Support Worker – ORYOR – Disability North

Area: York

Rate: £13.00-£16.00 per hour

Hours: Split shifts term time. Flexible school holidays.

APPLICATION FORM

IMPORTANT: The form must be completed in full or your application may be rejected.
A curriculum vitae will not be accepted as a substitute.

Required fields are marked *.

Your Personal Details

Title: *

First Name: *

Middle Name:

Last Name: *

Address: *

Telephone number

(Home):

(Mobile):

E-mail address: *

National Insurance Number:

Do you hold a current full, clean driving licence which is valid in the UK?

Yes

[group group-driving-licence] If yes, for how long?

Do you have your own transport?

Yes

[/group]

TELL US ABOUT YOU…… What makes you a good candidate for this post? Please make your response relevant to this particular post and detailed Job Description.

What achievements are you most proud of?

What do you like to do in your spare time? What are your interests and hobbies?

YOUR EMPLOYMENT HISTORY What is your current job (paid or unpaid) and what do you most enjoy about it?

Please list your previous occupations (paid or unpaid):

Employer 1

Date From

Date To

Employer

Position

Reason for leaving

Employer 2

Date From

Date To

Employer

Position

Reason for leaving

Employer 3

Date From

Date To

Employer

Position

Reason for leaving

More Employers
[group has-more-employers]

Employer 4

Date From

Date To

Employer

Position

Reason for leaving

Employer 5

Date From

Date To

Employer

Position

Reason for leaving

Employer 6

Date From

Date To

Employer

Position

Reason for leaving

Employer 7

Date From

Date To

Employer

Position

Reason for leaving

Employer 8

Date From

Date To

Employer

Position

Reason for leaving

Employer 9

Date From

Date To

Employer

Position

Reason for leaving

Employer 10

Date From

Date To

Employer

Position

Reason for leaving

[/group]

YOUR EDUCATION AND TRAINING

Please give details of your education/training including any qualifications relevant for this role:

Education/Training 1

Date From

Date To

School/College/University/Trainer

Qualification/Training Course

Grade

Education/Training 2

Date From

Date To

School/College/University/Trainer

Qualification/Training Course

Grade

Education/Training 3

Date From

Date To

School/College/University/Trainer

Qualification/Training Course

Grade

More Education/Training
[group has-more-education]

Education/Training 4

Date From

Date To

School/College/University/Trainer

Qualification/Training Course

Grade

Education/Training 5

Date From

Date To

School/College/University/Trainer

Qualification/Training Course

Grade

Education/Training 6

Date From

Date To

School/College/University/Trainer

Qualification/Training Course

Grade

Education/Training 7

Date From

Date To

School/College/University/Trainer

Qualification/Training Course

Grade

Education/Training 8

Date From

Date To

School/College/University/Trainer

Qualification/Training Course

Grade

Education/Training 9

Date From

Date To

School/College/University/Trainer

Qualification/Training Course

Grade

Education/Training 10

Date From

Date To

School/College/University/Trainer

Qualification/Training Course

Grade

[/group]

A FEW MORE QUESTIONS…… Could you work extra hours at short notice?

I may need assistance with form filling, paying bills and shopping. Would you be able to help me?

Would you be prepared to work in a house where smoking is not permitted?

Please tell me if there are any Personal Assistance tasks that you couldn’t perform, either for religious, cultural or medical reasons or just because you wouldn’t want to.

When would you be able to start work?

Where did you see this advert?

DETAILS OF CRIMINAL CONVICTIONS

Because of the nature of the work for which you are applying, this post is exempt from the provisions of Section 4 (2) of the Rehabilitation of Offenders Act 1974 (Exemptions Order 1975). Applicants are not entitled therefore to withhold information about convictions which, for other purposes, are 'spent' under the provisions of the Act unless they are subject to filtering. Any information given will be completely confidential.

Declaration: Have you had any criminal convictions that are not subject to filtering?

Yes

[group has-criminal-conviction] If yes, please give full details. Use a separate sheet if necessary

[/group]

REFERENCES

Please give the details of two people who have agreed to act as referees for you. One must be a current or most recent employer if you have one; they should not be a member of your close family.

1.
Name:

How do they know you:

Address:

Tel no:

e-mail:

Contact following Interview but Prior to Job offer?

Yes

2.
Name:

How do they know you:

Address:

Tel no:

e-mail:

Contact following Interview but Prior to Job offer?

Yes

DECLARATION

I confirm that, to the best of my knowledge, the information on this form is accurate and that I have not omitted any facts, which may have any bearing on my application. If I am employed and it later becomes apparent that the information is not accurate, I will be dismissed.

Your application will be passed on via email or post to the service user or their nominated person who is advertising.

Disability North will electronically store your application form for 6 months after this recruitment ends, it will then be deleted.

If you are successful your application form will be stored electronically throughout the course of your employment and 6 months thereafter. It will then be deleted. We may share your information with our payroll service in order for them to carry out the payroll service to your employer.

To view Disability North’s Privacy Notices visit http://www.disabilitynorth.org.uk/about-us/privacy-notice/