Waking Night Residential Support Worker – Colchester

SV Care Services Ltd. - Application Form

We want to ensure that we are an equal opportunities employer, in practice, which is why we want to monitor our recruitment procedures. We have separated the equal opportunities monitoring form from the application form and would be grateful if you would complete it. It will not be part of the selection/interview process.

PLEASE ENSURE ALL SECTIONS ARE COMPLETED FULLY AND ACCURATELY.

SAFER RECRUITMENT PROCEDURES MEAN THAT WE CANNOT ACCEPT INCOMPLETE APPLICATION FORMS OR OFFER INTERVIEWS BASED UPON CV’S

Personal details

Forename

Middle Name

Last Name

Title

Preferred name to be known by:

Address Line 1

Address Line 2

City/Town

County

Postcode

Country

Email

Daytime telephone number

Mobile Number

Home Number

National Insurance number:

Are you entitled to work in the UK?

Yes

No

Have you ever lived outside the UK?

Yes

No

Do you require a work permit to work in the UK?

Yes

No

Present/most recent employment

Please note: SV Care Services strives to safeguard children and young people. As a result, we may contact your current or previous employer(s) to confirm information you have given.

Job Role

Name and address of employer

Date commenced with the employer

Salary/Wage

£

Notice required

Reason for leaving/seeking new employment

Briefly describe your role; its main purpose and your responsibilities

Previous employment

Please list the most recent first. Include permanent and temporary work, service with HM Forces, voluntary work and any work experience since leaving full-time education (continue on a separate sheet as necessary). Follow instructions to add DD/MM/YYYY in the required column; this is a requirement for us as stipulated by regulating bodies.

Previous employer 1

Name & address of employer (Include nature of business)	Start date (DD/MM/YYYY)	End date (DD/MM/YYYY)	Position and salary	Reason for leaving

Previous employer 2

Name & address of employer (Include nature of business)	Start date (DD/MM/YYYY)	End date (DD/MM/YYYY)	Position and salary	Reason for leaving

Previous employer 3

Name & address of employer (Include nature of business)	Start date (DD/MM/YYYY)	End date (DD/MM/YYYY)	Position and salary	Reason for leaving

Previous employer 4

Name & address of employer (Include nature of business)	Start date (DD/MM/YYYY)	End date (DD/MM/YYYY)	Position and salary	Reason for leaving

Previous employer 5

Name & address of employer (Include nature of business)	Start date (DD/MM/YYYY)	End date (DD/MM/YYYY)	Position and salary	Reason for leaving

Previous employer 6

Name & address of employer (Include nature of business)	Start date (DD/MM/YYYY)	End date (DD/MM/YYYY)	Position and salary	Reason for leaving

Time Breaks in Employment

Please explain any gaps in employment, since leaving full-time education. Full details should be given for any period not accounted for by employment, education and training – no matter how short a period. For example, provide details of any time spent travelling, career breaks, time unemployed, time taken to raise a family. Please state all information in chronological order

From (DD/MM/YYYY)	To (DD/MM/YYYY)	Explanation of break:

From (DD/MM/YYYY)	To (DD/MM/YYYY)	Explanation of break:

From (DD/MM/YYYY)	To (DD/MM/YYYY)	Explanation of break:

From (DD/MM/YYYY)	To (DD/MM/YYYY)	Explanation of break:

Education and qualifications

From age 11 onwards, and please state whether full (F) or part (P) time

Follow instructions to add DD/MM/YYYY in the required columns.

Name of School, College, University etc.	From (DD/MM/YYYY)	To (DD/MM/YYYY)	F/P	Subjects studied and grades

Name of School, College, University etc.	From (DD/MM/YYYY)	To (DD/MM/YYYY)	F/P	Subjects studied and grades

Name of School, College, University etc.	From (DD/MM/YYYY)	To (DD/MM/YYYY)	F/P	Subjects studied and grades

Name of School, College, University etc.	From (DD/MM/YYYY)	To (DD/MM/YYYY)	F/P	Subjects studied and grades

Training

This includes government training schemes, apprenticeships, short courses, projects and secondments. Please also include trade/professional training and give the date of completion.

Course Title	Organisation	From / To

Course Title	Organisation	From / To

Course Title	Organisation	From / To

Course Title	Organisation	From / To

Course Title	Organisation	From / To

Membership of Professional Institutes

Please indicate whether membership is by examination

Institute	Level of membership	Year of membership

Institute	Level of membership	Year of membership

Institute	Level of membership	Year of membership

Institute	Level of membership	Year of membership

Driving Licence

Do you hold a current, Full-UK Driving Licence?

Yes

No

If YES, please state the type of licence you hold:

Do you have any current endorsements?

Yes

No

Please specify

Have you access to a vehicle?

Yes

No

Why are you applying for this job?

Please mention any specific skills or experience and ensure that this meets ALL of the requirements of the job description and person specification. These skills may have been gained in relation to your current or previous employment, education, training, domestic activities, voluntary work or leisure interests.

Additional Information

Please use this section for any other information you may wish to add to support your application. This can also be used if you need to explain any reasons why specific dates in your employment record cannot be completed.

References

Please provide a minimum of three references. One must be your present or last employer (as applicable) and at least one other previous employer. If you have not been employed previously, please provide academic and character references.

Please note, if you have previously worked within with vulnerable young people or adults (paid or voluntary, at any point in your career), we will need to obtain a reference relating to this. This is stipulated by our Regulator and means that we may require more than 3 references for some candidates.

We reserve the right to seek references at any point in the recruitment process and from any previous employers listed in the ‘Previous Employment’ section of this form.

Please be aware referees will be asked whether applicants have been the subject of any safeguarding concerns.

We will not be able to proceed with your application unless we have three referees’ full details below.

Present/last employer

Name

Address

Tel no.

Job title of Referee

In what capacity does this person know you?

Email address: (Professional email address, not personal)

CAN WE APPROACH THIS PERSON PRIOR TO INTERVIEW?

Yes

No

Second Referee (this needs to be a past employer or an academic/character referee if you have not had any previous employment)

Name

Address

Tel no.

Job title of Referee

In what capacity does this person know you?

Email address: (Professional email address, not personal)

CAN WE APPROACH THIS PERSON PRIOR TO INTERVIEW?

Yes

No

Third Referee (this can be another employment referee or a character referee)

Name

Address

Tel no.

Job title of Referee

In what capacity does this person know you?

Email address: (Professional email address, not personal)

CAN WE APPROACH THIS PERSON PRIOR TO INTERVIEW?

Yes

No

Safeguarding Children

Have you ever been disqualified from working with children?

Yes

No

Have you ever been prohibited from being a private foster carer?

Yes

No

Has your child, or a child of which you are, or have been the registered guardian of, been subject of a care order or supervision requirement removing him/her from your care?

Yes

No

Are you the parent of, or associated with any child who is on the at-risk register?

Yes

No

Has your conduct in relation to children ever been a cause for concern or investigation (irrespective of whether it resulted in a charge or conviction? This also includes workplace investigations

Yes

No

Have you ever been subject to any disciplinary proceedings?

Yes

No

Have you ever been dismissed, or have you ever resigned in the face of dismissal or warning?

Yes

No

If you have answered yes to any of the above questions, please give full details in the box below.

Attendance

Please give the number of days and reason for any sickness/absence days taken during the last 12 months.

The number of days:	Reason(s)

Rehabilitation of Offenders Act 1974

You are required to declare any criminal convictions (including bind over and cautions), in accordance with the Rehabilitation of Offenders Act 1974. The post you have applied for carries exempt status under the provisions of the Act and you are required to declare any convictions, regardless of whether or not they’re considered spent. All appointments are subject to an enhanced DBS check. Declaration of convictions will not necessarily bar you from employment.

Have you ever been convicted of a criminal offence?

Yes

No

Have you ever received a Caution, Reprimand or Warning?

Yes

No

Are there any alleged offences outstanding against you?

Yes

No

Have you had previous criminal investigations against you?

Yes

No

If YES to any of the above, please give full details in the box below. Failure to disclose any information relating to criminal convictions may disqualify your application or result in dismissal without notice.

Do you currently hold an Enhanced DBS Certificate (for children) that has been registered with the DBS Update Service? If NO, if successful in your application you will be required to apply for an Enhanced DBS Certificate and to subscribe to the DBS Update Service

Yes

No

Please provide the original certificate number

Do you have any relationships with any person employed by or connected with SV Care Services?

Yes

No

Please give full details (stating name and job title):

Disclaimer Form

The Disqualification for Caring for Children Regulations 2002 applies to anyone employed in a registered or voluntary children’s home.

These fall into three main areas:

Where a child of the individual has at any time been the subject of a care or similar order, or where an order has been made to remove a child from the individual’s care or prevent the child from living with him/her.
Where the person has been convicted of an offence specified in Schedule 1 of The Children and Young Persons Act or one involving injury or threat of injury to another person.
Where:

The person has been concerned with a voluntary or registered children’s home which has been removed from the register; or
An application by the person for registration of a voluntary or registered children’s home has been refused; or
The person has been prohibited from being a private foster parent, or the person has been refused registration to be a childminder or provider of daycare or had his/her registration cancelled.

I have read and understood the above and declare that I am not disqualified from caring for children under The Disqualification for Caring for Children’s Regulations 2002.

Declaration

I declare that the information given, both on this application form, disclaimer form and the attached equal opportunities monitoring form is true and correct. I understand that any false or misleading information, including omissions of information concerning canvassing or criminal convictions, may disqualify my application or may render my Contract of Employment, if I am appointed, liable to termination.

Signature

Sign Here

Date

If form has been completed electronically, please place an ‘x’ in this box to indicate your consent

Data Protection Act 1998

SV Care Services will only process the information you have provided in this form for the purpose of recruitment and selection and, if you are successful in securing this position, for purposes relating to your employment.

Your details may be kept both electronically and in hard copy. We will not disclose this information about you to outside organisations or third parties, unless there is a legal requirement to do so, or for the prevention and detection of fraud.

Thank you for completing this application. We will endeavour to respond to your application as soon as possible.

Job Details

Waking Night Residential Support Worker – Colchester

Application Form