Application Form:	Thank you for your interest.  This Application Form should be completed in full using BLACK INK.  Applicants will be assessed only on the information requested in the Application Form.  Curriculum Vitae will not be considered.  Failure to fully complete the Application Form may cause your application to be rejected.
Job applied for:	Ethnic Minority Support Worker

PERSONAL DETAILS

Surname
		
First Names
		
Title
		
Address		

Postcode	
	
National Ins No
		
Mobile Tel
		
Home Tel
		
Work Tel

May we contact you at work?		                                                  YES / NO

Closing Date- 19th October at 2pm
with Interviews to be held Week Beginning 1st November

Applications received after the above time will not be considered.
Please return form to:	Admin Assistant
			Coleraine Sure Start Partnership
			34c Society Street
			COLERAINE
			BT52 1LA						Job Reference:_________
EDUCATION

a)	Please give full particulars of all secondary level educational qualifications.
   Level 					    	Subject Passed		Grade		Year  Attained

				

b)	Please give full particulars of all further educational qualifications.
   Degree/Diploma/Certificate		Month/Year Obtained

		

c)	Please specify any professional qualifications/memberships obtained including dates awarded. 

Name of professional body		Part No. with date and result

		

d)	Additional qualifications, training etc relevant to this post (with dates).

 

MEDICAL HISTORY
a)	Please provide brief details an approximate dates of any periods of sickness over the past two years.

   

     b)	Do you have a medical condition which may affect your performance in the job?		Yes/No
If yes give details. 

EMPLOYMENT HISTORY

Name and address of present employer:

Date appointed: __________________	Present salary: __________________

Job Title: ________________________	Notice Period: ___________________

Principal duties of Present Post:

   

EMPLOYMENT HISTORY

PREVIOUS POSTS – starting with the most recent
   Dates	Name and Address of Employer	Post	

	

		

JOB RELATED EXPERIENCE

Applicants must indicate how their experience to date meets the requirements of the Job Description and fulfils the criteria contained in the Person Specification.  Experience gained outside the workplace may be included.  Please continue on a separate sheet if necessary. 		

Essential Criteria: Fluency in English both spoken and verbal and one other language (preferably Polish)

	
Essential Criteria: Two years’ experience working with families or in a supporting role in a community/voluntary organization

	
Essential Criteria: One year’s experience facilitating small groups	
Essential Criteria: IT Skills with the ability to use Microsoft office packages	
Essential Criteria: A full current driving license and access to a car to fulfil the requirements of the post Y/N
If No, a suitable alternative means of transport? Y/N
If Yes, what means of transport do you have to enable you to fulfil the requirements of the post?
	
Essential Criteria: available to work evenings and weekends as and when necessary (but with notice)

	
Desirable Criteria: Work undertaken with ethnic minority communities within a paid or voluntary capacity

	
Desirable Criteria: To be a parent or have significant parenting experience

	

REHABILITATION OF OFFENDERS – (NI) ORDER 1978 AND (EXCEPTIONS) ORDER 1979.

Unprejudiced consideration will be given to candidates who declare criminal conviction(s) unless their offence(s) is/are manifestly incompatible with the post in question.  Do you have or have ever had any convictions, cautions or bind-over orders in relation to any offence of any kind, which are to date unspent? 
Please write “Yes” or “No” _________________		(Do not leave blank)
Note:		Custodial sentences of over 30 months can never become spent.
If you answered “Yes”, please give full details of the offence including the nature of the conviction, dates of conviction and sentence imposed.
_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________
Note:  that under the 1979 Rehabilitation of Offenders (Exception) Order, as amended by the 1987 Amended Order, an ex-offender must disclose information about current and spent convictions if the post involves access to the young, the old, the mentally or physically disabled or the chronic sick.  If you are successful in this application, it may be necessary for a police check to be carried out before appointment can be confirmed.  By signing this application for employment, you are agreeing to this check.

Referees:
Please give the names and addresses of two persons not related to you from whom references may be sought.  One of these MUST be your present or most recent employer who is able to comment on your ability to carry out tasks of the position applied for.
Name:		______________________________________________	Tel No: ____________________

Address:	_________________________________________________________________________

	  	_________________________________________________________________________  

Occupation:	 _________________________________________________________________________

Name:		______________________________________________	Tel No: ____________________

Address:	_________________________________________________________________________

	  	_________________________________________________________________________  

Occupation:	 _________________________________________________________________________

I hereby declare that to the best of my knowledge the above information is true and accurate.
Signed ___________________________________________________	Date: ____________________
NOTE: A CANDIDATE FOUND TO HAVE KNOWINGLY GIVEN FALSE INFORMATION, OR WILFULLY SUPPRESSED ANY MATERIAL FACT, MAY BE LIABLE TO DISQUALIFICATION OR, IF APPOINTED, TO DISMISSAL.