Mental Wellbeing Officer

5 months ago

Castleford, United Kingdom Young Peoples Empowerment Project Full time

**APPLICATION FOR EMPLOYMENT**

**Position applied for**:
**Full/Part-time /Casual**:
**Surname & Title**

**Forenames**

N.I. Number

Address

Tel: Home

Tel: Mobile

**Vaccination Status**

As per the Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) Regulations 2021, it is mandatory for anyone working in care homes from 11 November 2021 to have received a full course of Covid-19 Vaccinations. Please confirm your vaccination / exemption status.

Do Not Vaccinated Yes ❒ No ❒

Do Fully Vaccinated Yes ❒ No ❒

Have Medically exempt (must be evidenced) Yes ❒ No ❒

Vaccinated with 1 dose and 2nddose booked before 11 November 2021 Yes ❒ No ❒

**Education and Training**

Have you ever been convicted of a criminal offence? Yes ❒ No ❒

Please tell us if:

- There are any reasonable adjustments we can make to the job itself to help you carry it out

Do you have the right to work in the UK? Yes ❒ No ❒

Do you hold a current driving licence? Yes ❒ No ❒

Have you applied to Durbia Healthcare in the last 12 month? Yes ❒ No ❒

Have you ever been employed by Durbia Healthcare? If yes state where you worked

**FULL EMPLOYMENT HISTORY - **_You must provide your _**_FULL_** _employment history with no gaps_

**Dates**

**From To**

**Employers name and address**

**Job title**

**Reason for leaving**

**REFERENCES - **_Please provide details of two appropriate referees from previous employment; one must be your current or last employer. The referees should be your line manager, supervisor or HR Department and must be able to provide a company reference. If you are without two previous jobs you should provide the name of your senior school and college along with one personal referee from a member of the community (though not ones who are related to you)_

**1. Name**

**2. Name**

Position

Position

Address

Address

Tel No.

Tel No.
- Please indicate how these people know you and about your work abilities, please state whether they are your current supervisor, manager, etc._

1

2

**SUITABILITY TO WORK WITH VULNERABLE ADULTS - **_Your answers below will be checked via a criminal records check with the relevant governing body._

Has your name been referred to the Secretary of State under any of sections 82, 83 and 84 of the Health and Social Care Act 2008 and Regulated Activities - Northern Ireland Care Council for inclusion in the list maintained by the Secretary of State of individuals who are unsuitable for work with vulnerable adults (“the list”)

Yes ❒ No ❒

If yes has the Secretary of State:

- Confirmed the inclusion of your name on the list ❒
- Removed your name from the list ❒
- Not yet completed their consideration of referral ❒

**DECLARATION**

**I CONFIRM THAT THE INFORMATION CONTAINED IN THIS APPLICATION FORM IS TRUE, COMPLETE AND NOT MISLEADING. I UNDERSTAND THAT THE PROVISION OF UNTRUE, INCOMPLETE OR MISLEADING INFORMATION ON THIS APPLICATION IS GROSS MISCONDUCT AND IF I AM OFFERED AND ACCEPT THE POSITION AND AT ANY TIME DURING THE COURSE OF MY EMPLOYMENT IT COMES TO LIGHT THAT I HAVE PROVIDED FALSE OR MISLEADING INFORMATION I WILL BE SUBJECT TO THE COMPANY’S DISCIPLINARY PROCEDURE AND SUMMARY DISMISSAL.**

**I UNDERSTAND THAT MY SIGNATURE ON THIS FORM CONSTITUTES MY CONSENT FOR THE PURPOSE OF THE DATA PROTECTION ACT 1998 AS REFERRED TO ABOVE.**

Signature

Dated
- Please return this form to:_

**This is controlled document. It should not be altered in anyway without the express permission of the author or their representative. On receipt of a new version, please destroy all previous versions**

**Salary**: £22,500.00-£26,500.00 per year

**Benefits**:

- Discounted or free food
- Health & wellbeing programme
- On-site parking
- Work from home

Schedule:

- Flexitime
- Monday to Friday

Ability to commute/relocate:

- Castleford, West Yorkshire: reliably commute or plan to relocate before starting work (required)

Work Location: In person

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