SECTION 1.
Please complete this section of the form using CAPITAL LETTERS
Surname: / Mr/Mrs/Miss/Ms/Dr
First Name(s):
Address:
______/ Postcode:
Day Time Tel No.______
Mobile Number: ______
Do you have a current full driving licence: YES NO
Do you have your own transport: YES NO
Are there any disabilities which may affect your application? YES NO
Please describe disabilities:
Referees: Heritage Care cannot accept references from personal friends or relatives.
Referee's Name: / Referee's Name:
Job Title: / Job Title:
Address: / Address:
Postcode: / Postcode:
Tel No: / Tel No:
Previous voluntary and/or work experience undertaken:
SECTION 2.Please take your time to complete this form, as we will use it to match your hobbies and interests to that of our Services Users.
Please state below when you would be available to work (ie days and times)Hobbies and interests Please tick as many boxes as possible
Cooking / Reading
Singing / Going to the cinema
Dancing / Watching films
Shopping / Swimming
Visiting the hairdressers / beauticians / Arts and Crafts
Going to local museums or places of interest / Making things
(ie: sewing or knitting)
Taking part in a sport / If so which sport
Watching a sport / If so which sport
Other hobbies you have, which will help us to match you up to our Service Users:
SECTION 3.
Please briefly give the reason(s) why you are applying for voluntary work with Heritage Care. What skills and abilities would contribute to a voluntary position within the organisation?
Disclosure:
If your application is successful, you will be required to apply to the Criminal Records Bureau for a Standard or Enhanced level Disclosure (Police Check), which will be paid for by Heritage Care. All applicants who are offered employment will be subject to this Criminal Records Check before their appointment is confirmed. This check will include details of cautions, reprimands or final warnings, as well as convictions.
I understand that if my application is successful, I maybe required to apply for a Standard or Enhanced level Disclosure and agree to present Heritage Care with the part completed Disclosure application to countersign and complete:
SIGNATURE: / DATE:
Declaration of Criminal Offences:
All convictions current or “spent” including fines and driving convictions (not parking fines) must be declared. (A “spent” conviction means the specified period for rehabilitation as deemed by the courts has been achieved, and would therefore not be disclosed under the provision of the Rehabilitation of Offenders Act). However, this post is considered exempt from the provisions of the Rehabilitation of Offenders Act concerning spent convictions. If you do not have or have ever had any convictions please state “None”. However, if you do not disclose ALL criminal records (including “spent” ones) and are appointed, summary dismissal may follow.
Please note, Heritage Care will take Criminal Records into account only where the conviction is relevant. Having a conviction/caution/warning/reprimand will NOT automatically bar you from employment. This will depend on the circumstances and background to your offences(s).
Do you have /or have you ever had any Criminal Conviction(s), caution(s), warning(s) and/or reprimand(s)
YES NO / If yes please give details below:
SIGNATURE: / DATE:
I certify that the information I have given in this form is correct to the best of my knowledge. I consent to Heritage Care checking any information that I am unable to verify personally, where an offer of employment is being considered. This information will be held for a minimum of one year and by signing this form I give my consent to Heritage Care to process it under the Data Protection Act.
SIGNATURE: / DATE:
Please note that any offer of voluntary work is made subject to satisfactory references and Disclosure check.
PLEASE RETURN THIS APPLICATION FORM TO:
HERITAGE CARE, CONNAUGHT HOUSE, 112-120 HIGH ROAD, LOUGHTON,
ESSEX IG10 4HJ