Application for Employment s13

ONE77, 175-177 York Road, Hartlepool, TS26 9EQ Tel – 01429 867016 Fax – 01429 288218 Email – [email protected] Website – www.hartlepoolfamiliesfirst.org.uk

APPLICATION FOR EMPLOYMENT / VOLUNTARY WORK / WORK BASED LEARNING PLACEMENT

Once completed, this application will form part of your employee / volunteer record with Hartlepool Families First.

Full Name

Hartlepool Families First is committed to safeguarding and promoting the welfare of children and young people and expects all staff and volunteers to share this commitment. All staff / volunteers and student placements are subject to a full enhanced Criminal Records Bureau Disclosure check along with other procedures designed to safeguard children and vulnerable adults. However, having a criminal record will not necessarily prevent you from working with the organisation. If you would like further information, please fee our policy on Recruitment of Ex-offenders and people with criminal conviction(s)

You have the right under the Data Protection Act to a copy of information held about you (the right of ‘subject access’). You can obtain this information by writing to: The Manger , Hartlepool Families First , ONE77, 175-177 York Road, Hartlepool TS26 9EQ.

Form-31 Please complete all sections of the application form as the information provided on this form will be used as part of the selection process.

PERSONAL DETAILS Vacancy Details Title: Surname / Family Name: Reference:

FAMWORKER-JULY2017 First Name(s): Job Title: Family Support Worker Address:

National Insurance Number Town: County: Postcode:

Contact numbers: Day: Evening: Fax: Are you eligible to work in the UK? Email: Yes No How much notice is required by your present employer? Where did you see this vacancy advertised?

SECONDARY AND HIGHER EDUCATION Please start with your most recent education, continuing on a separate sheet if necessary. Examinations taken, results/grades obtained, scholarships or School, college or Dates other distinctions. university From To Please state the title of any thesis if applicable.

OTHER TECHNICAL, PROFESSIONAL OR OCCUPATIONAL TRAINING/COURSES ATTENDED (i.e. those not covered in the previous section). Please start with your most recent training.

Dates Type of training Subjects studied and qualifications Institute or employer e.g. Full time, part time, From To distance learning gained

MEMBERSHIP OF PROFESSIONAL INSTITUTES OR SOCIETIES (if appropriate)

EMPLOYMENT HISTORY Please provide details of all previous employment, starting with your most recent employer.

Dates Current/final Employer's name, address and brief Position(s) held and brief salary and reason description of the type of industry details of duties From To for leaving

CURRENT EMPLOYMENT STATUS Employed Unemployed

Student Training Provider

Other If other, please detail Describe briefly the nature of your present appointment, or any other position which you have held that you consider relevant to this application. Please provide details and evidence of how you meet the person specification. Please continue on a separate sheet if necessary.

Do you consider yourself disabled? Yes No

(Under the Disability Discrimination Act, a disability is defined as a physical or mental impairment which has a substantial and long-term adverse effect on a person's ability to carry out normal day to day activities). Hartlepool Families First welcomes applications from disabled people. If you require any adjustments to the interview/selection arrangements, please provide the details below or contact the Manager on 01429 867016

Driving Licence – Only complete this if a driving licence is required for the job. Do you have a full current driving licence? YES/NO Do you have the use of a car? YES/NO What type of licence do you hold? (List entitlement/category codes)

Working Time Directive Are you intending to hold additional jobs? YES/NO If yes, please state the number of hours you will be working in other jobs. This information is required to ensure we comply with Working Time Regulations.

Nursing Information – Only complete this section if you are applying for a Nursing related job

Your Nursing PIN Number as issued by the Nursing and Midwifery Council Your Date of Birth (Needed to confirm NMC Registration) D D M M Y Y Y Y Please not that this registration will be checked with the Nursing and Midwifery Council. It is a condition of employment that a valid registration is maintained whilst employed by HFF.

Next of Kin Details: Availability to work : (please tick in all relevant boxes) Relationship: Morning Afternoon Evening Name: Monday Address: Tuesday Wednesday Thursday Post code: Friday Phone No: Saturday Mobile No: Sunday

Do not complete this section until after you have been offered a paid position within the organisation.

BACS Details for Employees

Account Name Sort Code Account Number Ref. No (if a building society account) Bank Name Bank Address

Post Code REHABILITATION OF OFFENDERS AND CRIMINAL RECORDS DISCLOSURE – Successful applicants for posts that are exempted from the provisions of the Rehabilitation of Offenders Act 1974 will require a criminal record disclosure. Criminal records will be taken into account only when a conviction is relevant to the post you are applying for.

SAFER RECRUITMENT PRACTICE – Hartlepool Families First is committed to safeguarding and promoting the welfare of children and young people and expects all staff and volunteers to share this commitment.

ADDITIONAL INFORMATION - Any information which you think is relevant but is not covered elsewhere please write on a separate sheet and attach to the application form.

Have you attached any continuation sheets to this application? Yes No

REFERENCES - Please give below the names and addresses of people to whom we may apply for information about your work, experience and attendance record and indicate your relationship to the referee. Please refer to the further particulars to confirm the number of referees required for this vacancy. One referee must be your most recent or current employer (if previously employed). If you have just left school/college, you may supply details of your Head Teacher/Principal.

1 Most recent/current employer 2 Relationship: 3 Relationship: Name: Name: Name: Address: Address: Address:

Post code: Post code: Post code: Phone number: Phone number: Phone number: Fax: Fax: Fax: Email: Email: Email: Can we contact this referee Can we contact this referee Can we contact this referee before interview? Yes No before interview? Yes No before interview? Yes No

I certify that the above information (and any further information enclosed) is correct and I agree that Hartlepool Families First may take reasonable steps to verify this information (e.g. by obtaining proof of qualifications). I agree to Hartlepool Families First processing and retaining the personal information contained on this form for any purposes connected with my application or my health and safety while on the premises, my employment record if appointed, and any additional analysis. Signed Date

You have the right under the Data Protection Act to a copy of information held about you (the right of ‘subject access’). You can obtain this information by writing to: The Manger , Hartlepool Families ONE77, 175-177 York Road, Hartlepool, TS26 9EQ For Administration Purposes only – do not complete this section

Item Date By Who Identification Checked CRB Disclosure Requested CRB Disclosure Received Certificate Number References Requested References Received Driving Licence copied and checked (if required) Health Questionnaire / Medical Completed Qualifications Checked Professional Bodies Checked (eg. NMC or GTC) Equal Opps Monitoring Form Completed Personnel File Set Up Signed Induction Checklist on file Pension Arrangements discussed

Pension Arrangements

If A Paid Member of Staff

Item Date By Who P45 Received / P46 Completed Entered on to Payroll Interview Results on file Copy of Conditional Offer Letter on file Copy of signed Contract / SMT on file

Start Date