Equal Lives Application Form

Position Title or Job Reference

Where did you see this vacancy advertised?

Telephone number

Full name

File upload

Please upload an up to date CV

Personal Statement

Please describe how you meet each of the criteria detailed in the person specification. It is important that you provide evidence and specific examples, which will be considered when short listing for interview. It is not sufficient to simply tell us that you meet the criteria. Your statement should be approximately 500 words.

File upload

Please upload a copy of your personal statement

References

Please list two references. At least one should be your most recently employer

Equal Opportunities Form

Equal Lives are striving to ensure equality of opportunity in all aspects of our activities. It is therefore really important that we monitor our staff and volunteers, in order to identify areas of under-representation.

Your co-operation in completing this form would be greatly appreciated. We must stress that any information given will be strictly confidential, and used to monitor the impact of our policies on recruitment, selection and retention of staff.

Gender

Male

Female

Non-binary

Prefer not to say

Is your gender the same as when you were born?

Yes

Prefer not to say

Ethnic Background

Asian or Asian British

Black or Black British

Mixed

White

Other Ethnic Group - Please specify

Prefer not to say

Sexual Orientation

I would describe my sexuality as

Other - Please specify

Prefer not to say

Disability and Mental Health Problems

The Equality Act 2010 defines a disabled person as someone who has a physical impairment, learning difficulty or mental health condition, which has long term, adverse effect on their ability to carry out normal day to day activities.

Do you have a physical impairment, learning difficulty, or mental health condition that could be described by the Equality Act 2010?

Yes

Prefer not to say

Do you consider yourself to be disabled, or experiencing disabling barriers, as defined by the social model of disability? (This might include long term, managed health conditions)

Yes

Prefer not to say

Would you describe yourself as someone who is experiencing, or has experienced mental health problems?

Yes

Prefer not to say

Religion or Belief

Caring responsibilities

Do you look after, or give any help or support to another person?

Yes

Prefer not to say

If yes, select all that apply

Primary Care giver of a child/children under 18

Primary Care giver of a disabled child/children under 18

Primary Care giver of a disabled adult (18 & over)

Primary Care giver of an older person (65 and over)

Secondary Care giver to any person

Are you a care leaver?

Yes

Prefer not to say

Employment of Ex-Offenders and Rehabilitation of Offenders Act

Equal Lives is of the opinion that the above post is exempt from the Rehabilitation of Offenders Act and that applicants are required to declare any relevant past criminal convictions. Equal Lives recognises that it has a duty to its service users to take account of offences that may have a direct bearing on an applicant’s suitability for this post. This is in accordance with the Rehabilitation of Offenders Act 1974 (exceptions) Order 1975 and subsequent amendments.

With regard to spent convictions, Equal Lives only requires applicants to provide details of those falling within the following categories:

1) Offences of a sexual nature

2) Offences involving minors under the age of 18

3) Drug trafficking

4) Theft, burglary, fraud or similar offences

5) Offences which involved the use or threat of violence

All information supplied by applicants will be treated in strict confidence. Where a short-listed applicant has a conviction we reserve the right to make further enquiries before reaching a decision on his or her application. A copy of Equal Lives’ policy on the recruitment of ex-offenders can be made available on request.

Please answer the following question either YES or NO:

Have you ever been convicted of a criminal offence?

Yes

If yes, please provide details:

Signature

Date

This policy complies with the Criminal Records Bureau Code of Practice. This can be viewed online at http://www.homeoffice.gov.uk/publications/agencies-public-bodies/CRB/about-the-crb/crb-cop. Alternatively you may request a copy from our HR department.

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