Ways People Can Be Discriminated Against
Cranstoun Job Application Form | |All appointments are subject to an enhanced CRB disclosure and satisfactory reference checks before any candidate is offered a post. | |Post Applied for: |Young People’s Outreach Worker |Post Number: |Ref: 951 | |Have you worked for Cranstoun before |Yes | |From |????? |To |????? No |NO | |Please complete this form fully using black ink or type. C. V. s are not accepted. Applications received after the closing date will not normally be considered. | |THE INFORMATION YOU SUPPLY ON THIS FORM WILL BE TREATED IN CONFIDENCE. | |Section 1: Personal details | |Last Name: |Mott |First Name: |Jean | Address: |9 Stockheath Road | | |Leigh Park | | |Havant | |Postcode: |PO9 5HE | |Home Telephone No: |02392480318 | |Daytime Telephone No: |02392480318 |Mobile Telephone No: |07887912736 | E-mail address: |jean. [email protected] co. uk | |National Insurance No: |W |K |6 |3 |5 |9 |3 |2 |D | |Are you free to remain and take up employment in the UK with no current immigration restrictions? |Yes |Y |No | | |Job Share Details |Yes | |No |N | |Are you applying on a job share basis? | | | | |Driving Licence – if relevant to post applied for. |Yes |Y |No | | |Do you hold a valid UK Drivers Licence? | | | | | | | | | | | |If you are successful you will be required to provide relevant evidence of the above details prior to your appointment. | |Section 2: Present Employment |Present Employment (If now unemployed please give details of your last employer) | |Name of Employer: |
Hampshire County Council | |Address: |Hampshire House | | |Southampton Road | | |Eastleigh | Postcode: |SO50 5PA | |Post Title: |Youth Worker P. T. | |Date of Appointment: |2004 |Salary: |3000(Part Time) | |Department / Section: |Children’s Services | Brief description of duties: | |Many activities in youth club and trips outside including: | | | |Having a relationship and maintaining dialog with young people | | | |Social activities with young people, music, cooking, plays, photography, trips, quizzes … | | | |Encouraging young people to gain the confidence to articipate in activities | | | |supporting and teaching young people about drugs and sexual health | | | |One to one sessions with young people who have problems. | | | |Working with small groups who may have difficulties within bigger groups. | | | |Outreach to contact young people at places where they may hang out to give information help and support | |Continue on a separate sheet if necessary | Period of Notice: |N/A |Last day of service |31-Aug-2011 | | | |(if no longer employed): | | |Reason for leaving |Cutbacks/Redundancy | |(if no longer employed): | | |Did you receive any redundancy payment or retirement benefit? |Yes |Y |No | | |Section 3: Previous Employment | |Previous Employment (most recent employer first). Please cover the last 10 years and please state nature of the business – if not public sector | |Name of Employer: |NHS Havant War Memorial Hospital |Address: |59 Crossway | | |Havant | | |Hampshire |Postcode |PO9 | | | |Position Held: |
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Health Care Support Worker (PT) Date (From/To): 2004-2011 | |Summary of duties: | |Observation, Personal Care, Supporting and helping patients emotionally and physically. | | | | | | | | | | | | | |Reason for leaving: |Redundancy (Hospital Closure) | | | Name of Employer: |BUPA (Spire) Hospital | |Address: |Barton’s Road | | |Havant | | | |Postcode |PO9 5NP | | | |Position Held: |Health Care Assistant (Bank) Date (From/To): 2003-2003 | |Summary of duties: | |Observation, Personal Care, Supporting and helping patients emotionally and physically. | | | | | | | | | | | |Reason for leaving: |Felt needed more regular position | | | Name of Employer: |Care UK (Homecare) LTD | |Address: |Unit F2 Cumberland Business Centre | | |Northumberland Road | | |Portsmouth |Postcode |PO5 1DS | | | |Position Held: |Community Carer Date (From/To): 1994-2003 | |Summary of duties: | Personal care, Supporting and helping patients emotionally and physically and day to day household duties | | | | | | | | | | | | |Reason for leaving: |Qualified at NVQ3 (Care) so able to work in hospitals. | | |Section 4: Education | |Qualifications obtained from Schools, Colleges and Universities. Please list highest qualification first: | |University |Course |Qualification and Date obtained | |N/A | | | College |Course |Qualification and Date obtained | | | | | |Hampshire Children’s Services |NVQ Level 3 Youth Work |Unit Credit (Jan 2006) | |(internal) |NVQ Level 2 Youth Work |NVQ Level 2 Youth Work (Mar 2006) | |Southdown’s College |NVQ2 (care) |NVQ2 (Care) 2001 | | |NVQ3 (care) |NVQ3 (Care) 2002 | |Southdown’s College |Certificate in Basic Counselling Skills |NFCE Basic Counselling Skills | | |Certificate in Further Counselling Skills |NFCE Further Counselling Skills | |Southdown’s College |New Clait |OCR Level 1 Certificate for IT Users | School |Subjects |Qualification and Date obtained | | | | | |Southdown’s College |English Literature |A Level ‘D’ 1984 (circa) | | |Psychology |GCSE ‘D’ 1983 | | |ART |GCSE ‘C’ | | |English Language |GCSE ‘C’ | |Continue on a separate sheet if necessary | |
Professional, Technical or Management Qualifications | Professional/Technical/ |Course Details & Date obtained | |Management Qualifications | | |N/A | | |Membership of any Professional / Technical Associations- Please state level of Membership: | |N/A | |Professional Registrations, please give details of any clinical registrations | Professional Body & Registration Status |Registration/PIN Number |Expiry / Renewal date | |N/A | | | |Are you currently the subject of a fitness to practice investigation or proceedings by a licensing or regulatory body in the UK or |Yes | |No |N | |in any other country? | | | | | |Have you been removed from the register or have conditions been made on your registration by a fitness to practice committee or the|Yes | |No |N | |licensing or regulatory body in the UK or in any other country? | | | | | Section 5: 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. | |Title of Training Course or Programme |Date & Duration of Course | |Various Youth Training relating to my time at Hampshire County Council. |2004-2011 | |
Continue on a separate sheet if necessary | |Section 6: Health | I confirm that to the best of my knowledge, there is no reason in respect of my physical or mental health why I should not be able to carry out fully the tasks | |described for this | |Yes |Y |No | | |If No, please give details: | |(Please note, because of the nature of the work undertaken by Cranstoun we cannot employ anyone with a personal history of addiction unless he or she has | |successfully completed rehabilitation and ceased drug or alcohol misuse for a minimum of two years). |Number of days sickness absence in the last 2 years: |16 | | | | |Please give details: |Broken Ankle prevented me from working at Hospital. | | | | | | | | | | |Section 7: Personal and Supporting Statement | |Abilities, skills, knowledge and experience. |Please use this section to explain in detail how you meet the requirements of the Job Description and Person Specification. If you are or have been involved in | |voluntary/unpaid activities, please also include this information. Attach and label any additional sheets used. (max 750 words) | | | |I have been a Youth Worker for Hampshire Council and a health care support worker for NHS for many years. | | | |I have considerable experience working with both younger and older people from the community with social and health issues. | | |My major location was busy open access youth clubs in Stakes and Wecock in specialising in ages 11 – 21 years and a significant number of members had behaviour | |challenges, though I feel our team was often able to have a positive influence. | | | |
I am used to working in a dynamic team as well as practising independently using a number of therapies including art, craft, drawing, cooking and music. | | | |Also occasionally stood in to cover shifts to work with disabled young teenagers at Rachel Maddox. | | |I aim to use my expertise and experience I have gained to apply to a different setting where I can further my skills. | | | |I also now wish to work in a single job to focus all of my energy. | | | | | | | | | |At the end of my last job I was still weak on my broken ankle, though I had returned to both jobs. | | |Before finding alternative employment my mother in law became mobility impaired (knee operation required that had to be re-done) as well as having medical | |conditions with visits to hospital and long recuperations at home. The last knee operation was successful and my mother in law is now fully recovered. | | | |I have enrolled to undertake NVQ 3 Counselling at Portsmouth College this September one evening per week. | | | |Continue on a separate sheet if necessary | Section 8: Protecting Children and Vulnerable Adults – | |Rehabilitation of Offenders Act (1974) Declaration of convictions | |The post for which you are applying is exempt from the provisions of the Rehabilitation of Offenders Act 1974. It is a condition of employment that all unspent | |convictions and cautions are disclosed. Dependent on the job role, successful applicants will be subject to an Enhanced Criminal Records Bureau check. | |1. Have you had a CRB check in the past 12 months? |Yes |Y |No | | |2. Have you ever been convicted of a criminal offence, received a formal caution, been bound over or received a conditional |Yes | |No |N | |discharge? | | | | | |3.
Are you aware of any police enquires undertaken, following allegations made against you, which may have a bearing on your |Yes | |No |N | |suitability for this post? | | | | | |If yes, to question 1, please give date and other relevant information. | |If yes, to either of questions 2 or 3 above, please give details / dates of offence(s) and sentence, (continue on a separate sheet if necessary): | |????? N/A | |Section 9: Disability Discrimination Act | |This Act protects people with disabilities from unlawful discrimination. We 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 has a substantial and adverse long term effect on his or her | |ability to carry out normal day to day activities. | |Do you have a disability which is relevant to your application? |Yes |Y |No | | |If yes, please give details: | |I am dyslexic, though I do have training to cope. I have also been able to pass some of this training and techniques to young people. | |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 we need to make any specific arrangements in order for you to attend the interview? Yes | |No |N | |If yes, please give details: | | | | | | | | | | | | | | | |Section 10: References | |Please give the names and addresses of your two most recent employers (if applicable). If you are unable to do this, please clearly outline who your references are. | |Reference 1 | |Reference 2 | |Name: |Human Resources |Name: |Human Resources | |Position (job title): |Youth Worker |Position (job title): |Health Care Support Worker | |Work Relationship: |HR Work Relationship: |HR | |Organisation: |Hampshire County Council |Organisation: |NHS | |Address: |Hampshire House |Address: |615 Hampshire PCT | | |Southampton Road | |HR Dept Fareham Reach | | |Eastleigh | |166 Fareham Road | | | | |Gosport | | |Postcode |SO50 5PA | |Postcode |PO13 0FH | |Telephone No: |02380383000 |Telephone No: |01329 224583 | |E-mail: |N/A |E-mail: |N/A | |Are you willing for this referee to be |Yes |Y |No | |Are you willing for this referee to be |Yes |Y |No | | |approached prior to the interview? | | | | |approached prior to the interview? | | | | | |Section 11: Declaration | |Are you related to a member of Cranstoun staff or a Board Member? Yes | |No |N | |I declare that to the best of my knowledge and belief the above information is true. | | | |(Please note, should any answers to the questions on this application form be found to be false, or should there be any wilful omission, or suppression of any | |material fact, your application may be disqualified or, if appointed, you will be liable to disciplinary action which may lead to your dismissal). | |Signed: | |Date: |29/8/2012 | R E T U R N I N G T H I S F O R M | | By Hand or Post: | | |Human Resources |By E-Mail: | |Cranstoun Drug Services |[email protected] org. uk | |1st Floor. St. Andrews House | | |St.
Andrews Road |Enquiries: | |Surbiton |Tel: 020 8335 1830 | |Surrey. KT6 4DT |Fax: 020 8399 4153 | |Cranstoun undertakes that it will treat any personal information (that is data from which you can be identified, such as your name, address, e-mail address etc) | |that you provide us with, or that we obtain from you, in accordance with the requirements of the Data Protection Act 1998. | |If you are returning this form by email, you will be asked to sign your application at interview. | Section 12: Recruitment Monitoring Form | | | |This sheet will be separated from your application form upon receipt and does not form part of the selection process. It will be retained by the Human Resources | |department strictly for monitoring purposes only. | |Post Applied for: | Young People’s Outreach Worker |Post Number: |Ref: 951 | |To help us ensure that our Equal Opportunities Policy is fully and fairly implemented (and for no other reason) please COMPLETE THIS SECTION OF THE APPLICATION | |FORM. | Marital Status: |Married | Place of Birth: |Portsmouth | |Ethnic Group (please tick): |Nationality: | | |A |British |Y |C |Bangladeshi | | |(White) | | |(Asian or Asian | | | | | | |British) | | | | |Irish | | |Indian | | | | | | | |I do not wish to provide this information |Yes |Y |No | | |Do you consider yourself to have a disability? |Yes |Y |No | | |Disability is defined as “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”. | |If yes, please give details: | |?????
Dyslexic but able to manage | |Employment Status |Internal Applicant | |External Applicant |Y | |Gender |Male | |Female |F | |Age Group | |18-25 | |Please state where you saw this post advertised: ‘The News’ Portsmouth | | |