ETV Programme Co-Ordinator

deafPLUS South 35-39 High Street ETV Programme Co-ordinator Aldershot GU11 1BH Application form 01252 316005 www.deafplus.org Please send us this form by noon Thursday 6th April 2017

You can send it to [email protected] or post it to Vacancies, deafPLUS, 35-39 High Street, Aldershot, Hampshire, GU11 1BH

The size of the boxes below do not indicate how much we expect you to write. As you type in the boxes they will expand as you need more space. If you are completing a printed copy please use extra sheets as appropriate.

If you need a large print or different format, please contact Rebecca on 020 7790 6147 or [email protected]

1. Your details

First name

Last name

Address

Home Telephone

Mobile Telephone

Do you have a UK or EU passport? If No, please explain your entitlement to work in the UK Languages spoken (other than English) - indicate to what standard Do you currently hold a DBS check issued within the last 3 years?

2. Details of current (or if not currently employed, most recent) employment

Name of employer and location

Position

Main duties

Salary

Date started

Notice required (if still working there) Date left (if applicable)

Reason for leaving

3. Previous employment/roles Please give brief details of your previous employment history and work experience, either paid or voluntary

Dates Employer Job title and brief description Reason for From To and leaving location Dates Employer Job title and brief description Reason for From To and leaving location

4. Education and qualifications Please give details of your education and training (add extra rows if necessary)

Dates Course Place of Qualification From To education obtained

5. Work-related training Please give details of any other specialised training or qualifications not covered in 4, such as CPD, short courses and on-the-job training.

Dates Course title Training provider From To 6. Why you would be good at this role

6.1 Please explain how you meet each point on the person specification, using examples to demonstrate how you meet each criteria. You should describe any qualifications, experience, skills and knowledge you have as evidence. This section is scored.

6.2 Why are you interested in this position?

7. Preferred start date If appointed, what date would you be able to start work? 8. Availability for interviews We have a tight schedule for this recruitment process. Please tick if you are available for interview on these dates. We can’t promise to provide you with an alternative opportunity if you are no longer available.

Friday 7th April 2017

9. Access needs Do you need support to take part in the interviews (e.g. special equipment, extra time, BSL/English Interpreter, Lipspeaker, Speech to text, or large print materials)?

10. References Please can you give the names and contact details of two referees. One must be your current or most recent employer. The second referee should be another employer if possible. If not, please think of someone who can comment on your abilities but would still be impartial. Ideally they will have known you for more than 12 months.

Referee 1 Referee 2 Title (Mr/Mrs/Ms, etc):

Full name:

Job Title:

Address:

Post Code:

Telephone Number:

E-mail address

How long have you known this person? How do you know them (e.g. manager, colleague)? Is it OK to contact them prior to interview?

11. Our advertising How did you find out about this role?

Website (please say which one)

Other (please say)

12. Disclosure and barring checks This post is exempt from the provisions of section 4(2) of the Rehabilitation of Offenders Act 1974, by virtue of the Rehabilitation of Offenders Act 1974 (Exemptions) Order 1975.

This means that you must tell us about convictions which for other purposes are `spent' under the provision of this Act, and so must disclose them below.

A criminal record will not necessarily exclude you from possible employment. Information given will be strictly confidential and will only be taken into account for the purpose of this application.

Have you ever been convicted of any criminal offence, whether ‘spent’ or ‘unspent’, as defined in the Rehabilitation of Offenders Act 1974 or do you have any charges pending? (Please tick or cross)

Yes No

If yes, please give details

13. Declaration DATA PROTECTION ACT 1998 deafPLUS will use the information provided by you only to assess the merits of your application. deafPLUS retains information about job applicants for 12 months, after which, all applications are destroyed. Application Forms for successful candidates are retained on their personal file.

By submitting this Application Form you are indicating your understandi ng and acceptance of the following conditions:

. To the best of your knowledge the information you have given on this form is correct and will be used as part of your contract of employment.

. Canvassing of officers or members of deafPLUS or any committee, directly or indirectly, for any appointment will disqualify your application.

. The provision of false information may result in disqualification or termination of your employment.

. Under the Rehabilitation of Offenders Act 1974 (if it applies to the post for which you are applying) failure to disclose any convictions may result in dismissal or disciplinary action by deafPLUS).

. Under legislation for the protection of children (if the post for which you are applying will have access to children) you will be asked to agree to a check being made through the DBS about the existence and content of a criminal record.

. You consent to the processing of your data for the purposes described in the ‘Data Protection’ section of this Application.

. By submitting your Application by e-mail you agree that your submission of this Application gives the same affirmation as a signature

Signature

Equality and Diversity information deafPLUS collects equalities monitoring information so that we can make sure that we are reaching all sections of our community in our recruitment activities, and to help ensure that we recruit a diverse and representative workforce. After a recruitment exercise we analyse this information at an aggregate level for these purposes. This information is only used for these purposes.

The information is collected separately from your application form and will not be used as part of the selection process. You can either return it with your application form, or if you prefer you can return it in a separate envelope to ensure complete anonymity.

Role applied for:…………………......

Disability or health condition Sensory Impairment Mental health condition Physical Impairment Long standing health condition I have no disability or long- Learning disability standing health condition Other (specify below) Prefer not to say

Age 16-20 21-30 31-40 41-50 51-60 61-70 71+ Prefer not to say

Relationship status Married Divorced Civil partnership Cohabitating Single Widowed Other Prefer not to say Ethnicity Asian or Asian British: Mixed: White & Black African Bangladeshi Asian or Asian British: Indian Mixed: White & Black Asian Asian or Asian British: Pakistani Mixed: White & Black Caribbean Asian or Asian British: Other Mixed: Any Other Mixed Black or Black British: African Vietnamese Black or Black British: Caribbean White: British Black or Black British: Somali White: Irish White: Traveller of Irish Black or Black British: Other heritage Chinese White: Gypsy/Roma Other Ethnic Group: Other Prefer not to say background

Gender Male Female Other Prefer not to say

Gender identity/re-assignment * If yes, is current gender different to that assigned at birth? Yes * Yes No No Prefer not to say Prefer not to say

Religion and belief Atheist Sikh Agnostic/No religion Hindu Muslim Humanist Christian Buddhist Jewish Prefer not to say Other religion (specify below)

Sexual orientation Bisexual Heterosexual / straight Homosexual/gay man Other Lesbian/gay woman Prefer not to say

If you want to return this form separately to your application form, please post it to:

Head of Services deafPLUS Trinity Centre Key Close Whitechapel London E1 4HG

deafPLUS is the registered working name of Breakthrough Deaf-Hearing Integration (Charity: 1073468, Company: 3680467)