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Support Worker Application Form

Support Worker Application Form

Community Lives Consortium is committed to equal opportunities in employment and making the application and recruitment procedure accessible both for you as the applicant and the people we support. When completing your application please be aware of the following:

  • C.V's are not acceptable. Please do not submit your CV with the application form.
  • Do not leave any section or boxes blank, please write N/A in any boxes that do not apply to you.

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Step 1: Personal Information

Personal Information

This information will not be viewed by the short listing officers
 
  • Please Select
  • Website
  • Social Media
  • Job Centre
  • Newspaper
  • Radio
  • Job Fair
  • Other
  • Word of mouth

Preferred place of work: *

 
  • Please Select
  • Mr
  • Mrs
  • Miss
  • Ms
  • Dr

Are you related to, or in a relationship with anyone that works for the Consortium, or anyone that is on the management committee for CLC? *

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Language

 
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  • Yes
  • No
  • Prefer not to say
 
  • Please Select
  • Good
  • Average
  • Basic
  • Not at all
 
  • Please Select
  • Good
  • Average
  • Basic
  • Not at all
 
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  • Basic
  • Bi-lingual
  • Conversational
  • Fluent

Right to work in the UK

Do you have the right to live and work in the UK without restriction? * ?

You will be required for Home Office regulations to provide proof of your eligibility to work in the UK prior to an offer of employment from Community Lives Consortium.

Acceptable documentation is as follows:

  • EU passport
  • Long UK birth certificate with proof of National Insurance number
  • Passport including relevant visa/stamps to work in the UK or remain in the UK

For further information please visit www.ukba.homeoffice.gov.uk. You will be required to provide this documentation at recruitment stage. Are you able to do this? *

Previous offences and Convictions

The nature of the work you are applying for is exempt from the provisions of the Rehabilitation of Offenders Act 1974. Your offer of employment will be subject to a satisfactory enhanced Disclosure and Barring check. It is therefore a requirement that all previous convictions are declared, even those which would otherwise be regarded as 'spent'. (Any such information will be treated confidentially). Please note that having a criminal record will not necessarily stop you from working for us.

Have you ever been convicted of a criminal offence including as a juvenile? *

Have you ever received any official cautions, reprimands or warning including as a juvenile? *

Are you currently the subject of any criminal proceedings or any police investigation? *

Transport

Do you hold a full valid UK driving licence (excludes automatic) that enables you to drive in the UK? *

Do you have Business Class 1 vehicle insurance? *

If successful, Business Class 1 insurance is an essential requirement for your job. If you do not currently have Business Class 1 insurance, you will need to add it to your policy. All job holders are required to provide evidence of this insurance.

Do you have any driving endorsements? *

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Step 2: References

References

If you are offered employment we are required by our Regulators to obtain two references.

All appointments are subject to the receipt of satisfactory references and we reserve the right to pursue alternative references if considered appropriate and/or withdraw provisional offers of employment upon receipt of unsatisfactory references. We are also required by our regulators to take up references from any of your previous employers within the care sector

If you are unable to provide two employment references, we will need to obtain a reference from a professional person (such as a teacher, doctor, solicitor, etc) whom you have known for at least two years.

Employment reference 1

Your current or most recent employer (or professional person, only where it is not possible to provide an employment reference)
 
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  • Current Employer
  • Ex-Employer
  • Professional
  • Education
 
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  • Mr
  • Mrs
  • Miss
  • Ms
  • Dr

Employment reference 2

Previous employer (or professional person, only where it is not possible to provide a employment Reference).
 
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  • Current Employer
  • Ex-Employer
  • Professional
  • Education
 
  • Please Select
  • Mr
  • Mrs
  • Miss
  • Ms
  • Dr

Employment History

Your current or most recent employment first
 
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  • Employed
  • Unemployed
  • Self Employed
  • Education

From Date

To Date

From Date

To Date

Previous Employment History

We are required by our Regulators to request details of your full employment history, including dates, from the time you left full time education. Please also include any periods of non-employment. There must be no gaps in the dates and information you provide.

Employment 2

 
  • Please Select
  • Employed
  • Unemployed
  • Self Employed
  • Education

From Date

To Date

From Date

To Date

Employment 3

 
  • Please Select
  • Employed
  • Unemployed
  • Self Employed
  • Education

From Date

To Date

From Date

To Date

Employment 4

 
  • Please Select
  • Employed
  • Unemployed
  • Self Employed
  • Education

From Date

To Date

From Date

To Date

Employment 5

 
  • Please Select
  • Employed
  • Unemployed
  • Self Employed
  • Education

From Date

To Date

From Date

To Date

Employment 6

 
  • Please Select
  • Employed
  • Unemployed
  • Self Employed
  • Education

From Date

To Date

From Date

To Date

Employment 7

 
  • Please Select
  • Employed
  • Unemployed
  • Self Employed
  • Education

From Date

To Date

From Date

To Date

Employment 8

 
  • Please Select
  • Employed
  • Unemployed
  • Self Employed
  • Education

From Date

To Date

From Date

To Date

Employment 9

 
  • Please Select
  • Employed
  • Unemployed
  • Self Employed
  • Education

From Date

To Date

From Date

To Date

Employment 10

 
  • Please Select
  • Employed
  • Unemployed
  • Self Employed
  • Education

From Date

To Date

From Date

To Date

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Step 3: Education / Training / Courses

Education / Training / Courses

Please provide details of all education (including GSCE’s, 'A' Levels, 'O' Levels etc achieved), training (including any qualifications achieved) and courses.
Year
achieved		 Subject /
Qualification		 Grade /
Qualification Level		 Educational
Institute		 Awarding
Body
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Professional Qualifications

Please provide details of all professional qualifications.
Date
achieved		 Qualification Profession
Body		 Membership
Number		 Date of
Expiry
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Your interests & hobbies

We work with a wide variety of people who themselves have many interests. This information may help us to put you in touch with people we support to help them pursue their interests and learn new skills which you may be willing to support them with. *
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Step 4: Suitability for the post

Suitability for the post

Are you flexible to work the full range of hours needed to our deliver services, this includes days, nights, weekends, bank holidays, sleep-ins and wakeful nights? *

Are you flexible to work in a range of services and/or locations when required? *

It is an essential requirement that you complete all training during your Induction period and that all training is kept up to date during your employment. Are you prepared to accept this requirement? *

Do you already have a QCF Level 2 in Health & Social Care? *

Would you be able to commit yourself to work towards QCF Level 2 in Health & Social Care? *

Do you already have Literacy and Numeracy skills up to Level 1 standard (A - G Grade GCSE)? *

Would you be able to commit yourself to work towards Literacy and Numeracy skills up to Level 1? *

Please give a detailed example of where you have been part of a team either in work or in your private life?

Please give a detailed example of when you have been required to use your initiative and/or work unsupervised either in work or in your private life?

Please give a detailed example either in work or in your private life?

It is important that you refer to the Person Specification when answering this section.

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Step 5: Additional information

Additional information

Is there any additional information that you would like to give about yourself in support of your application?

Data Protection Statement

All information provided in this form and obtained from other sources will be used to process your application for employment with CLC. If you succeed in your application and take up an offer of employment with CLC, the information will be used in the administration and processing of your employment with us. We may also use the information if there is a complaint or legal challenge relevant to the recruitment process.

We may verify the information provided with third parties or with other information held by us. We may also pass information to certain third parties to prevent or detect crime, to protect vulnerable adults or safeguard public monies, or in other ways as permitted by law.

By signing the application form we will assume that you agree to the processing of sensitive personal data (as described above) in accordance with the Data Protection Act.

Signatures

I have provided CLC with correct information - Please read the following declaration before signing this section.

I declare that the information I have given in this application is true and accurate to the best of my knowledge. I consent to CLC verifying any information that I have provided in this application for when an offer of employment is being considered. I understand that if at any time either before or during my employment CLC find that information is incorrect, missing or misleading it may disqualify me from appointment or result in dismissal.

Recruitment of ex Offenders - Please read the information on the reverse of this application form before signing this section.

I confirm that I have read and understood the policy statement on the last page of this application form and have declared previous cautions, convictions, bind overs or reprimands including as a juvenile. I understand that if at any time either before or during my employment CLC find that information is incorrect, missing or misleading it may disqualify me from appointment or result in dismissal.

Driving for work – Please read the following declaration before signing this section.

I confirm that the information I have provided is true and accurate to the best of my knowledge and:

  • I have declared all endorsements currently on my driver’s licence.
  • I have the appropriate vehicle insurance that enables me to drive my car in connection with my employment (Business Class 1) OR I will add Business Class 1 to my vehicle insurance policy before my employment or new job role with the Consortium begins.

I understand that if at any time either before or during my employment CLC finds that information is incorrect, missing or misleading it may disqualify me from appointment or result in dismissal.

Policy statement on the Recruitment of Ex-Offenders

As an organisation using the Disclosure and Barring Service (DBS) to assess applicants' suitability for positions of trust, Community Lives Consortium 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.

Community Lives Consortium is committed to the fair treatment of its staff, potential staff or users of its services, regardless of race, gender, religion, sexual orientation, responsibilities for dependants, age, physical/mental disability or offending background.

We have a written policy on the recruitment of ex-offenders, which is made available to all Disclosure applicants at the outset of the recruitment process.

We actively promote equality of opportunity for all with the right mix of talent, skills and potential and welcome applications from a wide range of candidates, including those with criminal records. We select all candidates for interview based on their skills, qualifications and experience.

A Disclosure is only requested after a thorough risk assessment has indicated that one is both proportionate and relevant to the position concerned. For those positions where a Disclosure is required, all application forms, job adverts and recruitment briefs will contain a statement that a Disclosure will be requested in the event of the individual being offered the position.

Where a Disclosure is to form part of the recruitment process, we encourage all applicants called for interview to provide details of their criminal record at an early stage in the application process. We request that this information is sent under separate, confidential cover, to a designated person within Community Lives Consortium and we guarantee that this information is only seen by those who need to see it as part of the recruitment process.

The nature of some positions within Community Lives Consortium allows us to ask questions about your entire criminal record. This covers any offences committed as a juvenile and includes cautions, reprimands and final warnings administered by the Police.

We ensure that all those in Community Lives Consortium who are involved in the recruitment process have been suitably trained to identify and assess the relevance and circumstances of offences. We also ensure that they have received appropriate guidance and training in the relevant legislation relating to the employment of ex-offenders e.g. the Rehabilitation of Offenders Act 1974.

At interview, or in separate discussion, we ensure that an open and measured discussion takes place on the subject of any offences or other matter that might be relevant to the position. Failure to reveal information that is directly relevant to the position sought could lead to withdrawal of an offer of employment.

We make every subject of a DBS Disclosure aware of the existence of the DBS Code of Practice and make a copy available on request.

We undertake to discuss any matter revealed in a Disclosure with the person seeking the position before withdrawing a conditional offer of employment.

Having a criminal record will not necessarily bar you from working with us. This will depend on the nature of the position and the circumstances and background of your offences.

If you are unsure about whether you need to tell us about any previous offence then please tell us so that we can discuss and consider the information.

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Step 6: Equal Opportunities

Equal Opportunities

Community Lives Consortium actively promotes the benefits of a diverse workforce and therefore is committed to eliminating any discrimination from our recruitment and employment procedures. We will ensure that each employee is recruited, developed and promoted on the basis of ability.

To ensure that Community Lives Consortium monitors it equal opportunities procedures effectively, you are asked to complete this form. The information you provide will be held in a secure and confidential manner and used for statistical purposes only.

 
  • Please Select
  • Under 25
  • 25-39
  • 40-49
  • 50-59
  • 60+
  • Prefer not to say
 
  • Please Select
  • Bisexual
  • Gay Man
  • Gay Women
  • Heterosexual
  • Other
  • Prefer not to say
 
  • Please Select
  • Male
  • Female
  • Transgender
  • Prefer not to say
 
  • Please Select
  • Civil Partnership
  • Divorced
  • Married
  • Single
  • Widowed
  • Co-habiting
  • Prefer not to say

Disability

 
  • Please Select
  • Yes
  • No
  • Prefer not to say

The Equality Act defines disability as "A physical or mental impairment which has a substantial and long term adverse effect on their ability to carry out normal day to day activities, which would include things like using a telephone, reading a book or using public transport."

Please tick any of the following that apply to you

Nationality

Ethnic Origin

 
  • Please Select
  • White
  • Mixed
  • Black or Black British
  • Asian or Asian British
  • Other ethnic group
  • Prefer not to say
 
  • Please Select
  • British
  • Irish
  • Scottish
  • English
  • Welsh
  • Northern Irish
  • Gypsy / Irish Traveller
  • Other
 
  • Please Select
  • White & Asian
  • White & Black African
  • White & Black Caribbean
  • Other
 
  • Please Select
  • Caribbean
  • African
  • Other
 
  • Please Select
  • Indian
  • Pakistani
  • Bangladeshi
  • Chinese
  • Other
 
  • Please Select
  • Arab
  • Other

Religion

In this section you may choose to disclose information about the groups that you most identify with: *
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