Application Form

Application Form

Please Complete This Employment Application Form.

Please indicate contract type
Full Time
Part Time
Bank

1. PERSONAL DETAILS

2. EDUCATION AND TRAINING – Please give details of qualifications gained, including professional ones.

3. DETAILS OF CURRENT OR MOST RECENT EMPLOYMENT

4. CURRENT OR MOST RECENT EMPLOYMENT

5. DETAILS OF PREVIOUS EMPLOYMENT AND ANY VOLUNTARY

We require a full employment history since you left school, including periods of unemployment. We are also interested in any involvement you may have had outside your work, in the voluntary sector or in the community.

6. SUPPORTING STATEMENT OF ABILITY

7. REFERENCES

Please give the names of two people who may be approached for a reference. One of these must be your current or most recent employer or, if this is your first job, your college or tutor. Please do not include friends or relatives.

8. Equality Act 2010

The Equality Act defines a person as having a disability if he or she “has a physical or mental impairment which has a substantial and long-term adverse effect (over 12 months) on his/her ability to carry out normal day to day activities.”

9. Data Protection Act Declaration

For the purpose of the Data Protection Act 1998 I give my consent to this form and related information being processed and retained on file and to Spectrum verifying the information I have provided with relevant third parties in administering its recruitment process.

I understand that it may be necessary for me to have a medical examination, either on being offered employment or during employment with Spectrum.

I hereby consent to any such examination, and I also consent to Spectrum having access to my medical records, if necessary.

I certify that the information given in this application is correct and understand that any misleading information or deliberate omissions will be regarded as grounds for withdrawal of an offer or, if appointed, subsequent disciplinary action which could result in dismissal.

10. Health Declaration

The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 require that all workers working with service users are physically and mentally fit for that work.

All service users at Spectrum may challenge staff. This could be a physical, verbal or mental challenge.

At Spectrum, physically fit means that you are fit enough to partake in mandatory training to train staff in Positive Behaviour Management techniques. This means you should consider if any of the roles in Spectrum houses or educational centre are suitable for you if you have a long-term injury to, for example, neck, shoulder, wrist, knee or ankle which restricts your mobility.

You also need to consider if the roles are right for you if you need to take medication before exercise, as often incidences of challenging behaviour develop quickly. You therefore need to ensure that you are physically capable of responding to these situations quickly to ensure both the safety of yourself and the service user.

Verbal and mental challenges can come in various forms, such as a service user constantly repeating certain words or phrases, shouting and making loud noises or making verbal outbursts of a passive or aggressive nature and which may or may not be focussed on you.

You will need to consider if a role is right for you if you suffer from any condition which affects your ability to cope with these verbal and mental challenges. For example, if it means you might find it a struggle to cope with inconsistent behaviour by service users, loud and sudden noises, or if you struggle to deal with emotional pressure and your ability to control your emotions.

If you have any concerns about your fitness for any role as detailed in the attached job description, you are advised to seek advice from your GP before making an application.

If you are successful in the recruitment process, you will be given a confidential medical questionnaire which asks you questions about your health. This is so we can be satisfied that you do have the required physical and mental fitness for your role.
If there are any concerns about this, they will be discussed with you and further information will be obtained as necessary. If appropriate (and possible), adjustments will be made to overcome any concerns. For example, conditions such as diabetes and epilepsy which are sufficiently well controlled by medication will not prevent the right candidate from obtaining a job with Spectrum. However, this will generally mean that a person will not be allowed to work on a one-to-one basis with service users in order to protect their health and safety and that of service users and colleagues.

Declaration
I have read the above information and Job Description and understand that under the regulations I need to be physically and mentally fit to work in a Spectrum house, educational centre, or community setting. If I have any concerns I will raise them with my GP before making this application. I understand that any false declaration, misleading information or omission of facts that may affect my ability to undertake work within Spectrum that may then come to light at a later date may result in either job offer being revoked or my employment being terminated if commencement has already taken place.

11. PREVIOUS CONVICTIONS FORM – Confidential when completed

Spectrum aims to promote equality of opportunity for all with the right mix of talent, skills and potential, and welcomes applications from diverse candidates.

As Spectrum meets the requirements in respect of exempted questions under the Rehabilitation of Offenders Act 1974 (as amended), all applicants who are offered employment will be subject to an enhanced disclosure by the Disclosure and Barring Service, with a check of the adults and children’s barred lists before the appointment is confirmed.

The amendments to the Exceptions Order 1975 (2013) provide that certain spent convictions and cautions are 'protected' and are not subject to disclosure to employers, and cannot be taken into account. If you have any convictions, cautions, reprimands or final warnings that are not "protected" as defined by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (as amended in 2013), please input the information below.

Guidance and criteria on the filtering of these cautions and convictions can be found on the Disclosure and Barring Service website (https://www.gov.uk/government/collections/dbs-filtering-guidance).

If you have nothing to declare please print your name in the top box and put a check mark in the None box. If you have anything to declare please provide as much detail as possible.

None

Offence Details

Date of Offence
Court Dealing with Offence
(Details of any offence taken into consideration, and anything pending)
(if applicable)
DECLARATION
For the purpose of the Data Protection Act 1998 I give my consent to this form and related information being processed and retained on file and to Spectrum verifying the information. I certify that the information given in this form is correct and understand that any misleading information or deliberate omissions will be regarded as grounds for withdrawal of an offer or, if appointed, subsequent disciplinary action which could result in dismissal.