Please remember we are unable to process any applications made by persons under 18 years of age.

Full Name of Applicant

What role are you applying for?

Closing Date of Vacancy

YYYY

Guidance Notes

All information on this form will be treated as strictly confidential. Data Protection (Jersey) Law 2017. We process personal data relating to those we employ at work. We do this for employment purposes, to assist in the running of the organisation and/or to enable individuals to be paid. We will not share information about you with third parties without your prior consent unless the law requires us to. Please make sure you clearly state for which role you are applying and specifying the hours, for example 'Full-time', 'Part-time', or Zero Hours (Bank). The minimum age of all Support Worker applicants is eighteen years of age.

Personal Details

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Do you have use of a mobile phone?

Yes

Telephone Number(s) (Home, Work, Mobile)

Home

Work

Mobile

Social Security Number

Date of Birth

YYYY

Email Address

Do you currently hold a clean driving license?

Yes

Do you have use of a vehicle during working hours?

Yes

Other

If 'Other' please specify

Residential Status

Entitled (You have lived in Jersey for 10 consecutive years)

Entitled to Work (You have lived in Jersey for 5 consecutive years)

None of the above

Do you have any relationships, or close friendships, with existing Autism Jersey employees, or Autism Jersey clients or their relatives?

Yes

If 'Yes' please explain

Autism Jersey welcomes applications from candidates who have a disability and will interview all who also meet the essential criteria to do the job. Do you consider yourself to have a disability (as defined by the Discrimination Act 2013)?

Yes

Prefer Not to Say

Do you require any reasonable alterations to be made during your interview?

Yes

If 'Yes', please give details

Should you be located off island, please select yes if this interview needs to be held via a Microsoft Teams call

Yes

Present Employment

Please provide details of your present or most recent position if currently unemployed

Name of Employer

Address of Employer

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Nature of Business

Job Title

Starting Date

YYYY

Date of Departure (if appropriate)

YYYY

Main duties and responsibilities

Salary and Benefits

Reason(s) for wishing to leave

Education, Qualifications, and Training

Education - most recent first. University or College, Part-time or Work-related courses.

Name of Establishment

Address of Establishment

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

From

YYYY

Grade Accomplished (if appropriate)

Subject/Course Studied

Any other further or higher education certification or award

Examinations taken (if appropriate)

Any professional or education examination of consequence or applicability you have taken, regardless of any expiration date, the date you took them, and the grade received.

Membership(s) of Professional Organisations and/or Institutions

Times available to work

The Below times are guidance for part-time hours only, please indicate what times you will be available to work. Please note that whilst we try to accommodate preferential times, full time staff will be expected to work alternative weekends and some holidays. Sleep-ins may be required. Please tick all that apply

Monday

Morning (7am-12am)

Afternoon (12pm-6pm)

Evening (6pm-10.30pm)

Anytime

Overnight Shift

Tuesday

Morning (7am-12am)

Afternoon (12pm-6pm)

Evening (6pm-10.30)

Anytime

Overnight Shift

Wednesday

Morning (7am-12am)

Afternoon (12pm-6pm)

Evening (6pm-10.30pm)

Anytime

Overnight Shift

Thursday

Morning (7am-12am)

Afternoon (12pm-6pm)

Evening (6pm-10.30pm)

Anytime

Overnight Shift

Friday

Morning (7am-12am)

Afternoon (12pm-6pm)

Evening (6pm-10.30pm)

Anytime

Overnight Shift

Saturday

Morning (7am-12am)

Afternoon (12pm-6pm)

Evening (6pm-10.30pm)

Anytime

Overnight Shift

Sunday

Morning (7am-12am)

Afternoon (12pm-6pm)

Evening (6pm-10.30pm)

Anytime

Overnight Shift

Additional Information

Please state why you want this job. Provide details of your skills, knowledge, experience, and explain why you feel they are relevant to your application. (please relate this information to the job description and person specification).

Interests and Activities

Please tell us about any interests you have and activities you participate in.

Referees

Due to the nature of some of our roles, we reserve the right to contact any previous employers. Please inform us if you do not wish us to do this. (references will only be taken up if you are invited for an interview).

Please provide details of your current or last employer. Character references are only accepted if you do not have two previous employers.

- If you have previously/are currently working within a health and social care setting, please list the organisation as your referee. - If you were previously/are currently employed through an Employment Agency, please list them as your referee.

Referee One

Name of Referee

Employer or Character Reference?

Employer

Character

Job Title (if employer reference)

Email of Referee

Address of Referee

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Can we contact prior to interview?

Yes

Referee Two

Name of Referee

Employer or Character Reference?

Employer

Character

Job Title (if employer reference)

Email of Referee

Address of Referee

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Can we contact prior to interview?

Yes

Criminal Convictions

All successful applicants are advised that employment which involves working with vulnerable people (whether adults or children) will necessitate an Enhanced Disclosure & Barring Service (DBS) check. This will be carried out under the Data Protection (Jersey) Law 2005. Because of the nature of the work for which you are applying, this post is exempt from the provision of Section 4(2) of the Rehabilitation of Offenders Act 1974 by virtue of the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975. Applicants are, therefore, not entitled to withhold information about convictions and in the event of employment, any failure to discuss such convictions could result in dismissal or disciplinary action by the Association.

Do you have any convictions, (spent or unspent) by the courts?

Yes

Do you have any cautions, reprimands, or final warnings by the police?

Yes

Do you have any criminal and/or abuse cases pending against you?

Yes

Do you currently, or have you ever been, the subject of an investigation of enquiry by the police, or a statutory agency or other body, into abuse or neglect of a child or vulnerable adult, or any other inappropriate behaviour?

Yes

How did you hear about this vacancy?

If you selected 'Other' please give details

Data Protection (Jersey) Law 2018

This reference request is subject to the provisions of the Data Protection (Jersey) Law 2018. It is the police of Autism Jersey to disclose their content if an appropriate request is received from the individual. As provided for in the Law, the identity of the person signing and completing the reference form will be withheld in the event of a disclosure request. The reference for a successful candidate will be held on their personal file and information relating to unsuccessful candidates will be retained for a limited period of time, in accordance with Autism Jersey's policies on the retention of records. Employees have a right to see their personal file and therefore will have an opportunity to see this reference.

Declaration

I confirm that the above information is correct and fully understand that misleading statements, deliberate omissions, or inclusion of incorrect details may be sufficient to cancel any employment offer or result in dismissal.

Signed,

Date signed,

YYYY

Upon submission, this application is sent to HR@autismjersey.org, if you have any questions, queries, or issues, please email!

Job Application Form