/ Camphill Community Mourne Grange
169 Newry Road
Kilkeel
Co.Down
Co-worker / Northern Ireland
BT34 4EX
Application Form /
Tel +44 (0)2841760128
Fax +44 (0)2841765392

First Name / Family Name /
Passport size photo
Address
Telephone / Fax
Email
Date of Birth(dd/mm/yy) / Nationality
Gender / Marital Status
If English is a foreign language, how well do you speak it?
(choose one) / Excellent Good LimitedExcellentGoodLimited
Please provide contact details of your next of kin.
(Emergency contact details)
Professional referee—Teacher/Last Employer / Other referee (see below)
Name / Name
Address / Address
Telephone / Telephone
Email / Email
You must include the names of two referees with this application form. If you are about to or have recently left school or college, one referee should be your teacher/tutor. Otherwise one referee should be your present or recent employer. Please give the names and contact details of these persons. They must know you for at least 2 years and must not be a family member or friend.
Dates you are available to come to Camphill and for what length of time.
Have you applied to any other communities? If so which?
Why are you interested in coming to Camphill
Have you ever visited or lived in any other Camphill community? If so which?
Have you had any previous contact with people with learning difficulties or in the social care field?
What are your main interests or hobbies?
Do you have any financial obligations?
E.g. Debts or loans etc. / Yes or No?YesNo
(Choose One)
Do you have any dependents?
(Please provide as much detail as possible)
Do you have any work experience or practical skills?
For instance people support, care skills, technical knowledge, administration, artistic, musical, writing, land care etc.

Education History

School / Subject / From / To

Employment / Volunteer History

Employer / From / To / Duties
Please give details of any extended gaps

Personal Statement – give a brief account of your life to date and anything else you consider to be of importance.

DECLARATION

I confirm that I have answered all questions to the best of my knowledge and ability; I would like to apply to join Camphill Communities Northern Ireland.

Signed / Date

Please return the completed form with all requested enclosures to your contact person at Camphill, Thank You.

The Information provided by you in support of your application will be subject to the Data Protection Act 1998. Camphill Communities will hold this information for the purpose of processing your application and if you are successful in obtaining a placement with us for our staff records. All information will be treated in strictest confidence
Please ensure that you have enclosed or provided the following copies of:
Birth certificate – Passport/Travel ID Card – Recent Photograph – Education Qualifications
If your application progresses further you will be requested to provide the following;
Police Clearance Certificate from home country
Medical Certificate (form will be supplied)
Declaration of Convictions (form will be supplied)
Access NI Police check in Northern Ireland (form will be supplied)

Co-worker Application Updated 27-Aug-14