Calcot Services for Children

Please read the guidance notes provided in full before you complete this application form. This form is the only document we consider when shortlisting applications and CVs are not considered. Please aim to meet / exceed the criteria given in the job description as much as possible. Employment and voluntary experience must be included.

What job are you applying for today?

Have you worked through an agency with us? If yes which agency?

What service are you applying for

Learning DisabilitiesSocial, Emotional and Mental HealthOffice supportEducation

Title: (Mr/Mrs/Miss/MX/ Prefer not to Say)

Full Name

Address

Postcode

Email

example@example.com

Phone Number

National Insurance Number*

Date of Birth*

Date

Do you have a valid UK manual car driving license

Do you have the right to work within the UK?

Is your right to work in the UK restricted? If YES, please specify restriction (Sponsorship)

DfES registration number: (Qualified Teachers only)

Where you are currently employed

Employer Name

Position held

Current salary

Phone Number

Date Appointed*

Date

Reason for Leaving?

Notice Period

Give a brief summary of your main responsibilities and duties

Work History

Please provide full and accurate details of all jobs since leaving school. If you have had more job roles, than available fields please add these to the end of the form.

Please supply any additional work history if needed

You must account for any gaps in your employment or education history that are longer than one month. Please provide specific details including exact dates (DD/MM/YYYY) explanation below

Your education history from secondary school. Please note you will be asked to provide original certificates of relevant qualifications should you be invited to attend an interview.

Further relevant training / qualifications and any professional registration details

References

Please supply the names and contact details of two referees who can comment on your suitability for this position. One must be your current employer, followed by your next most recent employer.

Note: if you are not currently working in education or social care but have done so previously, the details of this employer must be provided as the referee.

References from friends and relatives will not be accepted. Students may need to provide an education reference and an employer's details in order to provide two references.

Please note that any previous employer or organisation you have volunteered for and not given as a referee, may also be contacted.

Any offer of employment is subject to satisfactory references. In line with safeguarding procedures, references for positions within schools are taken up prior to interview. References are requested immediately following verbal acceptance of any job offer for all other positions. If you are giving a character reference, please ensure that this is stated on the reference details.

Do you give permission to contact your references ?

YesNo

Reference 1 Your Current Employer

Contact Name

Contact Position

Company Name

Address and postcode

Email

example@example.com

Phone Number

Position you held

Reference 2

Contact Name

Contact Position

Company Name

Address and Postcode

Email

example@example.com

Phone Number

Position you held

Please explain why you feel you have the necessary skills, experience, knowledge or aptitude to do this job

Calcot Services for Children is committed to providing a safe and secure environment for children, staff and visitors; and promoting a climate where children and adults will feel confident about sharing concerns which they may have about their own safety and wellbeing of others. We aim to safeguard and promote the welfare of children by protecting them from maltreatment, preventing impairment of children's health or development, ensuring children grow up in circumstances consistent with the provision of safe and effective care, and taking action to enable all children to have the best outcome.

Have you ever been the subject of any disciplinary and or sanction by any organisation due to concerns about your behaviour to children?

YesNo

Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (as amended in 2013): Due to the nature of the work of the company providing services to children and vulnerable adults, we use the Disclosure and Barring Service to undertake enhanced level checks. The company reserves the right to withdraw any offer of employment having taken into account the full individual circumstances. It is important to note that having a caution, conviction or bind over does not necessarily preclude you from employment; decisions are made taking the full circumstances into consideration. The information provided by you in this application form will be handled and processed in accordance with the General Data Protection Regulations 2018 (GDPR) for HR, safer recruitment processes and your personnel file, should you be appointed. Your data will be help for legitimate purposes to ensure the safety and welfare of children. The application form will be available to all authorised personnel involved in the recruitment and selection process. If you are appointed, the information will form part of your personnel record.

Please confirm you have read the box to indicate you have read the Information for you section

I confirm I have read this

The company must not employ a person or use as a volunteer in a regulated activity a person who is placed on the DBS Children's and/or Vulnerable Adults barred list(s) or live with somebody who is included on the DBS barred list. A person who is on one or more of the barred lists and attempts to undertake work with the group from which they are barred is breaking the law. For further details visit www.ofsted.gov.uk or www.gov.uk.I confirm that the information contained in this application is true and accurate. I understand that providing false, incomplete or misleading information will disqualify me from employment.

I confirm the above declaration

YesNo

Have you ever been cautioned or convicted of a criminal offence?

YesNo

Please give details if you have answered yes to the above question.

I confirm that I am / I am not on the DBS Children's or Vulnerable Adults barred list.

I amI am not

I confirm that a referral to the DBS has / has not been made in relation to me

HasHas not

I confirm that I do / I do not live with somebody who is included on the DBS barred list.

I doI do not

DBS Standard and Enhanced Disclosures Disclosure Information - Consent Form I have provided complete and true information in support of the application and I understand that knowingly making a false statement for this purpose is a criminal offence.

YesNo

Privacy Policy I have read the Standard/Enhanced Check Privacy Policy for applicants https://www.gov.uk/government/publications/dbs-privacy-policies and I understand how DBS will process my personal data and the options available to me for submitting an application.

YesNo

I consent to the DBS providing an electronic result directly to the registered body that has submitted my application. I understand that an electronic result contains a message that indicates either the certificate is blank or to await certificate which will indicate that my certificate contains information. In some cases, the registered body may provide this information directly to my employer prior to me receiving my certificate.

YesNo

I agree that my details will be kept on file and I agree to receive any news, offers or recruitment opportunities from Calcot Services for Children. I am submitting consent to CSfC to process my personal data for these purposes and as described in the Privacy Policy. I understand that I can withdraw my consent any time.

YesNo

Print Name

Signature: (Note: For electronic submissions, typing the name will be taken as a signature)

Date

For any further information please contact Peter Hildreth - Recruitment Manager on 01189952190 or email Peter.Hildreth@csfc.co.uk

Health Questionnaire - Private and Confidential

	Yes	No
Tuberculosis, asthma or chest problems?
Chest pain, Heart condition or raised blood pressure?
Blackouts, fits or giddiness?
Depression, mental illness or nervous breakdown?
Rheumatism or arthritis?
Back Trouble?
Typhoid,paratyphiod or other Infectious Disease?
Digestive or bowel disease?
Diabetes, thyroid or other gland trouble?
Bladder or kidney trouble?
Dermatitis or skin trouble?
Varicose veins?
Vision or hearing problems?
Any other accident, operation or illness?
Have you any reason to believe you may be infected with any communicable disease?
Any other current or recent medical condition or treatment which might affect your attendance or performance at work?
Do you intend to work night duties on a regular basis?
Any illness or medical condition that prevented you from attending work or your normal duties or activities for more than one week during the past year?
Any physical or mental impairment which has substantial and long term effect on your ability to carry out day to day activities? If yes please specify any special adjustments required in relation to work
Do you smoke/vape

If you have answered yes to any of the questions on the above form, please give full detail in the box below including dates, duration and outcome of illness or condition. If we have any concerns about your fitness for work, employment will be subject to satisfactory medical reports.

How many units of alcohol do you drink per week? (1 unit = 1/2 pint beer = 1 glass wine = 1 single short)

Disclaimer

I am of the understanding that Calcot Services for Children require references from my two most recent employers as well as to complete employment checks on any previous employment where I have worked with children or vulnerable adults regardless of time passed

Signature: (Note: For electronic submissions, typing the name will be taken as a signature)

Todays Date

Date

Consent

I give my consent for all required references, including any employment history checks, social media checks to be obtained by Calcot Services for Children

Signature: (Note: For electronic submissions, typing the name will be taken as a signature)

Todays Date

Date

Calcot Services for Children

Where you are currently employed

Work History

References

Please supply the names and contact details of two referees who can comment on your suitability for this position. One must be your current employer, followed by your next most recent employer.

Note: if you are not currently working in education or social care but have done so previously, the details of this employer must be provided as the referee.

References from friends and relatives will not be accepted. Students may need to provide an education reference and an employer's details in order to provide two references.

Please note that any previous employer or organisation you have volunteered for and not given as a referee, may also be contacted.

Reference 1 Your Current Employer

Reference 2

Personal Statement - Your Chance to shine

Safeguarding Declaration

Information for you

Your Declaration

Disclaimer

I am of the understanding that Calcot Services for Children require references from my two most recent employers as well as to complete employment checks on any previous employment where I have worked with children or vulnerable adults regardless of time passed

Consent

I give my consent for all required references, including any employment history checks, social media checks to be obtained by Calcot Services for Children