COVID SUPPORT WORKER ROLE APPLICATION

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IMPORTANT NOTE:

Thank you for requesting an Application Form to support the needs of the service in this unprecedented time. If you require assistance with this form, please contact 01274 437373.

Please read ALL enclosed information, particularly COVID 19 advice, DBS guidance, right to work and the role profile.

Applicant

Applicant first name(s)*

Applicant first name(s) is required
Applicant first name(s) is required
Invalid characters: < > in Applicant first name(s).

Surname(s)*

Surname(s) is required
Surname(s) is required
Invalid characters: < > in Surname(s).

Postcode:*

A postcode is required

Building Name:

Secondary Name:

Street:

District:

Town:

County:

Home phone number

Home phone number is required
Invalid characters: < > in Home phone number.

Mobile number

Mobile number is required
Invalid characters: < > in Mobile number.

Email address*

Email address is required
Email address is required
Email address is not valid
Invalid characters: < > in Email address.

National Insurance*

National Insurance is required
National Insurance is required
National Insurance is not valid, (AA123456A).
Invalid characters: < > in National Insurance.

Date of Birth*

Date of Birth is invalid, use the following format dd-mmm-yyyy
Date of Birth is required

Preferred hours of work*

Full Time

Part Time

Evenings

Weekends

Preferred hours of work is required

What hours are you available during the week, evenings and weekends?

What hours are you available during the week, even is required
Invalid characters: < > in What hours are you available during the week, even.

Do you have access to a vehicle that could be used for work purposes?

Type of Driving Licence

None	Buses	Minibuses
Cars	Large Vehicles	Motorcycles

Employment Status*

Council Employee

University Employee

Unemployed

Volunteer

Self Employed

Furloughed

Employed

Employment Status is required

Highest Level of Qualification*

Level 6

Level 5

Level 4

Level 3

Level 2

Level 1

No Qualifications

Entry Level

Full Level 2

Full Level 3

Level 7 or above

Highest Level of Qualification is required

Eligibility to work in the UK*

Eligibility to work in the UK is required

Emergency Contact Name

Emergency Contact Name is required
Invalid characters: < > in Emergency Contact Name.

Emergency Contact Number

Emergency Contact Number is required
Invalid characters: < > in Emergency Contact Number.

Relationship to You

Relationship to You is required
Invalid characters: < > in Relationship to You.

Please supply the names and details of two individuals who may be contacted for work related references. If you have not been employed, provide an academic and character reference.

Reference 1

Name*

Name is required
Name is required
Invalid characters: < > in Name.

Position*

Position is required
Position is required
Invalid characters: < > in Position.

Relationship to You*

Relationship to You is required
Relationship to You is required
Invalid characters: < > in Relationship to You.

Organisation*

Organisation is required
Organisation is required
Invalid characters: < > in Organisation.

Address*

Address is required
Address is required
Invalid characters: < > in Address.

Contact Number*

Contact Number is required
Contact Number is required
Invalid characters: < > in Contact Number.

E-mail*

E-mail is required
E-mail is required
Invalid characters: < > in E-mail.

Reference 2