APPLICATION FOR EMPLOYMENT
Whole Child Therapy Ltd is committed to safeguarding and promoting the welfare of
children and vulnerable adults and expects all staff to share this commitment.
An enhanced DBS (Disclosure and Barring Service) check will be required for all positions.
For photocopying purposes, please use black ink when completing form.
Post Applied For: / Closing Date:
Section A – Personal Details
Surname: / Forenames:
Home Address:
Postcode: / Home Tel:
Mobile:
Email:
National Insurance No:
Section B - Present or Most Recent Employment
Job Title: / Present Salary: / Period of Notice:
Date Joined: / Date Left (if applicable):
Name and address of employer:
Main Duties:
Reasons for leaving (or reason for wanting to leave):
Section C - Previous Employment
Please list all your previous jobs (both voluntary and paid) including any with your present employer. Start with the most recent and include months and years for dates from and to. References may be sought from your previous employers. In addition, verification checks may be made with your previous employers for employment that involved working with children or vulnerable adults to check the reasons the employment ended.
Dates / Position held / Employer
(name and address of employer) / Reason for Leaving
From
(month/yr) / To
(month/yr)
Section D – Breaks in Employment History
Please clearly explain any gaps in your Employment history (including month/year of gap) :
(If necessary, please continue on a separate sheet, placing your name in the top right corner and numbering the additional sheets.)
Section E – Education/Qualifications
Please give details of Secondary, Further and Higher Education qualifications achieved.
Start with the most recent and work backwards
From
(month/yr) / To
(month/yr) / Name and Location of School / College / University / Subject and type of Qualification / Grade
Section F – Training
Please list below the relevant job-related training you have undertaken, and any training qualifications achieved. Start with the most recent and work backwards
Date / Course Title, Details and Organising Body / Duration
Section G – Additional Details
Do you hold a current full driving licence? (delete clearly as appropriate) YES / NO
Do you have any driving convictions? (delete clearly as appropriate) YES / NO
Details of driving convictions (if applicable):
Please give details of any outside interests including hobbies, public duties, community / voluntary work or Reserve Forces duties
Section I - Memberships and affiliations
If you are registered and/or a member of a professional body, please list the relevant body, your registration or membership number and the annual date of renewal.
Section J – Right to Work in the UK
Do you have the right to work in the UK? (delete clearly as appropriate) YES / NO
In line with Home Office guidance on the prevention of illegal working we will need to verify and take a copy of your original ID documentation as evidence of your right to work in the UK if you are to be engaged.
Section K – Alternative employment
If you are employed by Whole Child Therapy Ltd, will you continue to work in any other capacity?
Please give details:
Section L – Supporting Statement
Please explain how you meet the requirements of the Job Description and Person Specification. Include the reasons why you wish to apply for the position and give details of any experience, skills, abilities and specialist knowledge that you have that you think is relevant, together with any other information which you think will help us to consider your application.
(Please continue on a separate sheet if necessary, placing your name in the top right corner and numbering the additional sheets.)
Section M – References
Please give details of two referees whom we may ask about your suitability for the post. Referees must not be related to you. One of these must be your current or most recent employer. Please note if you are shortlisted, we will contact your referees prior to interview. (If you have had no employment history then one professional referee should be from your most recent education provider.)
Name & Address / Occupation of referee / Years Known / Contact Details
1. / Tel No:
Email:
2. / Please ensure references are not from the same company/ organisation. / Tel No:
Email:
Please indicate below (tick box) if you do not want the referees approached before interview. Please only tick one box as we will want to contact at least one referee prior to interview. We reserve the right to request additional references as appropriate.

Referee 1Referee 2
Section N – Adjustment prior to interview
We are committed to equal opportunities in employment and are only interested in your ability to do the job. If there are any reasonable adjustments you require to enable you to attend interview or carry out your duties in the work environment, please provide information on a separate sheet. This information will be kept confidential and not used as part of the shortlisting process.
Section O – Rehabilitation of Offenders Act 1974/Disqualification
We are committed to safeguarding and promoting the welfare of children and young adults and expect all staff and volunteers to share this commitment. All posts involving direct contact with vulnerable children and adults are exempt from the Rehabilitation of Offenders Act 1974 (Exemptions) Order 1975. The amendments to the Exceptions Order 1975 (2013) provide that certain spent convictions and cautions are ‘protected’. These are not subject to disclosure to employers and cannot be taken into account. Guidance and criteria on the filtering of these cautions and convictions can be found on the Disclosure and Barring Service website.
Have you ever been convicted of a criminal offence which is not ‘protected’ YES / NO
If you have answered yes, supply details of all convictions in a sealed envelope marked ‘confidential’ and attach to this form. If your application is successful, this information will be checked against information from the Disclosure & Barring Service before your appointment is confirmed.
  • Are you subject to any current outstanding disciplinary action YES / NO
or legal proceedings
  • Are you aware of any police enquiries undertaken following allegations YES / NO
made against you that may affect your suitability for the position?
  • Are you subject to any sanctions imposed by a regulatory body? YES / NO
  • Are you disqualified from working with children or vulnerable adults? YES / NO
  • Do you currently subscribe to the DBS Employer Online Checking Service YES/NO
Including Adults and Children’s Barred List Check?
  • Have you been resident in this country for 5 years or more? YES/NO
  • Have you lived or worked abroad for any periods in excess of 6 months YES/NO
In the last 5 years?
Section P – Relationships within Whole Child Therapy Ltd
Are you related in any way to an employee ofWhole Child Therapy Ltd, or to someone whom to your knowledge has been employed or connected with Whole Child Therapy Ltd within the last 12 months? If yes, please give details:
Section Q – Data Protection
Whole Child Therapy Ltd is registered under the Data Protection Act 1998.
The information or data which you have supplied on this form will be processed and held on computer, and will also be processed and held on your personal records if you are appointed. The data may be processed by Whole Child Therapy Ltd for the purposes of equality monitoring, compiling statistics, and for the keeping of other employment records. When you sign and return this form, you are giving us permission to process and hold on computer, the information or data you have supplied or referred to on it, including any information that you may consider to be sensitive and personal.
Section R – Declaration
I understand that any offer of employment is subject to :
a) references which are satisfactory to Whole Child Therapy Ltd,
b) a satisfactory Enhanced Disclosure & Barring Service (DBS) check,
c) the entries on this form proving to be complete and accurate,
d) a satisfactory medical report, if appropriate.
I certify that details provided on this form and supporting papers are true. I understand that the provision of false or misleading information given in response to any questions on this form or failure to disclose information may result in the termination of any contract of employment entered into, or the withdrawal of any offer of employment. I also hereby give my explicit consent to the processing of data contained or referred to on this from, in accordance with the Data Protection Act 1998 and any amending legislation.
Section S – Availability
Should you be successful at the short listing stage, please list any dates in the next month that you will not be available to attend for interview.
Section T - To help us monitor the effectiveness of our advertising processes, please indication where you saw this post advertised.
Press
On-line 
Whole Child Therapy Website / Universal Job match website 
Other (please specify)  ......
Signature: / Date:
Equal Opportunities Monitoring Form

Whole Child Therapy Ltd values diversity and works to advance equality. We encourage and welcome applicants from all sections of society. We ask applicants to complete and return an equal opportunities monitoring form with their application to help us check the effectiveness of our recruitment and equality policies.

This information will be treated confidentially and will be separated from you application on receipt. This information will not form part of your application.

If you chose not to complete the form, your application will not be affected. You may also send this form in a separate envelope if you wish. Please answer the questions on the following 2 pages

Name

AgeDate of birth:

SexMaleFemale

Marital Status Single  Married  Divorced 

Is your gender identity the sameYesNoPrefer not to say

as the gender at birth?

Your ethnic groupAsian or Asian British

(listed alphabetically)Indian

Pakistani

Bangladeshi

Any other Asian background (please specify if you wish)

Black or Black British – Caribbean

Black or Black British – African

Any other Black background (please specify if you wish)

Chinese 

Any other Asian background (please specify if you wish)

Mixed – White and Asian

Mixed – White and Black African

Mixed – White and Black Caribbean

Any other Mixed background (please specify if you wish)

White – British

White – Irish

White – Gypsy or Traveller

Any other White background (please specify if you wish)

Which religious or beliefNo religion

group do you most identifyBahai

with?Buddhism

(these are the twelveChristianity

most recognised)Confucianism

Hinduism

Islam

Jainism

Judaism

Shinto

Sikhism

Taoism

Zoroastrianism

Other, please specify if you wish

Prefer not to say

Sexual orientation – pleaseBisexual

indicate if any of the followingHeterosexual

apply to youHomosexual

Other

Prefer not to say

Are you current on maternityYes

leave?No

Prefer not to say

Disability – do you consider yourself to have a disability, impairment, health condition or learning difference?

Yes

No

Unsure

Please describe your disability, impairment or health condition. You may use one of the descriptions below or use your own words here

Physical impairment or a condition that affects your mobility, eg requiring use of a wheelchair

Sensory impairment, such as a visual impairment or hearing impairment

Mental health condition such as depression 

Learning difference such as dyslexia

Learning disability or cognitive impairment such as autism or a head injury

Long standing illness or health condition such as heart disease, epilepsy, cancer, 

Other, please specify

Rev 02/2015