Application For: Community SupportWorkerPlease read and complete all sections of the applicationform including the Confidentiality statement on the final page.

Application For Residential Support Worker / Night Residential Support Worker

Please read and complete all sections of this form including the Confidentiality Statement at the end.

Forenames*

Surname*

Any Previous Surname(s)

Address and Postcode*

Phone*

Email*

National Insurance Number*

Date of Birth*

Education - Name of School(s) / From - To / Qualifications

Higher Education - Name of College or University / From - To / Qualifications

Training - Course of Study / From - To / Qualifications

Details of any other relevant courses or training including details of the care certificate

Your current or most recent employer / Name of present employer / Address & Postcode / Job Title / Duties / Pay rate / Length of time with employer / Reason for Leaving

Previous Employers - Name of Employer / Dates of Employments / Position Held and summary of duties / Reason for leaving

Supporting statement - Please tell us why you have applied for this job and the skills and experience that you can bring to the role:*

Declaration subject to the Rehabilitation of Offenders Act 1974 - Have you ever been convicted of a criminal offence?*

YesNo

If you answered YES to the previous question please give details

Interview arrangements and availability - If you have a disability, please tell us if there are any reasonable adjustments, we can make to help you in your application or with our recruitment process.

Are there any dates when you will not be available for interview?

When will you be available to start work and what are your available/preferred hours?

Right to work in the UK - Do you need a work permit?*

YesNo

Do you hold a valid and current Driving Licence?*

YesNo

References

Please give the names and contact details of two people who we can ask to give you a reference. We may ask them before an employment offer is made. We will not ask your current employer until we get your permission.

Referee 1 - Current Employer Reference?*

Permission to contact prior to interview?*

YesNo

Referee 2*

Permission to contact prior to interview?*

YesNo

Declaration

I confirm that to the best of my knowledge the information I have provided on this form is correct and I accept that providing deliberately false information could result in my dismissal.

I have read and understood this Declaration. Name / Date.*

Data Protection Statement

The personal information (data) collected on this form are collected for the purposes of recruitment, personnel administration (for new employees) and monitoring.

The Application Forms (and attachments) of unsuccessful applicants will be destroyed after six months.

It is the policy of Eastbank Residential and Supported Living to protect and keep secure all personal data collected. All personal data is processed for the purposes of recruitment, and, in the case of successful Applicants, for the satisfactory administration of their employment and for no other purpose.

Equality of Opportunity

Eastbank Residential and Supported Living Equal Opportunities Policy covers all employees or potential employees and adheres to the principle that everyone shall be treated equally regardless of their age, gender, ethnicity, nationality, colour, religion, marital status, sexual orientation, religion or belief or disability.

Confidentiality Statement

In the course of your duties, you will have access to confidential information about the people who use our services. On no account must information relating to identifiable service users be divulged to anyone other than the manger or colleagues involved in supporting the individuals. If you are concerned by any information, you have obtained and consider that you should talk about it to someone else you must make an appointment to speak, in private, to your manager. Failure to observe these rules will be regarded as serious misconduct and could result in disciplinary action.

I have read and understood this Confidentiality Statement and I agree to abide by this confidentiality statement. Name / Date.*