Age UK South Gloucestershire – Application for employment

as: Integrated Care Support Worker

Job Ref: ICSW/PD/10-17
Closing Date for Applications is: 12 noon, 31st October, 2017
Interviews: Thursday 9th & Wednesday 15th November
No applications submitted after this time will be considered.
We do not accept CV’s – APPLICATION FORM ONLY
Please email your completed application and equal opportunities form (at the back of this form)
to:or by post to:
Age UK South Gloucestershire, 67 High Street, Thornbury, Bristol BS35 2AW
Application Ref:
(For Age UK use)
PRESENT WORK (Paid or voluntary)
Name/ Address of Employer / Position(s) held and descriptions of responsibilities / Salary
Dates (from – to): / Notice Required:
PREVIOUS WORK (Paid or voluntary) - Please list any relevant roles (with the more recent at the top), which you feel demonstrate your skills and experience
Name/ Address of Employer / Position(s) held and descriptions of responsibilities / Salary and dates of employment / Reason for leaving

Continue previous work details overleaf if necessary……….

EDUCATION & TRAINING
Please list your formal qualification and any training undertaken which is relevant to this role.
School/College/ Training Provider / Qualifications obtained / training undertaken
Having read the Job Description and Person Specification, please inform us why are suited to the position and what strengths you can bring to the post.
Please use the the person specification headings in answering this section.
Please keep to a maximum of two A4 sides in total for this question.
Please do not submit a CV or any additional enclosures as the shortlisting decisions will be based on the information contained within this form only.
Age UK South Gloucestershire
Application for Employment
Your Full Name & Address / Telephone Numbers: / Email address
Home:
Work:
Mobile:
Date of Birth: / How did you hear about this vacancy?
REFEREES
Please provide two referees. (These will only be taken up if you are the successful candidate.) One of these must be your line manager at your last or current place of work, if applicable.
Referee One:
Title / Full Name / Address / Email Address / Referee Two:
Title / Full Name / Address / Email Address
Employment may be subject to satisfactory references and a Standard or Enhanced Disclosure from the Disclosure & Barring Service (DBS)
DECLARATION
I confirm that all the information included in this application is to the best of my knowledge correct.
Signed: Date:
Equalities Monitoring Form
(For Age UK use)
Please complete the details below and return with your application form. The two forms will be separated when received by Age UK South Gloucestershire. This will allow shortlisting to be completed without these details and therefore be based only on information enclosed in the application form.
AgeRange
up to 25
26 - 39
40 – 59
60 and over / Gender
Male
Female / Do you describe yourself as Disabled?
Yes
No
What is your ethnic group?
Choose ONE section from A to E, then tick the appropriate box to indicate your cultural background
A. White
British
Irish
Any other White background: please specify
B. Mixed
White and Black Caribbean
White and Black African
White and Asian
Any other Mixed background: please specify
C. Asian or Asian British
Indian
Pakistani
Bangladeshi
Any other Asian background: please specify
Continued over
D. Black or Black British
Caribbean
African
Any other Black background: please specify
E. Chinese or other ethnic group
Chinese
Other: please specify:

PLEASE REMEMBER TO COMPLETE AND RETURN THIS MONITORING FORM WITH YOUR COMPLETED APPLICATION FORM – WITHOUT THIS COMPLETED FORM, YOUR APPLICATION WILL NOT BE ACCEPTED