APPLICATION FOR EMPLOYMENT

Post applied for: SOCIAL SUPPORT WORKER Reference YLF/JA

Personal information
How did you find out about this vacancy? __________________________________
(Facebook/Twitter/Website/Other, please give details)

Surname ________________________ First Name ___________________________

Address ____________________________________________________________________
_______________________________________________Postcode______________
Tel No. Day: _____________________Evening_____________________________
Mobile No. _______________________E-mail Address________________________

Do you hold a current drivers licence?

Yes

No

Do you have access to a car for work?

Yes

No

Are you applying for this job on a part time basis?

Yes

No

Employment History
(Start with Current Employer)

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Salvere Independent Living Suite 6 Leyland House, Lancashire Business Park, Centurion Way,
Leyland PR26 6TY
SALVERE SOCIAL ENTERPRISE CIC. Company Registration number 07421416. Registered Address:
Sanderling Building Bird Hall Lane Cheadle Heath Stockport SK3 0RF .

Date
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To

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Month
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Name of
employer

Job title

Reason for leaving

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Salvere Independent Living Suite 6 Leyland House, Lancashire Business Park, Centurion Way,
Leyland PR26 6TY
SALVERE SOCIAL ENTERPRISE CIC. Company Registration number 07421416. Registered Address:
Sanderling Building Bird Hall Lane Cheadle Heath Stockport SK3 0RF .

Month
--------Year
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Mont
h
-------Year
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Please continue on a separate sheet if necessary

Education and Training History

Qualification

Level

Date

e.g. GCSE/GCE, further education degrees and diplomas,

professional qualifications, other

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Salvere Independent Living Suite 6 Leyland House, Lancashire Business Park, Centurion Way,
Leyland PR26 6TY
SALVERE SOCIAL ENTERPRISE CIC. Company Registration number 07421416. Registered Address:
Sanderling Building Bird Hall Lane Cheadle Heath Stockport SK3 0RF .

References
One of the references MUST be your most current employer
Most Current Employer
Name and address of employer
___________________________________________________________________
___________________________________________________________________
__________________________________________Postcode__________________
Name of person to contact _______________________________________
Position in organisation __________________________________________
Telephone Number: _____________________________________________
Previous Employer
Name and address of employer
____________________________________________________________________
____________________________________________________________________
___________________________________________Postcode _________________
Name of person to contact _________________________________________

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Salvere Independent Living Suite 6 Leyland House, Lancashire Business Park, Centurion Way,
Leyland PR26 6TY
SALVERE SOCIAL ENTERPRISE CIC. Company Registration number 07421416. Registered Address:
Sanderling Building Bird Hall Lane Cheadle Heath Stockport SK3 0RF .

Position in organisation ____________________________________________

Telephone Number: _______________________________________________
Will it be ok to contact above prior to a job offer?
delete as necessary

YES / NO

please

Additional Information
Please use the enclosed Job Description/Person Specification to demonstrate
how you meet the requirements of the job role.
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Support solutions you control

Salvere Independent Living Suite 6 Leyland House, Lancashire Business Park, Centurion Way,
Leyland PR26 6TY
SALVERE SOCIAL ENTERPRISE CIC. Company Registration number 07421416. Registered Address:
Sanderling Building Bird Hall Lane Cheadle Heath Stockport SK3 0RF .

_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________
EXEMPTION UNDER THE REHABILITATION OF OFFENDERS ACT
This form must be completed as Disclosure and Barring Service (DBS) checks are
required.
Job Title:

_________________________________________________

The Rehabilitation of Offenders Act (Exemptions) Order 1975 applies to this post.
This means that you must disclose ALL criminal convictions (including those defined as spent
under the Rehabilitation of Offenders Act), cautions, reprimands, final warnings, motor
offences and any other information that may have a bearing on your suitability for the post,
such as if your suitability to work with children or vulnerable adults has ever been questioned.
Failure to disclose any convictions / reprimands / cautions / final warnings or any other
relevant information, may disqualify you from employment or result in your later dismissal.
The Act does not provide any means of enforcing a persons right not to be refused
employment.
Dat
e

Nature of convictions / reprimands / cautions / final warnings / other relevant

information: (Please include dates)

Do you have any outstanding cases waiting to be heard? Please tick appropriate box
No
Yes give date (if known) _________________________and details:
___________________________________________________________________________
_________________________________________________________________
Have you ever been dismissed from any previous employment?
Yes
No
If yes, please give details_____________________________________________________________
_______________________________________________________________________________________________
_____________________________________________________________________
Declaration
I declare that the information I have given on this form is, to the best of my knowledge, true
and complete. I understand that if it is subsequently discovered that any statement is false or
misleading, or that I have withheld relevant information, my application may be disqualified
or, if I have already been appointed, I may be dismissed. I hereby give my consent to the
Employer processing the data supplied on this application form for the purpose of recruitment
and selection.

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Salvere Independent Living Suite 6 Leyland House, Lancashire Business Park, Centurion Way,
Leyland PR26 6TY
SALVERE SOCIAL ENTERPRISE CIC. Company Registration number 07421416. Registered Address:
Sanderling Building Bird Hall Lane Cheadle Heath Stockport SK3 0RF .

Signed _____________________________________________Date _________________

A signature is required even if you have nothing to declare.
Data Protection
The information you provide will only be used in conjunction with this application form.

Support solutions you control

Salvere Independent Living Suite 6 Leyland House, Lancashire Business Park, Centurion Way,
Leyland PR26 6TY
SALVERE SOCIAL ENTERPRISE CIC. Company Registration number 07421416. Registered Address:
Sanderling Building Bird Hall Lane Cheadle Heath Stockport SK3 0RF .

1. Training opportunities:
Salvere work with in partnership with Lancashire Workforce Development, LWDP, to provide
free training and development opportunities for Personal Assistants. This involves holding
your details as part of a PA network and being contract about training in your area.
If you do not want to be contacted then please tick here
2. Future employment opportunity
If you are not successful in this application, your details will be held on a PA register and
details will shared with employers looking for a PA in your area. You will be sent an email link
to register.
If you do not want your details to be shared then please tick here

Support solutions you control

Salvere Independent Living Suite 6 Leyland House, Lancashire Business Park, Centurion Way,
Leyland PR26 6TY
SALVERE SOCIAL ENTERPRISE CIC. Company Registration number 07421416. Registered Address:
Sanderling Building Bird Hall Lane Cheadle Heath Stockport SK3 0RF .