Empower Support Ltd Application Form

Position Applied For: Mental Health Support Worker

Personal Details

Education & Training

Please list your qualifications in chronological order, starting with the most recent.

Employment History

Previous Employment

Please give details of previous jobs you have undertaken. Voluntary employment is also relevant here.

Please include:

1. Date from and to (MM/YYYY)

2. Employer Name & Address

3. Job Title

4. Reason for Leaving

Gaps in Employment

References

Please give details of two referees who we can approach. One of whom should be your present or most recent employer. If you are currently in education, your tutor would be appropriate. Referees should not be a relative or personal friend.

Referee One

Referee Two

Supporting Information

Please use this section to tell us about yourself. We would like to know why you are suitable for the role in terms of your skills, experience, knowledge and personal attributes that make you suitable for the role you are applying for.

Right to Work

Criminal Convictions/Rehabilitation of Offenders Act 1974

The Rehabilitation of Offenders Act 1974 allows most convictions to be considered spent after a set period of time. Unless you receive a prison sentence of over 4 years or have any type of indefinite order, your conviction will become spent at some point.

Due to the nature of work for which you are applying, all convictions (both spent and unspent) should be disclosed as per the exemptions specified within the Act.

Empower Support Ltd aims to promote equality of opportunity and is committed to treating all applicants equally and fairly based on their skills, experience and ability to fulfil the duties of the role being applied for.

Empower Support Ltd’s pre-employment checks include an enhanced Disclosure and Barring Service check. This will search for convictions and any restrictions barring you from working with vulnerable adults.

Answering 'yes' to the question below will not necessarily bar you from appointment. This will depend on the information you provide and the position you are applying for.

If you declare information that is deemed irrelevant to the role you have applied for, suitable applicants will not be refused positions on this basis. If you declare information that is relevant to the role you are applying for, we will take into account:

• The seriousness of the offence(s)

• Your age when you committed the offence(s)

• The length of time since the offence(s) occured

• If there is a pattern of offending behaviour

• The circumstances surrounding the offence(s)

• Any evidence you provide to show that your circumstances have changed since the offending behaviour

Data Protection Act

In accordance with the Act, you should be aware that the personal details submitted with this application will only be used for selection and interview procedures; and for employment records if the application is successful.

Declaration

The information in this application form is true and complete to the best of my knowledge. I agree that any deliberate omission, falsification or misrepresentation in the application form will be grounds for rejecting this application or subsequent dismissal if later employed by Empower Support Ltd.