Independent Living Association (ILA), Worthing, West Sussex © Copyright 2010
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Charity no: 1092651
(All fields are mandatory,enter N/A if required.)
Title
First Name
Surname
Address
Postcode
Telephone
Mobile
E-mail Address
Would you prefer to be contacted by email?
Yes
No
SECTION 2 - FURTHER INFORMATION
Please confirm your gender
Male
Female
Do you have a full driving licence?
Are you willing to drive the employer in their car?
Are you willing to drive the employer in your car?
Would you prefer not to have to drive?
Are you comfortable with providing personal care for (including washing, dressing and help with using the toilet) ?
Would you work for an employer who smokes?
Would you work for an employer who does not allow you to smoke?
Are you comfortable working around pets?
Do you have any specific requirements or health problems affecting your ability to do aspects of this role ?
If yes please provide details below:
When are you available to start work?
Do not enter or copy your CV here, this will be uploaded in section 4 below.
What skills and experience do you have relevant to this post? Please provide details of any paid or unpaid work.
Why are you interested in doing this particular job? (Please see the job description and person specification)
DECLARATION
I confirm that, to the best of my knowledge, the information I have provided on this form is accurate and that I have not altered or omitted any facts which may have a bearing on my application.
Please tick to confirm your acceptance:
Signed (enter your full name)
Declaration Date
SECTION 3 - CRIMINAL RECORDS
Please note because of the nature of the work for which you are applying, this post is exempt from the provisions of Section 4 (2) of the Rehabilitation of Offenders Act 1974 (Exemptions Order 1975). Therefore applicants are not entitled to withhold information about convictions which, for other purposes, are 'spent' under the provisions of the Act. You need to declare any convictions (including spent convictions) as part of your application. Failure to disclose previous convictions may lead to removal of any provisional job offer. Any information given will be completely confidential. Applicants may be asked at interview whether they have any criminal convictions, spent or unspent.
If you are successful in your application you will be subject to an Enhanced Criminal Records Bureau check before any offer of employment is confirmed. An Enhanced Disclosure will include details of cautions, reprimands and final warnings as well as 'spent' and 'unspent' convictions.
As such please ensure that you have read and understood the two PDF’s below on ‘CRB Levels of Disclosure’ and the ‘ILA Policy statement on the Recruitment of Ex-Offenders’.
CRB Levels of disclosure
Vetting and Barring Scheme
Personal Assistant (PA) roles may involve working with children/vulnerable adults and are classified as: ‘regulated activity’.
You may not apply if you have been barred from working with these groups.
Are you barred from working with the client group involved in this post?
Further information on the Vetting and Barring Scheme can be obtained from the Independent Safeguarding Authority, 0300 123 1111 or on their web-site at http://www.isa-gov.org.uk
Criminal Records
Due to the nature of the work, this post is exempt from the provisions of the Rehabilitations of Offenders Act 1974 and associated Order. You are therefore obliged to disclose any details of any criminal record you may have. You will normally have the opportunity to discuss these details during your interview. Criminal records will be taken into account for recruitment purposes only when the conviction is relevant. Having convictions will not necessarily bar you from employment. This will depend on the circumstances and background to your offence. Information will be kept confidential and will only be used in relation to the application for the post.
Further information on disclosures can be obtained from the Criminal Records Bureau, PO Box 91, Liverpool L69 2UH or on their website at www.crb.gov.uk.
Additional Social Services Provisions
West Sussex Social Services provide the funding that ILA customers use to buy their personal care. When the post applies to working with children, Social Services must be satisfied that the Personal Assistant is a suitable person for the role. If any relevant convictions, cautions, reprimands or final warnings are noted on your Disclosure, Social Services will need to be notified and they will be asked to make the final decision on your suitability for the post. When the post applies to working with a disabled adult, and you have relevant convictions etc, Social Services may also be alerted as part of the council's safeguarding requirements.
Your ID
In order to process your criminal record check, you will need to provide us with proof of your identity by letting us see your original documents such as birth certificate and photographic evidence i.e. Passport or photo driving licence. Information on this will follow if you are selected for this post, or can be checked on the CRB website www.crb.co.uk.
Your Name
In certain circumstances the CRB are now able to issue Disclosure Certificates which do not show your previous names. If you do not wish to disclose a previous name to your employer, the person checking the ID on your CRB application form or have it shown on your Disclosure Certificate, please telephone the CRB on 0151 6761572 for confidential advice on how to do this.
I agree to:
SECTION 4 - CV UPLOAD
Current CV:
Please upload your current CV here, please note that you may need to reload your CV if the security code below is entered incorrectly.
Please enter your name as acceptance:
Have you ever had any convictions, cautions, reprimands or final warnings given by the police?
Date:
If yes, please give details below (this will be treated as private and confidential information)
After pressing submit below, you will be shown an anti-spam filter box, you will need to enter the letters EXACTLY as you see them in the box (case is important),
When you are happy with the information provided above please click the submit button below
ILA Policy statement on the Recruitment of Ex-Offenders
SECTION 1 - PERSONAL DETAILS
Safeguarding adults in Sussex
show my Disclosure to the employer (disabled person), and
let an ILA representative discuss my Disclosure with the employer, and
any relevant convictions, cautions, reprimands or final warnings being discussed with a senior staff member from Social Services, where deemed necessary
If you want to clear ALL the information in the above form, just press the reset button below
If you wish to discuss the potential impact of any previous convictions on your application, you can telephone 01903 219482 to speak, in confidence, to the advisor who is assisting the employer with recruitment.
SECTION 5 - SUBMISSION
WORK HISTORY
Can you provide a work referee (paid or unpaid)?
Can you provide an additional work or personal referee ( a family member cannot be given as a referee UNLESS the PA is /has been employed by that person)?
If you do not have a CV?
Please complete the following Education and Work History Word document and attach this in place of a CV.
Education and Work History
Men
Women
Children
None at all
All the above
Help on how to complete the form below and how to search for jobs within the form
