Post Applied For
Application Form
Therapeutic Support Worker
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Number
Mobile Number
Email:
example@example.com
Date Of Birth:
-
Day
-
Month
Year
Date
National Insurance No:
Are you free to remain and take up employment in the UK with no current immigration restrictions?
Yes
No
Other
Do you hold a full, clean driving licence valid in the UK?
Yes
No
Other
Can we contact you at work?
Back
Next
Save
Employment History
(Most recent employer first). Please cover the last 10 years and state nature of business - if not working directly with children.
Current Employer/ Most Recent
Name
Full Address
Job Title
Summary of Duties
Date of Appointment
DD/MM/YYYY
Department
Salary
Notice period
Last day of service
DD/MM/YYYY
(if no longer employed)
Reason for leaving
Current Employer/ Most Recent
Name
Full Address
Job Title
Summary of Duties
Date of Appointment
DD/MM/YYYY
Department
Salary
Notice period
Last day of service
DD/MM/YYYY
(if no longer employed)
Reason for leaving
Name
First Name
Last Name
Gaps In Employment (please provide dates)
Back
Next
Save
Education
Qualifications obtained from Schools, Colleges and Universities. Please list highest qualification first:
Education
Education Provision
Course
Qualifications and
grades obtained
Date (MM/YY)
Education
Education Provision
Course
Qualifications and
grades obtained
Date (MM/YY)
Education
Education Provision
Course
Qualifications and
grades obtained
Date (MM/YY)
Education
Education Provision
Course
Qualifications and
grades obtained
Date (MM/YY)
Education
Education Provision
Course
Qualifications and
grades obtained
Date (MM/YY)
Education
Education Provision
Course
Qualifications and
grades obtained
Date (MM/YY)
Education
Education Provision
Course
Qualifications and
grades obtained
Date
Back
Next
Save
Training and Development
Please give details of any training and development courses or non-qualifications courses which support your application. Include any on the job training as well as formal courses.
Training and Development
Title of training course
Duration
Date Completed
Training and Development
Title of training course
Duration
Date Completed
Training and Development
Title of training course
Duration
Date Completed
Training and Development
Title of training course
Duration
Date Completed
Training and Development
Title of training course
Duration
Date Completed
Training and Development
Title of training course
Duration
Date Completed
Training and Development
Title of training course
Duration
Date Completed
Training and Development
Title of training course
Duration
Date Completed
Training and Development
Title of training course
Duration
Date Completed
Training and Development
Title of training course
Duration
Date Completed
Back
Next
Save
Personal Statement
Abilities,Skills, Knowledge and Experience.
Please use this section to explain in detail how you meet the requirements within the competencies stated in the Job Description. If you are or have been involved in voluntary/unpaid activities, please also include this information.
Back
Next
Save
Rehabilitation of Offenders Act (1974)
Do you have any convictions that are unspent under the rehabilitation of offenders’ act 1974?
Please Select
Yes
No
If yes, please give details / dates of offence(s) and sentence:
Back
Next
Save
DISABDISABILITY DISCRIMINATION ACT:
This Act protects people with disabilities from unlawful discrimination. Ubuntu Group Ltd actively encourage applications from people with disabilities. The Disability Discrimination Act defines a disabled person as someone who has a physical or mental impairment which would impact on his or her ability to carry out normal day to day activities.
We will try to provide access, equipment or other practical support to ensure that people with disabilities can compete on equal terms with non-disabled people.
Do you have a disability which is relevant to your application?
Please Select
Yes
No
If yes, please give details:
Do we need to makeany specific arrangements in order for you to attend the interview?
Please Select
Yes
No
If yes, please give details:
Health
Number of days sickness absence in the last 2 years:
Back
Next
Save
Protecting Children
All posts advertised by Ubuntu Group Ltd will be subject to an Enhanced DBS Check.
Are you aware of any police enquires undertakenfollowing allegations made against you, which may have a bearing on yoursuitability for this post?
Back
Next
Save
References
Reference 1 (must be current/most recent employer)
Full Name
Position (Job Title)
Work Relationship
Organisation
Full Address
Phone Number
Email Address
(MUST BE FROM A WORK
EMAIL, NOT PERSONAL)
Are you willing for
this referee to be
approached prior
to the interview?
Reference 2
Full Name
Position (Job Title)
Work Relationship
Organisation
Full Address
Phone Number
Email Address
(MUST BE A WORK EMAIL,
NOT PERSONAL)
Are you willing for
this referee to be
approached prior
to the interview?
Back
Next
Save
Disclaimer Form
The Disqualification for Caring for Children Regulations 2002 applies to anyone employed in a registered or voluntary children’s home. The Regulations set out grounds for disqualification from caring for children. These fall into three main areas: 1. Where a child of the individual has at any time been the subject of a care or similar order, or where an order has been made with the purpose of removing a child from the individual’s care or preventing the child from living with him/her. 2. Where the person has been convicted of an offence specified in Schedule 1 of The Children and Young Persons Act or one involving injury or threat of injury to another person. 3. Where: The person has been concerned with a voluntary or registered children’s home which has been removed from the register; or An application by the person for registration of a voluntary or registered children’s home has been refused; or The person has been prohibited from being a private foster parent, or the person has been refused registration to be a child minder or provider of day care, or had his/her registration cancelled. I have read and understood the above and declare that I am not disqualified from caring for children under The Disqualification for Caring for Children’s Regulations 2002.
Name
First Name
Last Name
Signature
Date
-
Month
-
Day
Year
Date
Back
Next
Save
Declaration
I declare that the information given both on this application form, disclaimer form and the attached equal opportunities monitoring form is true and correct. I understand that any false or misleading information, or omissions of information concerning canvassing or criminal convictions, may disqualify my application or may render my Contract of Employment, if I am appointed, liable to termination.
All the information given by me on this form is correct to the best of my knowledge. All questions relating to me have been accurately and fully answered. I possess all the qualifications which I claim to hold. I have read and, if appointed, am prepared to accept the conditions set out in the conditions of employment and the job description.
Name
First Name
Last Name
Signature
Date
-
Month
-
Day
Year
Date
Back
Next
Save
Data Protection Act 1998
Ubuntu Group Ltd. will only process the information you have provided in this form for the purpose of recruitment and selection and, if you are successful in securing this position, for purposes relating to your employment. Your details will be kept both electronically and in hard copy. We will not disclose this information about you to outside organisations or third parties unless there is a legal requirement to do so, or for the prevention and detection of fraud.
Save
Submit
Should be Empty: