All fields marked with an * are required.
+ Add Experience Please give details of all your employment / voluntary work.
Please use this section to include anything that you feel passionate about or which you feel has not been included in any other section that would strengthen your application
(This would be in relation to potentially being a named driver on a mobility car).
(This may be in relation to moving & handling procedures for example).

I confirm to the best of my knowledge, the information supplied by me on this application form, and on any additional sheet submitted, is correct.

I understand that if I knowingly withhold or give any false information having been offered employment or appointed, this may lead to my appointment being withdrawn or to my dismissal.
C-Change requires all its managers, members and other employees to operate its policy of equal opportunity and not to discriminate against any person because of sex, race, colour, national or ethnic origin, disability or age. We must stress that any information you give will be treated as strictly confidential. You are not obliged to answer any of the questions, but you will appreciate that, for our monitoring policy to be wholly effective, we should hope to have 100% response. If you do not wish to answer any question(s), this will not affect your application in any way. We will only use the information on this section of the form to monitor recruitment and will not use it in the selection process. Thank you for your time and co-operation in completing our form.
Ethnic origin is not about nationality, place of birth or citizenship. It is about the group to which you perceive you belong. Please choose from the dropdown menu below.
Please specify:

Do you consider yourself to have a disability or a health related condition that has a substantial and long-term adverse impact on your ability to carry out normal day-to-day activities?
If Yes, please specify:

Under Section 4(2) of the Rehabilitation of Offenders Act 1974, no criminal offence is seen as spent due to the nature of our work. Having a criminal conviction does not mean that we would not consider your application. However, due to the vulnerability of many of the people we support, it is important to minimise any risk we may put them under.

If you answered Yes to any of the above, please provide details below including dates, nature of crime and convictions
I understand these details will be held in confidence by the Company, for the purposes of assessing this application, ongoing personnel administration and payroll administration (where applicable) in compliance with the Data Protection Act 1998. I understand that all successful applicants doing regulated work will be required to complete a PVG (Protection of Vulnerable Adults Group) application. I agree to give any personal details required for this check to be carried out. (Please note you will be asked to sign this form if selected for the interview stage.)