Application form – non support worker role – West House – Care and support provider for adults and children with disabilities.

If 'other', please specify what kind of position you are interested in e.g. bank relief, support worker, full time/part time, location.

Where did you hear about this job?

Name *

First

Last

Email *

Please note that by providing your email, you agree to receive relevant notifications from West House.

Address *

Postcode *

Home telephone number *

Mobile telephone number

Have you been employed by us before? *

Education history *

Please give: the name and location of the school/college or awarding body, dates you studied there, details of examinations taken (include date, level, grade)

Work related training *

Please give dates and course/training details.

PRESENT EMPLOYMENT - name and address of present or most recent employer *

If not applicable, please write N/A

Job title *

Salary *

Date started *

Date of leaving (if applicable)

Period of notice required *

Date available to commence employment *

Reason for leaving (if applicable)

Main duties and responsibilities *

PREVIOUS EMPLOYMENT - please provide the name and address of previous employers, dates you worked there, job title and brief description of the role and responsibilities, and reason for leaving. *

Please list in date order, most recent first, with no gaps unaccounted for. West House may contact all or any employers you have listed below in order to verify the employment details stated.

Rehabilitation of Offenders Act 1974 - have you ever been convicted of a criminal offence? *

If you answered 'yes' to the question above, please provide details

Immigration, Asylum and Nationality Act 2006 - do you have the right to live and work in the United Kingdom? *

The Immigration, Asylum and Nationality Act 2006 imposes civil and criminal penalties on West House if it employs those who do not have permission to live or work in the United Kingdom. Applicants will be required to provide evidence of their right to work in the United Kingdom if invited to interview.

The role for which you are applying may involve substantial moving and bending. Do you have any health problems that might prevent you from satisfying these requirements? *

The information gained from this question will only be used at the pre-employment offer stage to determine if you will be able (in conjunction with any reasonable adjustments) to carry out functions that are intrinsic to the work concerned.

If yes, please give details

The role for which you are applying may involve working variable shifts, working at night and at unsociable hours. Do you have any health problems that might prevent you from satisfying these requirements? (Please note office roles will not be based on shift work) *

If yes, please give details

Are you, to the best of your knowledge, related to any member or employee of West House? *

If yes, please state whether they are a member, management committee member or employee, and give their name, address and your relationship to them.

Please give a description below about what you know about West House and your reasons for applying. *

Please give a description below of any relevant experience you have relating to the job description. *

Please give a description below about why you think you are suitable for the role you are applying for in relation to the job description. *

Referee 1

Name of present employer *

Job title of referee *

Capacity in which known *

Address of referee *

Telephone number *

Email *

Can we contact them prior to interview? *

Referee 2

Name of character reference (professional body) *

Job title of referee *

Capacity in which known *

Address of referee *

Telephone number *

Email *

Can we contact them prior to interview? *

Any additional information you may wish to include.

Declaration

To the best of my knowledge I declare that the information contained in this application form is accurate and correct. I understand and agree that:

a) The provision of false information may result in disqualification from the recruitment process or termination of employment.

b) The information provided on this application may be stored and processed by West House for a period of 6 months for recruitment purposes and if successful the information will be stored on personal file and processed for the purpose of the employment relationship.

c) Where I cannot provide evidence of qualifications and/or suitable references the offer of employment may be rescinded and/or employment terminated.

d) Canvassing of Officers or members of West House directly or indirectly for any appointment will disqualify my application.

e) Depending upon the nature of the post and work I will be undertaking, failure to disclose any convictions spent or otherwise will result in non-appointment or disciplinary action and potential dismissal.

f) Where the post for which I am applying requires me to work with children and/or vulnerable adults I hereby agree to a disclosure being made by the Disclosure & Barring Service about the existence and content of a criminal record spent or otherwise.

g) Should I be short-listed I will be required to provide documentary evidence of my right to live and work in the United Kingdom (see guidance notes).

h) All information contained in this form will be treated as strictly confidential, and used only for recruitment purposes. By supplying information, I am indicating my consent to the information being processed for all employment purposes as defined in the Data Protection Act 1998, and any verification checks that may be made.

I agree to the declaration above (please write name) *

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