Older Peoples Support Worker (Casual)

AGE UK SUNDERLAND

Bradbury Centre, Stockton Road, Sunderland

Part-time

Bradbury Centre, Stockton Road, Sunderland. SR2 7AQ
Tel: 0191 5141131 Fax: 0191 5640378
Email: enquiries@ageuksunderland.org.uk
Website: www.ageuksunderland.org.uk

A P P L I C A T I O N F O R E M P L O Y M E N T

Please complete in block letters, using black ink, or type. Where necessary continue answers
on a separate sheet of paper.

1. Details of Post
For which post are you applying? Older Peoples Support Worker (Casual)

How did you learn about this vacancy?

2. Personal Details
First Names

Address
……………………………………………………

Last Name

……………………………………………………

Post Code…………..………………………….

National Insurance No.

Tel. No. (Home) including area code

Mobile No.

Tel No. (Work) including area code

May we telephone you at work?
Yes  No 

In order to comply with the Asylum & Immigration Act 1996 we require appropriate
documentary evidence of authorisation to work, e.g. National Insurance No.

You will also be required to produce a British/EU passport.

Do you require a work permit to work in the UK Yes  No 

If YES, please give details………………………………………………….…………………………
……………………………………………………………………………………………………………

3. Declaration
I understand that the information given on this form is true and correct, and understand
that any deception could result in instant dismissal.
Signed

Date

Private & Confidential for official use only

Ref No: Older Peoples Support
Worker (Casual)

App No:

4. Disability
What do we mean by disability? The Equality Act 2010 defines a disability as a "physical
or mental impairment which has a substantial and long-term adverse effect on a person's
ability to carry out normal day-to-day activities". An effect is long-term if it has lasted, or is
likely to last, more than 12 months.

If you consider yourself to have a disability as defined by the Equality Act 2010 and you require
any adjustments to or assistance with the interview process, please detail your requirements
below and we will try to make the necessary arrangements
………………………………………..……………………………………………….…………………
………………………………………..……………………………………………….…………………
………………………………………..……………………………………………….…………………
………………………………………..……………………………………………….…………………

5. Car Owner
Do you have a current full, clean driving licence? Yes  No 
Do you own/have access to a car for work? Yes  No 
Do you have D1 category on your driving licence? Yes  No 

Number of years licence held ………………………………………………………

6. Criminal Convictions and Cautions
Due to working with vulnerable adults all posts are subject to Disclosure and Barring Service
checks. A caution or conviction does not necessarily mean you will not be considered for
employment. Each case is considered on its merits. This post is exempt from the
Rehabilitation of Offenders Act of 1974. This means that applicants are not entitled to withhold
details of cautions or convictions (including those considered spent) unless the caution or
conviction is "protected". "protected cautions" and "protected convictions" are defined in the
The Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (Amendment) Order 2013
and are not subject to disclosure to employers, and cannot be taken into account. Guidance
on the filtering of these cautions and convictions can be found on the Disclosure and Barring
Service website.

Other than a "protected caution" or "protected conviction", have you ever been convicted of a
criminal offence, received a caution, or awaiting prosecution?
Yes  No 

If YES, details will be required from you in strict confidence on a separate sheet and they will
not necessarily debar you from employment within Age UK Sunderland.

Private & Confidential for official use only

Ref No: Older Peoples Support
Worker (Casual)

App No:

7. Employment History
Please give details of your present/most recent employer.
Job Title

Employment Status

Salary

Employer’s Name

Date appointed

Date of leaving

Reason for leaving

Period of notice required by current employer

Full time  Part time 

If part time, state number of hours worked.

Employers Address
……………………………………………………

……………………………………………………

Post Code………..…………………………….

Brief description of main duties and responsibilities

Private & Confidential for official use only

Ref No: Older Peoples Support
Worker (Casual)

App No:

8. Employment History cont.
Dates from
and to

Name and
address of
employer

Position held and
outline of
responsibility

Reason for
leaving

Full/
Part-time

Pay/
benefits

Private & Confidential for official use only

Ref No: Older Peoples Support
Worker (Casual)

App No:

8. Referees
Please give names and addresses of two referees. One should be your present or most
recent employer.

Reference 1 – should be current/last
employer

Reference 2

Name…………………………………………….

Position Held…………………………………..

Organisation…………………………………….

Address………………………………………….

……………………………………………………

Postcode………………………………………

Postcode……………………………………….

Email Address………………………………..

Tel. No. ………………………………………….

Capacity in which you know referee
……………………………………………………
Please tick the box if you do not wish
referees to be contacted unless you are
offered the post. 

Private & Confidential for official use only

Ref No: Older Peoples Support
Worker (Casual)

App No:

9. Secondary & Further Education
Name and address of
schools/colleges

Dates from
and to

Subjects taken

Grade (GCSE,
A-Level or
equivalent

Level
Attained

10. Higher Education & Professional Qualifications
*Please state whether attained/expected

Name & address of
University/college

Dates from
and to

Qualifications

Class attained/
expected*

Private & Confidential for official use only

Ref No: Older Peoples Support
Worker (Casual)

App No:

11. Training & Experience
Please include any training courses/voluntary work and non-paid work.
*Please state whether attained/expected.

Dates from and to

Description of course/work

Qualification*
(if applicable)

12. Experience & Skills
This is an opportunity to draw attention to your experience, skills and aspects or your career,
study, training, interests and ambitions which meet the requirements of the post as described
in the Person Specification. Please continue on separate sheet if necessary.

Private & Confidential for official use only

Ref No: Older Peoples Support
Worker (Casual)

App No:

13. Reason for Applying
Please state briefly why you are interested in applying for the post.

14. Additional Information
Please list any other information relevant to your application not covered elsewhere on the
form, e.g. public service/duties.

About your data

Your privacy is important to Age UK Sunderland. Age UK Sunderland is the Data Controller for all personal data you provide in a job application
or otherwise across the recruitment process. Our lawful basis for processing your personal data in this way is the legitimate interest of Age UK
Sunderland’s staff recruitment. All personal data you submit to Age UK Sunderland is collated and processed for recruitment purposes only.
This applies to the completed Application Form and the completed Equal Opportunities Monitoring Form.

Only authorised employees of Age UK Sunderland have access to submitted job applications and Age UK Sunderland will never supply any
personal data it holds for this purpose to any third party. Age UK Sunderland does not store or transfer your personal data outside of the UK.

The personal data you provide will be used to assess your application for employment with Age UK Sunderland. Should your application be
successful, the information collected will become part of your employment record.

If your application is unsuccessful, your application form and other any other personal data acquired over the recruitment process will be
shredded or otherwise destroyed securely within one month of the completion of the recruitment process. The Equal Opportunities Monitoring
Form is anonymous and will be detached and kept for one year in order to assist us with our recruitment and selection processes.

As a data subject you have the right at any time to request access to, rectification or erasure of your personal data; to restrict or object to certain
kinds of processing of your personal data; to the portability of your personal data and to complain to the UK’s data protection supervisory
authority, the Information Commissioner’s Office about the processing of your personal data. As a data subject you are not obliged to share your
personal data with Age UK Sunderland. If you choose not to share your personal data with us we may not be able to progress your application.

For more information please go to www.ageuksunderland.org.uk/privacy

Private & Confidential for official use only

Ref No: Older Peoples Support
Worker (Casual)

App No:

Bradbury Centre, Stockton Road, Sunderland. SR2 7AQ
Tel: 0191 5141131 Fax: 0191 5640378
Email: enquiries@ageuksunderland.org.uk
Website: www.ageuksunderland.org.uk

E Q U A L O P P O R T U N I T I E S M O N I T O R I N G F O R M

We are committed to ensuring that all job applicants and members of staff are treated equally,
without discrimination on the grounds of gender, sexual orientation, marital or civil partner
status, gender reassignment, race, ethnicity or nationality, religion or belief, disability or age.
This form is intended to help us maintain equal opportunities best practice and identify barriers
to workforce equality and diversity.

Please complete this form and return it with your application. The form will be separated from
your application on receipt. The information on this form will be used for monitoring purposes
only and will play no part in the recruitment process.

All questions are optional. You are not obliged to answer any of these questions but the
more information you supply, the more effective our monitoring will be. All information
supplied will be treated in the strictest confidence. It will not be placed on your personnel
file.

POST APPLIED FOR: Older Peoples Support Worker (Casual)

GENDER

Male  Female  Other ☐ Prefer not to say 
Please specify

GENDER IDENTITY

Does your gender identity match your sex registered at birth? Yes ☐ No ☐
prefer not to say ☐

ETHNIC GROUP
British/ 
English, Scottish
or Welsh
White and 
Black Caribbean

Irish  Other White 

background

Other Asian 
background

White and 
Black African

White and 
Asian

Prefer 
not to say

Indian  Pakistani 

Bangladeshi 

Caribbean 

African 

Other Black 
background

Chinese 

Other 
ethnic group

Other Mixed 
background

Private & Confidential for official use only

Ref No: Older Peoples Support
Worker (Casual)

App No:

AGE
16-19  20-24  25-29  30-34  35-39  40-44  45-49 

50-54  55-59  60-64  65 & over  Other 

please specify

Do not wish to 
disclose age

SEXUAL ORIENTATION
Heterosexual  Homosexual 

Bisexual 

Other 
please specify

Prefer not to say 

RELIGION OR BELIEF
Agnostic  Atheist  Bahai  Buddhist  Christian  Hindu  Jewish 

Muslim  Pagan  Sikh  Not 

Religious

Other 
Please
specify

Do not wish to 
disclose my religious
beliefs

DISABILITY

The Equality Act 2010 defines a disability as a "physical or mental impairment which has a substantial
and long-term adverse effect on a person's ability to carry out normal day-to-day activities". An effect
is long-term if it has lasted, or is likely to last, more than 12 months.

Do you consider that you have a disability under the Equality Act (please tick)?

Yes 

No 

Used to have a disability 
but now recovered
Prefer not to say 

Don’t know 

How did you find out about this post? Please state the source of any advertisement.

Private & Confidential for official use only

Ref No: Older Peoples Support
Worker (Casual)

App No: