Covering Letter

Document Sample
Covering Letter Powered By Docstoc
					Re: Care Attendant Bank and Permanent Positions: PLEASE ADD THE APPLICABLE

JOB REFERENCE BELOW TO YOUR APPLICATION FORM:


NDA/JUNE 12

Dear applicant,

Thank you for your interest in working for Crossroads Caring for Carers (NI) Ltd.

As one of the leading care providers within Northern Ireland, we are seeking to recruit caring people to provide personal, social
and domestic care to individuals within the community.

You will find information on the role of a Care Attendant with Crossroads contained in the enclosed job description.

If you are interested in progressing an application with Crossroads, please complete the enclosed form. Guidance notes are
provided for your information.

Please return your completed application form, with sufficient postage, to:

        The Human Resources Department
        Crossroads Caring for Carers (NI) Limited
        7 Regent Street
        Newtownards
        Co Down
        BT23 4AB

Closing Date for All Applications: 4.00pm on Wednesday 11th July 2012

We look forward to receiving your completed application.

Yours sincerely



Human Resources Department
Crossroads Caring for Carers (NI) Ltd
                                    Crossroads Application Form Guidelines

                 Please read these guidelines carefully, before completing the application form.

1. Complete the application form in type or black ink. Please complete all sections as clearly and fully as possible.

2. If, due to a disability, you wish to complete this form in a different format, please contact the
   Human Resources Department.
3. Canvassing means contact or communication at any time in any manner (direct, indirect, oral or written, specific or
   general) with any person involved with the recruitment for the post for which you are applying which could be
   deemed or perceived to be for the purpose of advancing your application. Anyone found to be canvassing will be
   disqualified.

4. Please note that a Curriculum Vitae will not be accepted.

5. Applications will be accepted electronically. By completing and emailing the application form, we understand that
   you accept the terms of the declaration as detailed on the form and understand that any false statement or omissions
   may result in your application being withdrawn or your appointment being terminated.

6. Only information that has been included in the application form will be used to consider suitability for interview.

7. All information provided will be treated with the utmost confidentiality and within the terms of the Data Protection
   Act 1998 and as may be subsequently amended. This clause is also applicable to any other statutory legislation
   pertinent to employment within the Domiciliary care sector.

8. Requirements:

    This organisation is required by reason of statutory legislation to comply with certain mandatory requirements
    prior to the employment of a new employee in certain positions.

    You may be required to consent to and pay for a pre-employment check to be carried out by Access NI at a cost of
    £30.00. This fee is payable to Crossroads on acceptance of a provisional offer of employment and is non-
    refundable. Under the Rehabilitation of Offenders (Exceptions) Order (NI) 1979 you are not entitled to withhold
    information about convictions which for other purposes are regarded as “spent” convictions including road traffic
    and motoring offences.

    If you have a current Enhanced Disclosure Certificate from Access NI, please provide a copy for our reference.
    However, please note that you will still be required to apply for an Enhanced Disclosure Certificate for
    employment with Crossroads.

    You are required to inform us if you are or have been the subject of a referral to the Independent Safeguarding with
    (ISA) or its predecessor for barring consideration, even if the outcome was not to bar.

    Disclosure of criminal convictions will not necessarily debar you from employment, however if you do not
    disclose criminal convictions, and this is subsequently made available to us, it may affect your application and
    could result in the non progression of the application for employment. A successful application will be dependent
    on such disclosure being acceptable to Crossroads.

    Crossroads is a registered body with Access NI and has a legislative requirement to comply with their Code of
    Practice. The Code is intended to ensure that information released in Disclosures is used fairly; and, to provide
    assurance to applicants that this is the case. The Code also seeks to ensure that sensitive personal information is
    handled and stored appropriately and kept for only as is necessary.

    Full details of Access NI Code of Practice can be found on their website:-
    www.dojni.gov.uk/accessni
    Access NI
    Support
    Code of Practice
     You can also find further information on legislative requirements in the above site or by visiting
     www.nidirect.gov.uk/vetting

9.      Other requirements for all posts within Crossroads:

     a) References
         Crossroads will require receipt of two references deemed to be satisfactory to Crossroads. One of these
         references must be from your current or most recent employer. Crossroads does not accept references from
         family members or current Crossroads employees and reserves the right to approach any past employer for a
         reference or another referee mutually agreed as acceptable.

     b) Sickness Absence Information / Pre-employment Health Questionnaire
        Any situation of sickness absence / health conditions will be assessed using a number of means such as
        information provided within the application form, information from your previous employers, and if
        appropriate a request for medical report/s to establish evidence of physical or mental suitably for work in the
        Domiciliary Care Sector. We ask you to complete the attached medical questionnaire and return to the H.R.
        Department, sealed, in the envelope provided with your application form.

     c) Qualifications/ Training
        You will be required to provide evidence of stated qualifications and or training (photocopies only) indicated
        on your application form. Photocopies will be non-returnable.

     d) We require a full employment history, including written explanation of any gaps in employment.

     e) Equal Opportunity Questionnaire
         To demonstrate our commitment to equality of opportunity in employment, we need to monitor the community
         background of our employees as required by the Fair Employment Act 1989. You are not obliged to answer
         the questions on this form and you will not suffer any penalty if you choose not to do so. Nevertheless, we
         encourage you to answer these questions and return the completed form, sealed in the envelope provided with
         your application form.

10. Completed forms are to be returned to:

     The Human Resources Department
     Crossroads Caring for Carers (NI) Limited
     7 Regent Street
     Newtownards
     Co Down
     BT23 4AB

                APPLICATION FORMS RECEIVED AFTER THE CLOSING DATE WILL
                                  NOT BE CONSIDERED.
CROSSROADS CARING FOR CARERS (NI) LTD




          JOB DESCRIPTION




          CARE ATTENDANT
      May 2012



                     CROSSROADS CARING FOR CARERS (NI) LTD

JOB DESCRIPTION CARE ATTENDANT/ BANK CARE ATTENDANT

1.       Title:                As Above

1.1      Employed by:          Crossroads Caring for Carers (NI) Ltd

1.2      Responsible to:        Service Manager/ Assistant Service Manager

2.       OVERALL PURPOSE OF THE JOB

         To provide assistance and relieve stress on:-

         A) The provision of care to any service user formally referred to Crossroads by Social Services and
         subsequent implementation of Personal Care Plan.

         B) The carer of a person with a disability living in their own home in order to prevent   a breakdown in
         care.

         C) In circumstances where a person with a disability may live alone.

This will involve the provision of personal, social and domestic care similar to that given by the primary carer or
as stipulated within a personal care plan in conjunction with advice from the Service Manager/ Assistant Service
Manager respecting confidentiality at all times.

3.       PRINCIPAL DUTIES AND RESPONSIBILITIES

3.1      SUMMARY OF ROLE TASKS:

3.1.1    Attend at the homes of families/individuals and perform duties as specified by
         the Service Manager/ Assistant Service Manager and stipulated in a personal care plan.

3.1.2    Listen to the directions and requests of both the person with a disability and carer and whenever possible
         only apply these where they are consistent with the care plan.

3.1.3    Ensure compliance with provisions of personal care plan and whenever possible apply these where
         consistent with care plan.

3.1.4    Comply with Registration Requirements of N.I.S.C.C.

3.1.5    Comply with requirements of Regulation and Quality Improvement Authority

3.1.6    Advise Scheme Management of any change to your personal circumstances which impinge upon your
         duties as a care attendant.
3.1.7   PERSONAL AND SOCIAL CARE TASKS


        a)     Bathing in bed/bathroom/chair to include essential aspects of personal
               hygiene.
        b)     Assist in the management of continence of bladder and bowel.
        c)     Assist with dressing and undressing.
        d)     Assist with mobility and transfers, using correctly, any specialised
               equipment provided. Clients must not be moved / lifted without use of
               specialised equipment.
        e)     Assist with feeding as stipulated in care plan.

        f)     Administer only the medication as prescribed by a qualified medical
               practitioner under the direction of the Service Manager /assistant Service Manager. Check for any
               changes that have been made in
               dosage and ensure recording of medication is made in the appropriate care plan document, and
               always comply with organisation’s medical policy
        g)     Assist with therapeutic programmes designed, under medical direction,
               to help an individual’s progress, as advised by the relevant professional
               and under the direction of the Service Manager/ Assistant Service       Manager.
        h)     Assist with the provision of a safe environment for those who need
               constant supervision and help. This must be in accordance with
               current health and safety legislation.
        I)     Assist with the provision of emotional support to the family as part of
               a caring team.
        j)     Supervise the person with a disability outside the home as advised by
               Service Manager/ Assistant Service Manager, with written permission from the disabled person,
               responsible carer or as is stipulated in the care plan.

DOMESTIC TASKS

3.1.7   Some light domestic duties may be carried out as follows:

        a)     Making and changing the service user’s bed.
        b)     Essential laundering for the service user only.             Should be set
        c)     Essential shopping for the service user only (receipts      out in the
               should be obtained for all purchases).                      client’s
        d)     Preparing meals for the service user and washing up         personal care
               thereafter.                                                 plan.
3.2     ADMINISTRATION AND TRAINING

3.2.1   Notify the Service Manager/ Assistant Service Manager immediately of any change in availability
        to work. Please note this must be in accordance with your contractual obligation and is subject to
        mutual agreement between you and Scheme Management (see staff handbook, appendix 4).

3.2.2   Observe and report back promptly to the Service Manager / assistant Service Manager any alteration in
        the family circumstances affecting service provision.

3.2.3   Liaise regularly with the Service Manager/ Assistant Service Manager and colleagues.

3.2.4   Provide flexible cover for colleagues in the event of holiday/sickness, or absence for personal reasons
        whilst working as part of a local team of Care Attendants.

3.2.5   Attend regular team meetings as convened by the Service Manager/assistant Service Manager. This is a
        contractual obligation.

3.2.6   Complete accurately, correctly and submit to the Service Manager/ Assistant Service Manager signed
        weekly time sheets and expense claims.

3.2.7   Assist with completion of incident / accident forms accurately and submit
        promptly to the Service Manager/ Assistant Service Manager.

3.2.8   Place typed up Care Plans in clients homes.

3.2.8   Participate in an induction programme and attend ongoing in-service training
        determined by individual need; or organisational requirements or statutory obligations.

Relevant information about the families who receive Crossroads care will be
given, to or subsequently obtained by the care attendant. It is vital that this information is kept
confidential and unauthorised disclosure of personal client information is considered to be gross
misconduct; which may result in disciplinary action.

You should note that the various duties; responsibilities and associated activities as stipulated in this job
description constitute part of a care attendant’s terms and conditions of employment. Consequently none
of these terms and conditions of employment may be altered in whole or in part without prior
authorisation from the designated manager.

This Job Description and the tasks identified are not exhaustive and will be subject to review in light of the
changing circumstances. It is not intended to be rigid and inflexible, but should be regarded as providing
guidelines within which the individual works. Other duties of a similar nature and appropriate to the grade may
be assigned; this may involve working in a different scheme.
                      APPLICATION FORM

Please read the attached guidance notes before completing this application form
Please ensure you complete ALL sections fully - only applications
containing all the information requested will be considered.



Vacancy applied for:                                                                                                  Vacancy No.

                                                                                                          Applicant Ref No.:
                                                                                                          (Office use only)

Surname               ...........................................................             Title (Mr/Mrs/Ms/Miss/other) ........................

Forenames .........................................................                           Place of Birth                  ..................................................

                                                                                    National Insurance number                              ........................................
                                                                                                                                           .
Address            ..................................................................                     Telephone:                    ..........................................

    ...................................................................................                   Home             ....................................................

    ...................................................................................                   Work .........................................................

Post Code                ..........................................                                       Mobile ...................................................

Private e-mail address (if applicable) ..........................................................................................................

Next of Kin / Name ................................................... Relationship ............................................................

Contact Number/ Address
                                                    ..............................................................................................................................

If offered employment when would you be available to start?                                                          ............................................................

How did you learn of this vacancy? ...............................................................................................................
PREVIOUS APPLICANT / EMPLOYEE OF CROSSROADS
Have you applied for work in this company before?                                                                              Yes / No
If yes please give details (approx date):                                  ................................................................................................

Outcome:           .........................................................................................................................................................

Have you previously worked for Crossroads?                                                                                     Yes / No
If yes, when and in what position? ............................................................................................................
Reason for leaving                  .......................................................................................................................................

WORKER REGISTRATION SCHEME
Do you have a current work permit / employment visa?                                                                           Yes / No / N/A

If yes, please supply the following:

Registration no: ..................................................                        Issuing Authority: .................................................

Date of issue: ......................................................                      Date of expiry: ...................................................
ENHANCED DISCLOSURE CERTIFICATE
Do you have a current Enhanced Disclosure Certificate                                                                          Yes / No
If yes please give your Enhanced Disclosure no:
(If yes please enclose a copy for our records)                                             .................................................................................



NISCC REGISTRATION
Are you currently registered with the Northern Ireland Social
Care Council (NISCC)?                                                                                                          Yes/ No
If yes please give your NISCC registration number                                                .....................................................................

If no are you currently seeking registration?                                                                                  Yes/ No
Are you currently or have you ever been the subject of proceedings
by the NISCC or being referred for any reason whatsoever to the
Independent Vetting Authority (ISA) for barring consideration:      Yes / No.
If yes please provide full details to include dates and the outcome
of these proceedings. (Please use a separate page with your name at
the top and place in a sealed envelope marked with your name and
designated confidential for attention of H.R. Assistant).
If currently registered with the N.I.S.C.C. have you fully / partially*
completed the N.I.S.C.C. Induction Standards workbook.                  Yes / No
(If yes, you will be asked to provide sight of your workbook to Crossroads or a completion
certificate).
(*delete as appropriate)
EMPLOYMENT HISTORY

Please complete in full using a separate sheet if necessary, starting with your most recent
employment. You must also ensure that you account for any gaps in employment.

From - To                 Name & Address Job Title & Duties                                                         Salary                on Reason for Leaving
                          of employer                                                                               leaving




OTHER EMPLOYMENT

Please advise us of any other employment you intend to/ or would continue with if you were
offered this position:

 ..............................................................................................................................................................................

 ..............................................................................................................................................................................
EDUCATION AND TRAINING

Level of Education                        Dates (from/ Examinations         Date Gained
(Secondary/ Grammar/ University/          To           (state
Further Education)                                     subjects/grade




OTHER TRAINING COURSES ATTENDED

Please include any formal training on Manual Handling, CPR/ First Aid etc. and date of most
recent certificate. You may be required to produce appropriate certification document(s).
Dates (from/ To)                 Training Provider               Course          title    and
                                 i.e. University/ F.E. Institute qualification obtained
                                 or Training Agency




PROFESSIONAL / VOCATIONAL QUALIFICATION


Professional      Body       / Date Obtained                   Registration Number
Qualification
FURTHER INFORMATION

Please give any information in support of your application for this post. The details should
include a description of your present or most recent job, your reasons for applying for this post
and how you meet the requirements of the post. You may continue on additional sheets if
required.


_________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

DRIVING INFORMATION

Please complete the following:

Do you hold a current full driving licence?                                                                 Yes / No

If yes, how long have you held your licence for?                                                  ...............................................................

Have you any endorsements/pending prosecutions?                                                             Yes / No

If yes, please give details:
...................................................................................................................................................................................

...................................................................................................................................................................................
Do you have access to a car for work purposes?                                                              Yes / No

Do you have full business insurance                                                                         Yes / No

PLEASE NOTE: For all Care Attendant posts an essential qualification is the holding and retention of a current
Driving Licence, Car Insurance (must be full business use) Tax disc and current MOT certificate (if applicable).
INFORMATION ABOUT AND CONSENT TO AN ACCESS NI ENHANCED DISCLOSURE CHECK
BY APPLICANTS FOR POSTS INVOVLING WORK WITH CHILDREN AND OR VULNERABLE
ADULTS.

Care Attendant posts within Crossroads are subject to the Safeguarding Vulnerable Groups (NI) Order 2007.
You have applied for a post involving care work with children and vulnerable adults, which is a regulated
position. Before appointing anyone to such a post, we are required to undertake an Enhanced Disclosure of
Criminal Background check. This check is to ensure that individuals who might be at risk to children and
vulnerable adults are not appointed.

The check will tell us if you have a criminal record or if your name is included on the Independent Safeguarding
Authority “Barred Lists” as noted below;
     a list of people barred from working with children (replacing List 99, the POCA list and disqualification
       orders); and
     a list of people barred from working with vulnerable adults (replacing the POVA list).
Any information received will be treated confidentially and we may talk to you about it before a final decision is
reached.

REHABILITATION OF OFFENDERS

A check will only be carried out if you are considered to be the preferred candidate and are being offered an
appointment. You must tell us now if you have ever been convicted of a criminal offence, or cautioned by
the police, or bound over. You must tell us about all offences, even minor ones such as a motoring offences
and ‘spent’ convictions. Under the Rehabilitation of Offenders (Exceptions) Order (NI) 1979, when
recruiting for Crossroads no previous criminal conviction may be regarded as “spent”. If you do not
advise of any of the above, which are subsequently made available to us, it may affect your application and could
result in the non progression of the application for employment.

Please complete information required below and to indicate your written consent to this check.                                                                If you do not
indicate your consent, we will not proceed with your application.

CONSENT TO ACCESS NI ENHANCED DISCLOSURE

Do you have any prosecutions pending?
                                                          YES / NO (delete as appropriate)

If Yes, please give details:

 ..............................................................................................................................................................................


Have you even been convicted at a court or cautioned by the police for any offence?                                                           YES / NO
                                                                                                                                              (delete as appropriate)


If yes, please list below details of all prosecutions, convictions, cautions or bind-over orders, including “spent”
convictions. Give us as much information as you can, including, if possible, the offence, the approximate date of the Court
Hearing and the Court which dealt with the matter.

 ...............................................................................................................................................................................
 ...............................................................................................................................................................................
 ............................................................................................................................................................................

I understand that an Enhanced Disclosure check must be carried out before an offer of appointment can be confirmed. This
has been explained to me and I am aware that spent convictions must be disclosed. I declare that the information I have
given is accurate and I consent to the check being made.

Signature:              ............................................................       Date             ......................................................

Name:
SICKNESS/ ABSENCE
How many days have you been absent from work due to illness during the last
12 months or during the period of your last employment?
(Please note days and not periods of absences).


Have you suffered any illness in the last 3 years?                                                                                                        YES / NO
If yes, please give details:
 ...............................................................................................................................................................................
 .............................................................................................................................................................................
Complete the table below, giving dates, duration and outcome of any illness or condition where applicable. Please
refer to the declaration for your signature below.
Have you ever had:                                                                 * delete as Additional information to “yes” response
                                                                                   applicable
Tuberculosis, asthma, bronchitis or chest problems?     *Yes/No
Chest Pain, heart condition or raised blood pressure?   *Yes/No
Blackouts, fits or attacks of giddiness?                *Yes/No
Depression, mental illness or nervous breakdown?        *Yes/No
Rheumatism or arthritis?                                *Yes/No
Back trouble?                                           *Yes/No
Typhoid, paratyphoid or other gland trouble?            *Yes/No
Bladder or kidney trouble / Digestive or bowel disease *Yes/No
Dermatitis or skin trouble / Varicose Veins?            *Yes/No
Any other accident, operation or illness?               *Yes/No
Diabetes, thyroid or other gland trouble?               *Yes/No
Have you any reason to believe you may be infected *Yes/No
with any communicable disease?
Any other current or recent medical condition or *Yes/No
treatment which might affect your attendance or
performance at work?
Do you intend to work night duties on a regular basis? *Yes/No
Any illness or medical condition that prevented you *Yes/No
from attending work on your normal duties or
activities for more than one week during the past year?
Any physical impairments, including defect of sight or *Yes/No
hearing? If yes, please specify any special needs in
relation to your disability?
Do you smoke?                                           *Yes/No
Are you currently under any medical supervision, *Yes/No
requiring treatment and/or medication.
Immunisation Status
Please give details of any immunisations you have had and the dates you have had them below:-


DECLARATION (PLEASE READ CAREFULLY BEFORE SIGNING)
I declare that I have answered ALL questions honestly and fully and that I am not otherwise aware of any physical or
mental disability, which will, or may, affect my working capacity. I realise that, if appointed, any false or incomplete
statement on my part will render me liable to dismissal.
I agree to make myself available for a medical examination by a suitably qualified practitioner at the Company’s expense
if it is felt details disclosed in the document warrant further investigation in the light of the vacancy for which I am being
considered and / or if it is necessary for the Company to communicate with my own doctor and/or consultant who has
treated me, I authorise them to reply to any query concerning my health or medical history in accordance with Access to
Medical Reports Act 1988 and Data Protection Act 1998. I agree to my doctor being informed of the results of any tests
taken, which the Company considers should be brought to my doctor’s attention. If it is discovered that I have an illness or
disability, the details of which should be made known to my potential employer for my own safety, or that of other
members of the staff or clients, I authorise the examining medical officer to disclose to my potential employers such
details, as he/she may consider necessary.

Signed: _____________________________________________________ Date: _________________________________
EXPLANATION OF AVAILABILITY SHEET


FOR CARE ATTENDANT APPLICANTS ONLY

IMPORTANT – PLEASE READ BEFORE YOU FILL IN THE AVAILABILITY PAGE AS THIS WILL
ULTIMATELY FORM PART OF YOUR CONTRACTUAL TERMS AND CONDITIONS.

The majority of Crossroads work is through Contracts we have with the Health Trusts within the three Health
Board Areas. We must provide care 365 days per year.          The work is spread in most areas over a 24 hour
period. Therefore we would ask you to be as flexible as possible when indicating your availability. (The more
available and flexible you are, the easier it will be for us to try and increase your weekly working hours). You
may also be required to work on ‘special days’ in order to ensure that the service is provided to all our Clients in
accordance with the Policies of Crossroads Caring for Carers (NI) Limited.


Crossroads do not receive additional money from Trusts for work carried out in the evenings, at weekends or on
special days.


You are requested to be realistic when completing your availability sheet, as this will be used on a daily
basis by scheme offices to allocate work to you, which has been taken as a referral from the Trusts. You
are also required to indicate your preferred day off (Mon-Fri) which would constitute a contractual
arrangement thereafter, and subject to change thereafter by mutual agreement. You should note that a
unilateral decision by an employee to amend-alter-or change in any way your previously notified
availability without prior discussion with and agreement of your manager is not acceptable to us.


If you do not accept the work we offer, which is based on the information you provide on the attached
Availability Page we will consider this to be non-adherence to your contractual obligations and may
consider the contract inoperable and consequently subject to termination. Changes to your availability can
be progressed by written request to your manager and subject to mutual agreement.


When ticking the availability page, please note that the time range is the hours you will be available to
work and not what Crossroads may actually ask you to work.


Care Attendant staff are entitled to Annual Leave and on occasions, staff may be off work due to illness.
During these times, you will be expected to help provide cover for your colleagues, as they will in turn,
cover for you.     You will appreciate that it would be impossible to grant leave to staff if no alternative
form of cover is available to enable a service to be provided to our Clients.


When completing the availability page, you must only TICK the relevant box - DO NOT INSERT TIMES.
 AVAILABILITY PAGE


FOR CARE ATTENDANT APPLICANTS ONLY

You must read the explanation page carefully before completing this schedule.
To enable us to determine a flexible rota consistent with the needs of our clients, please be as flexible as
possible in ticking the boxes between columns A and C to provide a range of days and times.

Column    Time Range               Monday     Tuesday    Wednesday      Thursday    Friday   Saturday   Sunday
A         07.00am – 12.00noon

B         12.00noon – 6.00pm

C**       6.00pm – 11.00pm

D*        11.00pm – 7.00am


PLEASE TICK THE APPROPRIATE BOX BELOW TO STATE WHICH POSITION YOU ARE
APPLYING FOR.


TO APPLY FOR PERMANENT CARE STAFF                         PLEASE TICK


* Please note that overnight work is only available in certain Trust areas.

** Please note Permanent Care Staff must be prepared to work a minimum of 2 evenings per week Monday-
Friday

I understand that I must be available to work a minimum of 20 hours per week Monday - Friday.

I also understand that in addition to the minimum of 20 hours, I must be available to work every other
weekend.

I also understand that a reduction to less than 20 hours (Mon-Fri) may amend my contract to that of Bank Care
Attendant and also my contractual terms and conditions of employment will be amended.

I further understand that work rota are not permanent and will need to be changed from time to time to meet
client needs and/or service or other requirements of Crossroads Domiciliary Care Service.

TO APPLY FOR PERMANENT BANK CARE STAFF                                             PLEASE TICK


Variable work hours available evenings and/or weekends only.


Signature: _________________________________________________ Date: ________________________
REFERENCES
Please provide details of two referees who can provide information relating to your competency to undertake this
role, one of whom must be your present or most recent employer. If you are a student, please give an
academic referee. You are applying for a post which requires unsupervised access to children / vulnerable
adults, the company reserves the right to approach any past employer for a reference or any other referee
mutually agreed as acceptable. This is in addition to the Protection of Children and Vulnerable adults service
check set out on page no. 6. (Please note we do not accept references from family members or Crossroads
employees).
Please note it is your responsibility to obtain consent from named persons from whom references will be sought
and provide full contact details for same.
 Referee one                                                                            Referee Two

 Name ............................................................                      Name          ......................................................

 Company Name ..........................................                                Company Name                    ....................................

 Company Address .....................................                                  Address             .................................................
  .......................................................................
                                                                                          ...................................................................
    .......................................................................
                                                                                          ....................................................................
 Postcode             ....................................................
                                                                                        Postcode .....................................................
 Company Tel No                   ........................................
                                                                                        Telephone                 ............................................

 In what capacity do you know this person?                                              In what capacity do you know this person?
   .........................................................................              .....................................................................
                                                                                        How long have you known this person?
 How long have you known this person?
                                                                                          .....................................................................
    .........................................................................



DECLARATION

I confirm that the above information is complete and correct and that any untrue or misleading information will give my
employer the right to terminate any employment contract offered. I agree that should I be successful in this application, I
will, if required, apply for a full disclosure of criminal records, including any spent convictions. I also agree that the
company may apply to for references as noted above. If required I agree to co-operate in providing any relevant medical
information which may be appropriate to determining suitability to undertake the post. I understand; should I fail to do so,
or should any information become come to light which is not to the satisfaction of the company, any offer of employment
may be withdrawn or my employment terminated.


Signature                ............................................................        Date          .................................................................


For administration purposes, please indicate planned holiday arrangements. It should be noted that
Crossroads is under no obligation to take account of your holiday arrangement, but will endeavour to do so.

From                                                                                         To
             ....................................................................                     .......................................................................
                                                                                         Reference No.

EQUAL OPPORTUNITY QUESTIONNAIRE
Crossroads Caring for Carers (Northern Ireland) Limited is an Equal Opportunity Employer, committed to ensuring
that the talents and resources of all our employees are utilised to the full. We will not discriminate unfairly against
any individual in matters of recruitment or selection for any position, promotion, development or training on the
grounds of perceived religious or political affiliation, sex, marital status, disability, colour, race or ethnic origins.

To demonstrate our commitment to equality of opportunity in employment, we need to monitor the community
background of our employees, as required by the Fair Employment Act 1989.

It would be appreciated, therefore, if you would please answer the questions by ticking the appropriate boxes.
This information will be treated in a confidence and used only for equal opportunity purposes.

1. Sex                 Male                                                     Female



2. Age        ___________________                                      Date of Birth ___ ___/___ ___/___ ___


3. Nationality: (please specify) _______________________________

4. Religion
                           I am a member of the Protestant community

                           I am a member of the Roman Catholic community

                           I am a member of neither the Protestant nor Roman
                           Catholic communities

5. Marital Status

                           Single                            Married                              Other


6. Disability
The Disability Discrimination (NI) Act 1995 describes a disability as a physical or mental impairment, which has
substantial and long term adverse effect on a person’s ability to carry out normal day to day activities. Do you
consider yourself to have a disability?

YES                                                                    NO

If Yes, please indicate the nature of your disability by ticking the appropriate box(es).

                           Mobility                Dexterity/Co-ordination                        Learning

                           Vision                  Psychiatric/Mental                             Speech

Other (please state) ____________________________________________________________




7. Race
                       African                     Asian                                 Caribbean                Other


                       Chinese                     White European                        White Other


Please return completed questionnaire, sealed, in the envelope provided, to the Human Resources Department.

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:83
posted:10/1/2012
language:English
pages:18