APPLICATION FOR THE POST OFSESSIONAL FAMILY ASSESSMENT WORKER

PERSONAL INFORMATION

Surname:Forenames:

Home Address:

Telephone No.Home:Mobile:

Work: (if convenient)

e-mail:

EDUCATIONAL AND PROFESSIONAL QUALIFICATIONS:

Please list any educational and professional qualifications you may have obtained with dates and locations.

EMPLOYMENT INFORMATION

Please list all previous employment beginning with your present employer or most recent employment.

Name & Address of Employer / Post Held / Duties & Achievements / Dates / Reason for Leaving / Salary

OTHER EXPERIENCE, INTERESTS & VOLUNTARY ACTIVITIES

All time since leaving full-time education should be accounted for. Full details should be given for any period not accounted for by full-time employment, education or training –e.g. unemployment, voluntary work, raising a family etc.

SUPPORTING STATEMENT

Please show what skills/qualities as described in the personal specification, you feel you would bring to this job and state why you are interested in this post. Do continue on a separate sheet if necessary.

REFERENCES

Please give names and address of two people who may be approached to give a reference. One should be your present or most recent employer. References will always be sought from your current employer after shortlisting. St. Michael's reserves the right to take up any or all previous employment references.

1.Name 2.Name:

Address:Address:

Tel. No.:Tel. No.:

e-mail:e-mail:

How do you know him/her?How do you know him/her?

Because of the nature of the work for which you are applying this post is exempt from the provisions of Section 4 (2) of the Rehabilitation of Offenders Act 1974 (exemptions) order 1975. Applicants are therefore not entitled to withhold information about convictions which for other purposes are spent under the provision of the Act. In the event of employment any failure to disclose such convictions could result in dismissal.

The amendments to the Exceptions Order 1975 (2013) provide that certain spent convictions and cautions are 'protected' and 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 at the Disclosure and Barring Service website.

Have you been convicted of a criminal offence in the past?

If ‘yes’ please give details.

Are you aware of any physical, medical or related problem which would prejudice you undertaking this post?

If ‘yes’ this would need to be disclosed in confidence during the interview.

I declare that to the best of my knowledge, the information given on this application is true.

Signed:Date:

Please e-mail completed application form to

EQUAL OPPORTUNITIES INFORMATION

This information is for monitoring purposes only and will not be used in the selection process.

Post applied for:

Gender: Male / Female

Age:

Health:

Do you have a health need or disability which requires special facilities in theworkplace?

Yes / No

If yes, please describe

Racial Group:

Please indicate which of the following racial groups you belong to:

(Classifications recommended by the CRE)

☐White British☐Black – other background

☐White Irish☐Bangladeshi

☐White – other background☐Chinese

☐White and Black Caribbean☐Indian

☐White and Black African☐Pakistani

☐White and Asian☐Any other Asian background

☐Any other mixed background☐Other ethnic origin

(Please specify ………………….)

☐Black – African☐Not stated

☐Black - Caribbean

Dependants:

Are you responsible for dependants?Yes / No

Where did you see this post advertised?

Working together to keep families together