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 to 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 consent unless the law require us to. Please make sure you clearly state for which role you are applying for and specifying the hours, for example Full-time, Part-time, or Zero Hours (Bank). The minimum age of all Support Worker applicants is 18+ Years of age.

Application for employment as

Closing date for vacancy

Personal Details

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Telephone - home

Telephone - work

.Telephone - mobile

Social Security number

Date of birth

YYYY

Do you hold a current clean driving licence?

Yes

Do you have use of a vehicle during working hours?

Yes

How many hours are you looking for on average per week?

0 - 10

10 - 20

20 - 30

30+

Residential Status

Registered

Yes

Entitled for work

Yes

Entitled

Yes

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

Yes

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 1995 Disability Discrimination Act)?

Yes

Present Employment

Provide details of your present or most recent position if currently unemployed.

Name and address of employer

Nature of business

Job title

Starting date

YYYY

Date of leaving (if appropriate)

YYYY

Main duties and responsibilities

Salary and benefits

Period of notice

Reason for wishing to leave

Previous Employment

Provide full details of previous employment. Most recent first.

Education, Qualifications and Training

Secondary Education. Most recent first.

Name and address of school/college

From

YYYY

Examinations taken

(include date, level, grade)

Name and address of school/college

From

YYYY

Examinations taken

(include date, level, grade)

Further Education

University, College, Part-time or Work Related Courses. Provide name and location of establishment, from and to dates and examinations taken. Most recent first.

Membership of Professional Organisations and Institutions

Provide details of names, dates attained, membership status, by examination. Most recent first.

Additional Information

Please state why you want this job. Provide details of your skills, knowledge and experience and explain why you feel they are relevant to your application. Please relate this information to the Job Description and Person Specification.

Times available to work

Please tick where appropriate

Monday

Morning (7am – 12 am)

Afternoon (12pm – 5 pm)

Evening (5pm– 9pm)

Overnight Shift

Tuesday

Morning (7am – 12 am)

Afternoon (12pm – 5 pm)

Evening (5pm– 9pm)

Overnight Shift

Wednesday

Morning (7am – 12 am)

Afternoon (12pm – 5 pm)

Evening (5pm– 9pm)

Overnight Shift

Thursday

Morning (7am – 12 am)

Afternoon (12pm – 5 pm)

Evening (5pm– 9pm)

Overnight Shift

Friday

Morning (7am – 12 am)

Afternoon (12pm – 5 pm)

Evening (5pm– 9pm)

Overnight Shift

Saturday

Morning (7am – 12 am)

Afternoon (12pm – 5 pm)

Evening (5pm– 9pm)

Overnight Shift

Sunday

Morning (7am – 12 am)

Afternoon (12pm – 5 pm)

Evening (5pm– 9pm)

Overnight Shift

Additional comments based on shift patterns provided:

The above times are guidance only, please indicate what times you will be available for work. e.g 3pm – 6pm or anytime.

Interests / Activities

Criminal Convictions

All successful applicants are advised that employment which involves working with vulnerable people (adults and/or children) will necessitate an Enhanced Disclosure and 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 in disciplinary action by the Association. Please answer the following questions by choosing either Yes / No.

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/abuse cases pending against you?

Yes

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

Yes

If 'Yes', please give details.

Referees

lease provide details of 2 people to whom you are not related and to whom reference can be made; It should be your current and last employer, or if you are currently unemployed, your last employer and the employer before that. 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. If you are employed through an Employment Agency please list as a referee. (References will only be taken up if you are invited for interview)

Referee 1

Name

Job title

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Can we contact prior to interview?

Yes

Referee 2

Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Can we contact prior to interview?

Yes

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.

Date

YYYY

Thank you for your interest in working with Autism Jersey, your application will be processed once the closing date has expired.

Should you not hear from us within two weeks of that date then please assume your application has been unsuccessful.

Kind regards,

Julie Barras

Head of HR & Administration

01534 871888

j.barras@autismjerey.org

Job Application Form