Application Form
Team Leader/Senior Activity Worker/Activity
Worker
Position Applied For:
Team Leader
Senior Activity Worker
Preferred site: Northampton
Kettering
Activity Worker
Daventry Corby Any
(Circle to indicate)
First Name: ____________________________________________________
Last name: _____________________________________________________
Any previous names:_____________________________________________
D.O.B:_______________ Nat. Insurance No:_________________________
Address: ______________________________________________________
______________________________________________________________
Postcode: ______________________________________________________
Tel: Home number: ______________________________________________
Mobile number: _________________________________________________
E-mail address: _________________________________________________
Relevant Education and training background- Including Academic qualifications and
certificates e.g Level 3 Play worker, NNEB, BTec, NVQs, First aid, Team TEACH,
TEACCH, MIDAS, Life Saving, Child protection.
Relevant Education and Training Background and/or Relevant Experience:
including current First Aid Training; Life Saving; NNEB; Team TEACCH
(please continue on a separate sheet of A4 if needed)
Full History of Employment including part-time and reasons for any gaps
Personal qualities and experience statement and why you believe you are suitable
for the post.
(Please continue on a separate sheet of A4 if needed)
REFERENCES
Please give details of 2 referees who would be willing to provide a reference of your
suitability to work with children:
Referee 1:
Name:________________________________________________________
Address: _______________________________________________________
Telephone number: ______________________________________________
Email: ________________________________________________________
Job Title: ______________________________________________________
Relationship to yourself: ___________________________________________
Referee 2:
Name:________________________________________________________
Address: _______________________________________________________
Telephone number: ______________________________________________
Email: ________________________________________________________
Job Title: ______________________________________________________
Relationship to yourself: ___________________________________________
Autism Concern play schemes are committed to safeguarding and promoting the
welfare of children and young people and expect all staff, play leaders, play
assistants and volunteers to share this commitment.
Have you recently been registered to work with children?
Yes
No
Do you have a prosecution pending or have you ever been convicted at a court of
any violent crimes or offences against children?
Yes
No
All of our staff have a CRB (Criminal Records Bureau) check carried out prior to
working with children
Would you be happy for a CRB check to be carried out? Yes No
Please state where you heard about this job role (job site, friend, website facebook
etc):
Please return completed form to:
Children and Young People Programmes Manager
Autism Concern Suite 39-42 Burlington House, 369 Wellingborough Road,
Northampton NN1 4EU
Or via email to: [email protected]