OptionsforSupportedLiving

Application Form

Technology Lead

Part of our recruitment process is that all applicants should complete an application form. Please note if all sections of the application form are not completed this may result in your application not being taken further in the process.

1. PERSONAL DETAILS

Title: ______

Surname: ______Forename(s): ______

Home Address: ______

______Postcode: ______

Telephone number

Home: ______Mobile: ______

National Insurance Number: ______

E-mail address: ______

Yes No

Do you: have your own car?

possess a current full UK driver's licence for a manual car

possess a current full UK driver's licence for an automatic car

Have you: applied to Options before?

Right to work in the UK Yes No Are you legally entitled to work in the UK?

Where did you hear about this vacancy?

 Internet Please specify______ University Job Page

 Newspaper Please specify ______ Word of mouth

 Other Please specify ______Internal memo

 If an employee Please specify ______

2.PRESENT EMPLOYMENT Please note details will be verified when seeking a reference.

Name / Address
Telephone: / Type of Business
Job Title / Responsible to / Date Appointed
Present Salary / Notice Required / Reason for wanting to leave
Brief Description of Duties:

3.All PREVIOUS EMPLOYMENT OR WORK EXPERIENCE Starting with the most recent.

Dates:
From/To / Name and address of Employer, including title of manager from whom we can obtain a reference.
From
To / Name:
Address: / Job Title
Salary details
Reason for leaving / Main Duties
From
To / Name:
Address: / Job Title
Salary details
Reason for leaving / Main Duties
From
To / Name:
Address: / Job Title
Salary details
Reason for leaving / Main Duties
Please start from the point where you left school or full time education and explain any gap/s in your employment history. Please use an additional sheet if needed.
(We are obliged by law to check everyone’s full employment history).

4.Education

Dates: From – To / School/College/University / Qualifications obtained

Detail below any training courses which you have attended, and any supplementary qualification or certificates attained which are not mentioned above. (Verification of qualifications and certificates will be asked for).

5.REFERENCES

We require Employer references covering the previous 3 years of your employment but may wish to take up references from any of your previous employers. Please ensure that your employment history given in section 2 and 3 cover these details. If you have not been employed for three years or if you have had only one previous employer, please also provide a personal reference.

Reference One from EmployerReference Two Employer/Personal

Company Name: ______Name: ______

Address: ______Address: ______

______

______Postcode: ______Postcode: ______

Telephone: ______Telephone: ______

Email: ______Email: ______

Line Manager Name: ______Relationship to you: ______

6.PERSONAL INFORMATION

Tell us about a time when you have used technology to increase the independence ofpeople withdisabilities?
What was your personal contribution to this?
How did you involve others in this?
Describe how you achieved this?
Thinking back, how would you do things differently if you had the opportunity to do it again?
Describe your experience of supporting an organisation using Information Technology
Tell us how you keep up to date with local and national research to use assistive technology with people with disabilities.
How do you deal with conflicting priorities and multiple tasks to ensure they are completed?
What activities, interests and groups are you involved with outside of work, in your local community?
Using only 100 words, discuss how you would remain compliant with Data Protection laws within the role.
Finally, tell us what support needs you would have if you were working for Options
Please include any other relevant information here

7.MEDICAL HISTORY

Do you have a disability?Yes  No 
If yes do you require any reasonable adjustments to be made, please detail below:

8.REHABILITATION OF OFFENDERS

Posts are exempt from the provisions of Section (42) of the Rehabilitation of Offenders Act 1974 by virtue of the Rehabilitation of Offenders Act 1974 (Exemptions) Order 1975. You are therefore not entitled to withhold information about convictions which for other purposes are ‘spent’ under the provision of the act and in the event of employment any failure to disclose such convictions could result in disciplinary action or subsequent dismissal from employment. This includes all civil and criminal convictions.
All applications will be screened against an Enhanced Disclosure Certificate and, since October 2009, an ISA check from the Criminal Records Bureau.
Have you had any criminal convictions/ warnings? / Yes / No
If ‘yes’ please give details:
Date / Court / Nature of Offence / Penalty Imposed
Details of driving licence endorsements, if any:
Options meet the requirements in respect of exempt questions under the Rehabilitation of Offenders Act 1974. All applicants who are offered employment will be subject to a Criminal Record Check from the Criminal Records Bureau/Disclosures England before appointment is confirmed. This will include details of cautions, reprimands or final warnings as well as convictions.

9.DECLARATION

I declare that the information contained in this form is, to the best of my knowledge, true and complete. I understand that if it is subsequently discovered that any statement I have made is false and misleading then I can be dismissed from my employment with Options.

I declare that by signing this form I am legally entitled to work in the UK, with or without the necessary permission from the Home Office or any other relevant authority. I understand that if I am short listed for interview I will bring any relevant original documentation with me to be checked.

I acknowledge that if I am found to be working without relevant permission, my employment will be terminated with immediate effect and my details passed to all relevant authorities.

Signature of applicant: ______Date:

10.Returning your application

On completion please return this form to: Options for Supported Living, 1st Floor, St. Nicholas House, Old Churchyard, Liverpool, L2 8TX

Or email it to:

Options for Supported Living Diversity Monitoring Form

Options is committed to diversity, equal opportunities and fairness in all aspects of the work we do.

The personal information requested in this form will help us to comply with the law and to ensure that our policies and practices are fair and effective. The information provided will be treated in strictest confidence and processed in accordance with the Data Protection Act 1998.If you would prefer not to answer any individual questions then please leave them blank. The responses that you give will assist us greatly in our commitment to diversity.

1. Gender

I would identify myself as:Male Female

2. Age

Date of birth:

D D M M Y Y Y Y

3. Ethnicity

Asian or Asian British – Indian Mixed – White and Black Caribbean

Asian or Asian British – Pakistani Mixed – White and Black African

Asian or Asian British – Bangladeshi Mixed – White and Asian

Asian or Asian British – Other Mixed – Other

Black or Black British – Caribbean White – British

Black or Black British – African White – Irish

Black or Black British – Other White – Other

Chinese Other (please specify) ______

4. Do you consider yourself to be a disabled person*?

* Disability, as defined by the Disability Discrimination Act, covers many people who may not usually have considered themselves disabled. It covers physical or mental impairments with long term, substantial effects on ability to perform day-to-day activities.

Yes No

Nature of disability (please tick all that apply):

Deaf or hearing impaired Learning disabilities (includes dyslexia)

Blind or visually impaired Long-term illness or debilitating disease

Musco-skeletal (co-ordination/dexterity/mobility) Other

Mental health (including serious depression)

5. Do you have any dependent children (under the age of 16) living with you?

Yes No

6. Sexual orientation

BisexualHeterosexualMarriedSingle

GayLesbianPermanent

Relationship Civil Partnership

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