Position applied for
Sessional Activity Worker
PERSONAL DETAILS
First name
Surname
Address
Telephone
Mobile
Date of birth
Post code
Nat Ins No.
Email
What activity(s) are you able to deliver with young people?
Please indicate the evenings you could potentially be available for bookings
Monday
Tuesday
Weds
Thursday
Friday
Saturday
Sunday
Worcester Action for Youth (CIO)Registered Charity No: 1169888
www.wayworcester.org
Tel: (01905) 350550 email: [email protected]
TRAINING
Please list any training received, skills or courses attended
relevant to working with young people or delivering your
activity.
Dates
EMPLOYMENT HISTORY
Employer/Organisation
(most recent first)
Position held and brief
description of
duties/responsibilities
Dates
From - To
Reasons for leaving
and final salary
Worcester Action for Youth (CIO)Registered Charity No: 1169888
www.wayworcester.org
Tel: (01905) 350550 email: [email protected]
MEDICAL HISTORY
Give a brief outline of any health problems or disabilities.
Do you hold a current, valid full driving licence?
Yes / No
Do you have use of a car? Yes/ No
NAMES AND ADDRESSES OF TWO REFEREES
(One must be a previous employer and it is preferable if the other is someone who has
knowledge of any work or volunteering previously done with children and young
people.)
Employers’ Name
Name
Address
Address
Tel no.
Tel no.
Email:
Email:
Job title
Job title
Relationship to You:
Relationship to you:
Do you wish to be consulted before these referees are approached?
Yes / No
Date you could start employment.
Worcester Action for Youth (CIO)Registered Charity No: 1169888
www.wayworcester.org
Tel: (01905) 350550 email: [email protected]
Because the work involves contact with children and young people you are
required by the Rehabilitation of Offenders Act 1974 to declare all convictions,
including spent convictions. Please sign one of the following statements as
applicable.
1.
I declare that I have no criminal convictions for offences involving children
and/or young people and any unspent criminal convictions for any offence
involving dishonesty, deception or assault against a person.
Signed: ……………………………………..………………
2.
If short listed I will provide a list of all convictions in a separate sealed
envelope to the Manager.
Signed: ……………………………………..………………
Having a conviction will not necessarily prevent you from working for Worcester
Action for Youth.
I consent to a criminal record check if this is required and agree to abide by the
relevant policies and procedures. By signing this form I agree to the details
recorded here being held on computer by the Charity.
I understand that if any information I have provided is found to be untrue any
offer may be withdrawn or any contract of Employment may be terminated.
Signed: ................................................................ Date: ...........................
Do you have a current and active DBS dated in the last 6 months?
Yes
No
If your answer is NO then you will be required to pay £44 to have a DBS check,
refundable after 6 months on Worcester Action for Youth payroll.
Worcester Action for Youth (CIO)Registered Charity No: 1169888
www.wayworcester.org
Tel: (01905) 350550 email: [email protected]
Additional information
Please give details of any paid or voluntary work you have undertaken with
children or young people before?
Please give any further information you wish in support of your application.
How did you hear about the post?
Worcester Action for Youth (CIO)Registered Charity No: 1169888
www.wayworcester.org
Tel: (01905) 350550 email: [email protected]