Personal Details
Emergency Contact
Formal Education and Qualifications
Employment History
General information
Preference regarding work
Please specify which types of work you would prefer. You should tick all appropriate boxes. The
service we give depends on accurate, up to date information. Please keep us informed of all
developments, in your career and work preferences.
Additional Information
Give details of any additional information which you would like to include in support of your
application. Such information, for example, may include skills and/or achievements which you think
may be of interest, and/or a summary of why you believe that you have the qualities we are
looking for. Please provide details of any relatives employed by the Agency and their relationship to
you.
References
Professional Referee 1
Professional Referee 2
Personal Referee 1
Personal Referee 2
Confidentiality declaration
Registration implies acceptance of our code of confidentiality.
In the course of your duties you may have access to confidential information about your clients. On no account
must information relating to identifiable client be divulged to anyone other than the manager of the agency. You
should not disclose ANY information to your family, friends or neighbours.
If you are worried by any information you have obtained and consider that you should talk about it to someone else MAKE AN APPOINTMENT TO SPEAK IN PRIVATE TO YOUR MANAGER.
Failure to observe these rules will be regarded as serious misconduct which could result in removal from the agency
register.
Rehabilitation of Offenders Act
As a general rule, no-one need answer questions about spent convictions. However this general rule does not apply to specified professions, employments and occupations. By virtue of the Rehabilitation of Offenders Act 1974 (Exceptions) (Amendment) Orders, the exemption rule does not apply to: a) any employment or other work which is concerned with the provision of health services and which is of such a kind as to enable the holder of that employment or the person engaged in that work to haveaccess to persons in receipt of such services in the course of his normal duties, or b) any employment or other work which is concerned with the provision of care services to vulnerable adults and which is of such a kind as to enable the holder of that employment or the person engaged in that work to have access to vulnerable adults in receipt of such services in the course of his normal duties One or both of the above apply to work with the Agency, and covers all occupations. You are therefore requested to provide details of all convictions, including those which would otherwise be considered as “spent”. All employment applications will be considered carefully, and the disclosure of a conviction does not imply that this employment application will be rejected.
Records will be checked via the Criminal Records Bureau procedures
Note
33B
(To protect the confidentiality of this information, please detail convictions on a separate sheet of paper. Place it in
a sealed envelope with your name clearly visible, and headed “Private and Confidential – Criminal Convictions” and
attach this to your completed Application Form)
Criminal Records – Disclosure Certificate
The Criminal Records Bureau (CRB) have issued a Code of Practice regarding Disclosure Information, a copy of
which is available upon request. A Disclosure Certificate (standard or enhanced) will be requested from the CRB
which will detail all convictions, including those which would otherwise be “spent”, as well as details of cautions,
reprimands or final warnings. You will be advised of the type of certificate being requested, and asked to give your
approval to this application. The Disclosure Certificate will only be requested in the event that you are successful in
your application for employment.
Asylum and Immigration Act 1996
Under Section 8 of the Asylum and Immigration Act 1996 it is a criminal offence to employ a person aged 16 or
over who is subject to immigration control unless:
That person has current and valid permission to be in the United Kingdom and that permission does not
prevent him or her from taking the job in question; or
The person comes into a category specified by the Home Secretary where such employment is allowed
Any employment offered will be subject to the successful applicant producing appropriate evidence that the Asylum
and Immigration Act is not being contravened.
Required Documents
Personal Declaration
