Position applied for:
Where did you hear about this vacancy?
  • Please take time to complete the form completely and as fully as you possibly can.
  • Please be aware that due to safer recruitment we will seek references from all previous employment involving vulnerable adults or children.
  • Please ensure you provide only official contact information, phone numbers and email addresses for people authorised to complete references from your previous employers.
  • Please be aware that we will verbally verify the information you supply to us, this might include checking dates of employment, reasons for leaving and any safeguarding or disciplinary information. Any discrepancies will be investigated.
  • If you need to supply more references please continue on a seperate sheet of paper.
  • Please also complete the equal opportunities monitoring form when submitting your application form.
  • For more information or if you require help in completing the form please call us on 01785 598161 and we will be happy to assist.

1. Personal Details

Title:
Forename(s)
Surname
Other Names
Date of Birth
CANDIDATES MUST BE OVER THE AGE OF 21
Home Telephone
Email Address
Mobile Telephone
Address: Post Code: Date at this address:
to
Do you have a full current driving license?
Sorry, we require our staff to hold a full UK Driving Licence to transport Young People to school / meetings.
Do you need a Work Permit before you can be employed in the UK?
If you were appointed how quickly could you take up a post?
Have you had any previous contact with Unity Residential Care Services, do you know or are you related to anyone who works for the company?

2. Interview Dates

Please indicate days and times that are generally good for you to attend an interview or any dates you will not be available.

3. Current/Most Recent Employment Details

Name of present/last employer:
Position held
Salary and benefits
Date of commencement and leaving date: to
Notice Period
Reason for leaving:
Main duties and responsibilities of present/last post:
Address: Post Code:

4. Past Employment History

Please give details of all previous paid employment or volunteer placements. For each position give dates of employment, employer, position held and your reason for leaving.

PLEASE START WITH THE MOST RECENT FIRST.
Are you intending on having secondary employment or working elsewhere as a volunteer if you were successful in your interview? If yes, please tick and complete the following that will appear:
Name of secondary employer
Position held
Dates from/to
Name & address of employer
to
Position held
Reasons for leaving
ADD MORE EMPLOYMENT HISTORY
Dates from/to
Name & address of employer
to
Position held
Reasons for leaving
ADD MORE EMPLOYMENT HISTORY
Dates from/to
Name & address of employer
to
Position held
Reasons for leaving
ADD MORE EMPLOYMENT HISTORY
Dates from/to
Name & address of employer
to
Position held
Reasons for leaving
ADD MORE EMPLOYMENT HISTORY
Dates from/to
Name & address of employer
to
Position held
Reasons for leaving
ADD MORE EMPLOYMENT HISTORY
Dates from/to
Name & address of employer
to
Position held
Reasons for leaving
ADD MORE EMPLOYMENT HISTORY
Dates from/to
Name & address of employer
to
Position held
Reasons for leaving
ADD MORE EMPLOYMENT HISTORY
Dates from/to
Name & address of employer
to
Position held
Reasons for leaving
ADD MORE EMPLOYMENT HISTORY
Dates from/to
Name & address of employer
to
Position held
Reasons for leaving
ADD MORE EMPLOYMENT HISTORY
Dates from/to
Name & address of employer
to
Position held
Reasons for leaving

5. Education (From High School or Equivalent)

Dates from/to
Name of school/college or university
to
Subject or qualifications gained
Grade
ADD MORE EDUCATION
Dates from/to
Name of school/college or university
to
Subject or qualifications gained
Grade
ADD MORE EDUCATION
Dates from/to
Name of school/college or university
to
Subject or qualifications gained
Grade
ADD MORE EDUCATION
Dates from/to
Name of school/college or university
to
Subject or qualifications gained
Grade
ADD MORE EDUCATION
Dates from/to
Name of school/college or university
to
Subject or qualifications gained
Grade
ADD MORE EDUCATION
Dates from/to
Name of school/college or university
to
Subject or qualifications gained
Grade
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Dates from/to
Name of school/college or university
to
Subject or qualifications gained
Grade
ADD MORE EDUCATION
Dates from/to
Name of school/college or university
to
Subject or qualifications gained
Grade
ADD MORE EDUCATION
Dates from/to
Name of school/college or university
to
Subject or qualifications gained
Grade
ADD MORE EDUCATION
Dates from/to
Name of school/college or university
to
Subject or qualifications gained
Grade

6. Work based or other professional training

Provider / Accrediting Body
Qualification
Date
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Provider / Accrediting Body
Qualification
Date
ADD MORE TRAINING
Provider / Accrediting Body
Qualification
Date
ADD MORE TRAINING
Provider / Accrediting Body
Qualification
Date
ADD MORE TRAINING
Provider / Accrediting Body
Qualification
Date
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Provider / Accrediting Body
Qualification
Date
ADD MORE TRAINING
Provider / Accrediting Body
Qualification
Date
ADD MORE TRAINING
Provider / Accrediting Body
Qualification
Date
ADD MORE TRAINING
Provider / Accrediting Body
Qualification
Date
ADD MORE TRAINING
Provider / Accrediting Body
Qualification
Date

7. Supporting Statement

Use this section to tell us why you consider you are suitable for the post. Please show how your skills, abilities, experience & knowledge match those in the Job Description.

8. References

Please ensure that you provide details of your most recent employer and any other former employer or volunteer placements that are related to working with children or vulnerable adults. References can only be accepted from the designated person from that organisation and all references will seek to confirm your suitability in the role you have applied for. All references will be verbally verified.

Current Employer
Name
Job Title
Telephone No
Email Address
In what capacity did you know them?
Organisation address in full:

9. Safeguarding Children

This position is covered by the 'disqualification from Caring for Children (England) Regulations 2002'. You are to complete these details before you can be considered for a position.

Has a child of yours at any time been the subject of a care order?
Has an order been made at any time for the purpose of removing a child from your care or preventing a child living with you?
Have you ever been concerned with a Children's home that has been removed from the register?
Has an application by you to register a Children's home ever been refused?
Have you ever been prohibited from being a private foster?
Have you ever been refused registration to be a child-minder or provider of care, or had your registration as either of these cancelled?

If yes to any of these questions please give dates and details:

10. Disclosure and Barring Service Declaration Form

The position for which you have applied is one giving substantial opportunity for access to vulnerable children and young people. It is covered by various Government Circulars and The Rehabilitation of Offenders Act 1974 (exceptions) (Amendments) Order 1986, concerning the protection of such individuals. You are therefore to complete the following declaration. Failure or refusal to do so will prevent further consideration of your application.

Forename(s)
Surname
Maiden Name
National Insurance No
Any previous Fore/Surnames (include date of change)
Date of Birth
Gender
Place of Birth (county/district)
Previous addresses in last 5 years
Dates from/to
to
ADD ANOTHER ADDRESS
to
ADD ANOTHER ADDRESS
to
ADD ANOTHER ADDRESS
to
ADD ANOTHER ADDRESS
to
ADD ANOTHER ADDRESS
to

Do you have any current or previous convictions, bind over orders or cautions?


Please declare all convictions, cautions, reprimands or final warnings no matter what the offence or how long ago it occurred (all posts at Unity Residential Care Services are exemp from the Rehabilitation of Offenders Act 1974)

Are you aware of any current police enquiries being undertaken following allegations made against you, which may have a bearing on your suitability for this post?

If your answer to any of the above was yes, please provide full details below. You should specify the date and nature of the offence. Please note, a criminal record does not automatically preclude applicants from being considered for a position but all information will be considered based on seriousness of the offence, frequency of offending, time served since the offence and what punishment was received.


I declare that to the best of my knowledge and belief the information given in this application is true and complete. I understand that any information given or disclosed will be used in assessing my suitability for the position applied for.


All appointments at Unity Residential Care Services are subject to checks under the Disclosure and Barring Service.


ELECTRONIC SIGNATURE

11. Health Questionnaire

Having read through the job description do you have a health condition or disability that could be made worse by the work activities listed, that would involve the following...

Stress or mental health illnesses through working within a high pressured challenging environment?

Please give details:

Back or joint pain made worse through physical activities such as heavy lifting?

Please give details:

Health condition that may affect your balance/co-ordination or render you unconscious that we should be made aware of (for your own safety or others – the role requires the job holder to be responsible for looking after one or a number of young people working day/night shifts)?

Please give details:

Difficulty with your mobility, gaining access to buildings, climbing stairs, moving around, standing or sitting for long periods of time?

Please give details:

Have you ever been advised for medical reasons not to do night work/shift work?:

Please give details:

How many days have you been absent from work through illness or injury in the last two years? NUMBER OF DAYS


Declaration

I declare that, to the best of my knowledge and belief, the information provided to Unity Residential Services Ltd is correct. I understand that should any information provided in my application is found to be false or deliberately omitted it will cause my application to be unsuccessful or, if appointed, it will make me liable to dismissal without notice.


Data protection: Information from this application may be processed for purposes registered by the Employer under the Data Protection Act 1998. Individuals have, on written request and on payment of a fee the right of access to personal data held about them.


I hereby give my consent to the Employer processing the data supplied in this form for the purpose of recruitment and selection.


ELECTRONIC SIGNATURE

12. Equal Opportunities

In accordance with its policy on equal opportunities in employment, the Employer will provide equal opportunities to any employee or job applicant and will not discriminate either directly or indirectly because of race, sex, sexual orientation, gender reassignment, religion or belief, marital or civil partnership status, age, disability, or pregnancy and maternity.


In order to assess how successful this policy is we have set up a system of monitoring all job applications. We would therefore be grateful if you would complete the questions on this form.

Position applied for
Forename(s)
Surname
Maiden Name
Date of Birth
Gender
Marital Status
Do you have a disability?

What is the nature of the disability?:

Sexual Orientation
Religion
Ethnic Origin

Please state if you selected other above:

Thank you for providing information about yourself which will help Unity Residential Care Services to promote equality of opportunity.