disclose such convictions could result in dismissal or disciplinary action by Newcastle Carers. Any information given will be confidential and will be considered only in relation for purposes to which the order applies.

Do you have any convictions, cautions, reprimands or final warnings that are not ‘protected’ as defined by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (as amended in 2013) by SI 2013 1198 Yes No Are you aware of any police enquiries undertaken following allegations made against you, which may have a bearing on your suitability for this post? Yes No If your answer is 'yes' to either of the above, please provide full details, including dates of the offence(s) and conviction(s) on a separate piece of paper and return with your application in a sealed envelope to 'The Chief Executive’ and marked 'Private & Confidential'.For those candidates invited for interview relevant criminal records will be discussed to assess job related risks. Only relevant convictions and other information will be taken into account, so disclosure need not necessarily be a bar to obtaining this position.

As an organisation using the Disclosure & Barring Service to assess applicants’ suitability for positions of trust, Newcastle Carers complies fully with the DBS Code of Practice and undertakes to treat all applicants for positions fairly. It undertakes not to discriminate unfairly against any subject of a Disclosure on the basis of conviction or other information revealed.

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REFERENCES:You must provide the name and contact details of two referees, i.e. people who can comment on your suitability for this post. If you are, or have been, employed in the last five years then at least one must be your most recent employer e.g. your most recent 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 possible, please give an email address as this is our preferred method of contact.

CURRENT / MOST RECENT EMPLOYER OTHER

Name: Name:

Job title:How do you know this person?

Company: Job title (if appropriate)

Postal address:

Postal address:

Telephone number:

Telephone number:

Email address:

Email address:

ELIGIBIITY TO WORK IN THE UK: please tick if you have any of the following. If you are invited to interview please bring the original documents with you.

British Passport or UK birth certificate and letter Certificate of registration / naturalization as a British Citizen Passport showing right to live and work in the UK EEC passport or identity card plus required to work registration letter Non-European passport with relevant work visa Any other document that supports your eligibility to work in the UK

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EMPLOYMENTPRIVACY STATEMENT – about your dataYour privacy is important to Newcastle Carers. Newcastle Carers is the Data Controller for all personal data you provide in a job application or otherwise across the recruitment process. Our lawful basis for processing your personal data in this way is the legitimate interest of Newcastle Carers staff recruitment. All personal data you submit to Newcastle Carers is collated and processed for recruitment purposes only. This applies to the completed Application Form and the completed Equal Opportunities Monitoring Form.

Only authorised employees of Newcastle Carers have access to submitted job applications and Newcastle Carers will never supply any personal data it holds for this purpose to any third party. Newcastle Carers does not store or transfer your personal data outside of the UK.

The personal data you provide will be used to assess your application for employment with Newcastle Carers. Should your application be successful, the information collected will become part of your employment record.

If your application is unsuccessful, your application form and any other personal data acquired over the recruitment process will be shredded or otherwise destroyed securely within one month of the completion of the recruitment process. The Equal Opportunities Monitoring Form is anonymous and will be detached and kept for one year in order to assist us with our recruitment and selection processes.

As a data subject you have the right at any time to request access to, rectification or erasure of your personal data; to restrict or object to certain kinds of processing of your personal data; to the portability of your personal data and to complain to the UK’s data protection supervisory authority, the Information Commissioner’s Office about the processing of your personal data. As a data subject you are not obliged to share your personal data with Newcastle Carers. If you choose not to share your personal data with us we may not be able to progress your application.

DECLARATION:I declare the information I have given is, to the best of my knowledge and belief, true and complete. I understand that my application may be rejected or, if I have been appointed, that I may be dismissed for withholding relevant details or giving false information.

Signed: Date:

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PART THREE: DIVERSITY & EQUAL OPPORTUNITIESNewcastle Carers wants to meet the aims and commitments set out in our Equality & Diversity Policy, this incudes not discriminating under the Equality Act 2010 and building an accurate picture of the make-up of our workforce in encouraging equality and diversity.

We need your co-operation to enable us to do this, but filling in this form is voluntary.

The information you provide will stay confidential, be stored securely and available to limited staff as and when necessary.

WHAT IS YOUR GENDER? (Please Tick)

Male Female Prefer not to say Prefer to self-describe as ……………………………….

HOW WOULD YOU DESCRIBE YOUR ETHNICITY (Please Tick)

White: Asian or Asian British Mixed race: British Indian White and Black Caribbean Irish Pakistani White and Black African Any other white background Bangladeshi White and Asian Black or Black British: Chinese Any other mixed background Caribbean Any other Asian background African Any other black background

WHAT IS YOUR DATE OF BIRTH?

HOW WOULD YOU DESCRIBE YOUR SEXUAL ORIENTATION? (Please Tick) Heterosexual Bisexual Lesbian Gay Other Prefer not to say

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HOW WOULD YOU DESCRIBE YOUR RELIGION/FAITH?

My religion is:

Prefer not to say I am not religious

DEPENDANTS

Children None Other (parents/relatives/friends)

HEALTH DETAILSPlease give details of any health problems, medications, allergies that we should be aware of:

DO YOU CONSIDER YOURSELF TO HAVE A DISABILITY OR LONG TERM HEALTH CONDITION?Yes NoPrefer not to say

PLEASE DESCRIBE THE NATURE OF YOUR DISABILITY OR LONG TERM HEALTH CONDITIONAsperger’s Syndrome/Autism Need personal care/support Blind/partially sighted Unseen disability e.g. Asthma, Diabetes, Epilepsy, hepatitis Deaf/hearing Impediment Dyslexia Wheelchair user/mobility difficulties Mental health condition Other (Please State)

WHERE DID YOU HEAR ABOUT THIS POST? (Please Tick) Evening Chronicle//Fish 4 Jobs JobCentrePlus Friend/Word of Mouth Newcastle Carers Website NCVS/VONNE website Third Sector Website

THANK YOU FOR YOUR CO-OPERATION IN COMPLETING THIS FORM.

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APPLICATION FORM - Newcastle Carers€¦ · Web viewFriend/Word of Mouth Newcastle Carers Website...

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