Sample Page

Which Role are you applying for?
Care WorkerSenior Care WorkerAssistant Care Team Manager

Are you a Driver?
YesNoCurrently learning and expect to be within three months.

Your Full Name

Your email

Your Phone Number

Your Address

Your Postcode

Prefer Full or Part Time?
Full timePart time

National Insurance Number

Education History - Starting with your most recent please include dates and qualifications obtained.

Employment History - starting with your most recent please list your employers, job roles and dates you were employed (please include any periods of unemployment with dates)

A little about you - Tell us how you feel you meet the role, any voluntary interests or information you would like us to know.

Have you ever been convicted in a Court of Law and / or cautioned in respect of any offense?
YesNoPending
If yes please outline details.

(Please read the Policy Statement on the recruitment of ex-offenders at the bottom of the page)
Yes, I have read the policy.No, I have not read the policy or do not understand and do agree with it.

References - We require two references, they should not be related to you and reference one should be your last employer.
Reference One - Name & Relationship / Role

Reference One's email address

Reference Two - Name & Relationship / Role

Reference Two's email address

Please confirm you are happy with us contacting the above referees prior to any employment offer.
Happy that can contact both at any stage.Prefer you do not contact either until after I have accepted any provisonal offer of employment.

Access NI Statement
All organisations using Access NI Disclosure and Barring service to help assess the suitability of applicants for positions of trust and who are recipients of disclosure information must comply fully with the relevant Code of Practice. Amongst other things this obliges them to have a written policy on the recruitment of ex-offenders, This must be given to all applicants for posts where a disclosure will be requested. The Code also requires such organisations to have a written policy on the correct handling and safekeeping of Disclosure information. This is available on request.

Special Requirements (Care Sector)
Because this position involves the care of vulnerable adults employment is dependent on the following:
Your written consent to obtaining an Enhanced Disclosure from Access NI.
Such disclosure being acceptable to us.
Proof of Identity — Birth or marriage certificate (where appropriate) and passport (if available).
Two satisfactory references.
That you will supply a photograph of yourself for retention in your records.
Evidence of physical or mental suitability for your work.

I confirm that all the above information is complete and correct and that any untrue or misleading information will give my employer the right to terminate any employment contract offered.

Should we require further information and wish to contact your Doctor with a view to obtaining a medical report, the law requires us to inform you of our intention and obtain your permission prior to contacting your Doctor. I agree that the organisation reserves the right to require me to undergo a medical examination. In addition, I agree that this information will be retained in my personnel file during employment and for up to six years thereafter and understand that information will be processed in accordance with the Data Protection Act.

I agree that my previous employers may be approached for references. I also agree that should I be successful in this application, I will apply to Access Ni for an Enhanced Access Ni Disclosure. I understand that should I fail to do so, or should the disclosure or reference not be satisfactory, any offer of employment may be withdrawn or my employment terminated.
I have read the accessni statement
I have read and understood statement.I have not read / or do not agree with statement

Policy statement on the recruitment of ex-offenders
1. As an organisation using Access NI to assist in assessing applicants suitability for positions of trust, the company complies fully with the relevant Code of Practice (a copy of which is available on request) and undertakes to treat all applicants for all posts fairly. The company will not discriminate unfairly against any subject of a disclosure on the basis of a conviction or other information revealed.
2. We actively promote equality of opportunity for all and we select all candidates for interview on the basis of their talent, skills, qualifications and experience. We welcome applications from a wide range of candidates, including those with criminal records.
3. A disclosure is only requested where it is legally required or after a thorough risk assessment has indicated that one is both proportionate and relevant to the position concerned. Where a disclosure will be required from a successful candidate, all applicants will be made aware of this at all stages of the recruitment process.
4. Where disclosure is to form part of the recruitment process, we encourage all applicants called for interview to provide details of their criminal record at an early stage in the application process.
5. Unless the nature of the position allows the company to ask questions about a candidate's entire criminal record we only ask about "unspent" convictions as defined in the Rehabilitation of Offenders legislation.
6. We ensure that all those in the company who are involved in the recruitment process have been suitably trained to identify and assess the relevance and circumstances of offences. We also ensure that they have received appropriate guidance and training in the relevant legislation relating to the employment of ex-offenders.
7. At interview, or in a separate discussion, we ensure that an open and measured discussion takes place on the subject of any offences or other matter that may be relevant to the position. Failure to reveal information that is relevant to the position sought could lead to withdrawal of an offer or termination of employment.
8. We undertake to discuss any matter revealed in a disclosure with the person seeking the position before withdrawing a conditional offer or terminating employment.
9. Having a criminal record will not necessarily bar an applicant from working for us. This will depend on the nature of the position and the circumstances and background of the offences.