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Your Details - Section 1 of 11

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Preferred title? *

if other, please specify

Your name *

Your email *

Your Address *

Your post code *

Telephone *

Mobile *

Present or last employer - Section 2 of 11

Are you currently employed? *

Name of present or last employer

Address

Post Code

Job Title

Present Salary (if presently employed)

Please give a brief description of your duties

Start date

End date

Reason for leaving

How much notice are you required to give your current employer?

Your Experience - Section 3 of 11

Experience *

+ Add Experience Please give details of all your employment / voluntary work.

About You - Section 4 of 11

Interests, Achievements and Leisure Activities *

Other

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

Do you have a full driving licence? *

(This would be in relation to potentially being a named driver on a mobility car).

Do you have any endorsements on your licence?

If yes, please give further details including dates

Are you subject to any restrictions or commitments which might restrict your working activities? *

(This may be in relation to moving & handling procedures for example).

If yes, please give full details

Your Education - Section 5 of 11

Education *

+ Add Education

Your Training - Section 6 of 11

Training

+ Add training

Your References - Section 7 of 11

References *

+ Add References

Where did you see this job advertised? *

Other (please detail)

PDW Questions - Section 8 of 11
Please only answer these questions if you will be applying for Personal Development Worker positions

+ Click to answer PDW Questions

Additional - Section 9 of 11

Work Permit - Do you have the right to work or to remain in the UK? *

Yes
No

Are you SSSC registered? *

Yes
No

Declaration *

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or give any false information having been offered employment or appointed, this may lead to my appointment being withdrawn or to my dismissal.

Would any particular arrangements have to be made in order to allow you to attend an interview? *

If yes, please give further details

Equal Opportunities - Section 10 of 11

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

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.

Specify any other details if you wish

Nationality

Please specify:

Prefer not to say

Age

Gender

Prefer not to say
Male
Female

Disability

Prefer not to say
No
Yes
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:

Criminal Declaration - Section 11 of 11

Previous Name(s) and Addresses

+ Add a name/address

Have you ever been convicted of any criminal offence?

No
Yes
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.

Are there any criminal charges pending against you at the moment?

No
Yes
If you answered Yes to any of the above, please provide details below including dates, nature of crime and convictions

Convictions

+ Add Convictions

Data Protection Act 1998

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.)