About Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Your TitleYour Name *FirstLastLayoutDate of birth *Your Email *Nationality *Please use dropdownAfghanAlbanianAlgerianAmericanAndorranAngolanAntiguansArgentineanArmenianAustralianAustrianAzerbaijaniBahamianBahrainiBangladeshiBarbadianBarbudansBatswanaBelarusianBelgianBelizeanBenineseBhutaneseBolivianBosnianBrazilianBritishBruneianBulgarianBurkinabeBurmeseBurundianCambodianCameroonianCanadianCape VerdeanCentral AfricanChadianChileanChineseColombianComoranCongoleseCosta RicanCroatianCubanCypriotCzechDanishDjiboutiDominicanDutchEast TimoreseEcuadoreanEgyptianEmirianEquatorial GuineanEritreanEstonianEthiopianFijianFilipinoFinnishFrenchGaboneseGambianGeorgianGermanGhanaianGreekGrenadianGuatemalanGuinea-BissauanGuineanGuyaneseHaitianHerzegovinianHonduranHungarianI-KiribatiIcelanderIndianIndonesianIranianIraqiIrishIsraeliItalianIvorianJamaicanJapaneseJordanianKazakhstaniKenyanKittian and NevisianKuwaitiKyrgyzLaotianLatvianLebaneseLiberianLibyanLiechtensteinerLithuanianLuxembourgerMacedonianMalagasyMalawianMalaysianMaldivianMalianMalteseMarshalleseMauritanianMauritianMexicanMicronesianMoldovanMonacanMongolianMoroccanMosothoMotswanaMozambicanNamibianNauruanNepaleseNew ZealanderNi-VanuatuNicaraguanNigerianNigerienNorth KoreanNorthern IrishNorwegianOmaniPakistaniPalauanPanamanianPapua New GuineanParaguayanPeruvianPolishPortugueseQatariRomanianRussianRwandanSaint LucianSalvadoranSamoanSan MarineseSao TomeanSaudiScottishSenegaleseSerbianSeychelloisSierra LeoneanSingaporeanSlovakianSlovenianSolomon IslanderSomaliSouth AfricanSouth KoreanSpanishSri LankanSudaneseSurinamerSwaziSwedishSwissSyrianTaiwaneseTajikTanzanianThaiTogoleseTonganTrinidadian or TobagonianTunisianTurkishTuvaluanUgandanUkrainianUruguayanUzbekistaniVenezuelanVietnameseWelshYemeniteZambianZimbabweanNoneAddress *Address Line 1Address Line 2CityState / Province / RegionPostal CodeNational Insurance Number *LayoutDBS Number *Date of issue *LayoutMobile Number *Home Phone Number *Teacher Reference Number/IFL NumberDfE/IFL Registered?YesNoClosest Station: *Driving License Number: *Emergency Contact Name: *FirstLastLayoutEmergency Contact Number *What is their relation to you *What is your expected daily rate (Before Tax/ NI)? £ 0 Is your DBS registered online? *YesNoWhat job title are you applying for? *Other than English which other languages can you either speak or write in? *Please use dropdown listAfghanAlbanianAlgerianAmericanAndorranAngolanAntiguansArgentineanArmenianAustralianAustrianAzerbaijaniBahamianBahrainiBangladeshiBarbadianBarbudansBatswanaBelarusianBelgianBelizeanBenineseBhutaneseBolivianBosnianBrazilianBritishBruneianBulgarianBurkinabeBurmeseBurundianCambodianCameroonianCanadianCape VerdeanCentral AfricanChadianChileanChineseColombianComoranCongoleseCosta RicanCroatianCubanCypriotCzechDanishDjiboutiDominicanDutchEast TimoreseEcuadoreanEgyptianEmirianEquatorial GuineanEritreanEstonianEthiopianFijianFilipinoFinnishFrenchGaboneseGambianGeorgianGermanGhanaianGreekGrenadianGuatemalanGuinea-BissauanGuineanGuyaneseHaitianHerzegovinianHonduranHungarianI-KiribatiIcelanderIndianIndonesianIranianIraqiIrishIsraeliItalianIvorianJamaicanJapaneseJordanianKazakhstaniKenyanKittian and NevisianKuwaitiKyrgyzLaotianLatvianLebaneseLiberianLibyanLiechtensteinerLithuanianLuxembourgerMacedonianMalagasyMalawianMalaysianMaldivianMalianMalteseMarshalleseMauritanianMauritianMexicanMicronesianMoldovanMonacanMongolianMoroccanMosothoMotswanaMozambicanNamibianNauruanNepaleseNew ZealanderNi-VanuatuNicaraguanNigerianNigerienNorth KoreanNorthern IrishNorwegianOmaniPakistaniPalauanPanamanianPapua New GuineanParaguayanPeruvianPolishPortugueseQatariRomanianRussianRwandanSaint LucianSalvadoranSamoanSan MarineseSao TomeanSaudiScottishSenegaleseSerbianSeychelloisSierra LeoneanSingaporeanSlovakianSlovenianSolomon IslanderSomaliSouth AfricanSouth KoreanSpanishSri LankanSudaneseSurinamerSwaziSwedishSwissSyrianTaiwaneseTajikTanzanianThaiTogoleseTonganTrinidadian or TobagonianTunisianTurkishTuvaluanUgandanUkrainianUruguayanUzbekistaniVenezuelanVietnameseWelshYemeniteZambianZimbabweanNoneIs your DBS - Child Checked? *YesNoIs your DBS - Adult Checked? *YesNoDo you have access to a car? *YesNoDo you have any holidays booked or are unavailable on certain days which you know about in advance? *YesNoLayoutDate from *Date to *LayoutSingle date un available 1Single date unavailable 2How did you hear about SENCare Recruitment? *Please use dropdown listSearch EngineSocial MediaRadioTVPrintWord of mouthBOTH UK & NON UK PASSPORT HOLDERS SHOULD ALSO FILL IN THE DETAILS BELOW:Do you have a UK Passport? *YesNoEnter your UK passport number here *Enter your non-UK passport number here *Do you have a Biometric ID Card? *YesNoDo you have an Overseas Police Check? *YesNoDo you have the right to work in the UK? *YesNoUKBA GuidanceIn line with UKBA guidance on the prevention of illegal working we will need to verify and take a copy of your original ID documentation as evidence of your right to work in the UK if you are to be engaged by SENCare Recruitment Ltd for temporary workREFERENCESReferences will only be taken up with your knowledge and agreement. List present or most recent position firstReference 1Referee full name *FirstLastLayoutDates you knew this referee from *Their role/ job title *Their telephone number *Your role/ job title *Reason for Leaving *Dates you knew this referee to *Their place of work *Their Email address *Salary *Reference 2Referee full name *FirstLastLayoutDates you knew this referee from *Their role/ job title *Their Email address *Your role/ job title *Reason for Leaving *Dates you knew this referee to *Their telephone number *Their place of work *Salary *Have you included a minimum of one work email for your references? *YesNoHave you asked permission first in the last 12 months from this person for a reference? *YesNoHow many days off sick have you required in the past year: Selected Value: 0 MEDICAL QUESTIONNAIRE AND DECLARATION FORMThe following questions on health and disability are asked in order to find out your needs in terms of reasonable adjustments to access our recruitment service and to find out your needs in order to perform the job or position sought.Do you have any health issues or a disability relevant which may make it difficult for you to carry out functions which are essential for the role you seek? *YesNoIf yes, please specify:If you have a disability, what are your needs in terms of reasonable adjustments in order to access this recruitment service and to attend interview, or to take aptitude tests etc? *YesNoPlease specify:Do you consider yourself medically fit for teaching/supporting in the UK? *YesNoI declare that all the answers to the above questions are true and complete to the best of my knowledge. I understand that any false statement or material omissions may lead to my removal from the register and/or refusal or any offer of work: *YesNoREHABILITATION OF OFFENDERS ACT 1974 (EXCEPTION ORDER 1975)Assignments will involve you in close contact with pupils under the age of 18 or with students with learning difficulties or disabilities; your registration with SENCare Recruitment Ltd is therefore exempt from the provisions of the Rehabilitation of Offenders Act 1974 and its supporting regulations. Consequently, you are NOT entitled to withhold information about convictions which for other purposes are “spent” under the Act. SENCare Recruitment Ltd will check the information given in this section with the relevant authorities. You will be required to apply for an enhanced disclosure level of police check through DBS (Disclosure & Barring Services). Have you been convicted of a criminal offence other than a road traffic offence not involving injury to a 3rd Party, or a sentence of imprisonment? *YesNoLayoutDate OffenceSentence Date Offence Sentence Has anyone living in your household been barred from working with children by the DBS? *YesNoHas anyone living in your household been disqualified from working with children under the childcare Act 2006? *YesNoEmployees living in a shared householdTo the best of your knowledge, is anyone living at your address subject to the above? *YesNoIf you have answered YES to any of the above, please provide further information below (you may provide an additional information sheet if necessary):Disqualification by AssociationAll employees are required to provide relevant information about a person who lives in the same household as them, who may have influence over the employee working with children and who may therefore pose a risk to children i.e. “by association”. You are therefore required to disclose: Details of any order, determination, conviction, or other ground for disqualification from registration under the Childcare (Disqualification) Regulations 2009. You are required to declare whether anyone living in your household is disqualified from working with children under the childcare Act 2006. This covers the following offences: offences against a child against an adult (e.g. rape, murder indecent assault, actual bodily harm etc.) The date of the order, determination or conviction, or the date when the other ground for disqualification arose; Information about the body or court which made the order, determination or conviction, and the sentence (if any) imposed; and A certified copy of the relevant order (in relation to an order or conviction). LayoutApplicants Signature *FirstLastDate of Signature *DeclarationI confirm that the information I have declared above is correct and understand that I have duty to inform the Head teacher/Care manager should any of this information change at any time during my employment with the school.LayoutApplicants Signature *FirstLastDate of Signature *Appendix A (to be read by all new employees)A check as to the existence and content of any relevant criminal record will be requested from the Disclosure and Barring Service after a person has been selected for appointment. Refusal to agree to a check being made could disqualify you from being considered for the appointment.Rehabilitation of Offenders Act 1974Under the Rehabilitation of Offenders Act 1974, you have the right not to disclose details of ‘spent’ convictions. However, for certain jobs, employers are allowed to ask about these offences. The Rehabilitation of Offenders Act 1974 (Exception Amendment) Order 1986 sets out details of all jobs to which this applies and the job you have applied for is included in the list. The amendments to the Exceptions Order 1975 (2013) provide that certain spent convictions and cautions are 'protected' and are not subject to disclosure to employers, and cannot be taken into account.FILTERING OF CAUTIONS AND CONVICTIONSThe filtering rules (which remove certain old and minor convictions and cautions, reprimands and warnings from a DBS Certificate) were developed by the Home Office and the Ministry of Justice and introduced with new legislation: The legislation is:Police Act 1997 (Criminal Record Certificates: Relevant Matters) (Amendment) (England and Wales) Order 2013 Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (Amendment) (England and Wales) Order 2013 The Filtering Rules. For those 18 or over at the time of the offence:An adult conviction will be removed from a DBS Certificate if, 11 years have elapsed since the date of conviction; and, it is the person’s only offence, andIt did not result in a custodial sentence.Even then, it will only be removed if it does not appear on the range of offences which will never be removed from a certificate, which include serious sexual and violent offences. (see Exceptions to the Rules). If a person has more than one offence, then details of all their convictions will always be included. An adult caution will be removed after six years have elapsed since the date of the caution – and if it does not appear on the list of offences relevant to safeguarding. For those under 18 at the time of the offence:For convictions, the same rules apply as for adult convictions, except that the elapsed time period is five and a half years. For cautions, the same rules apply as for adult cautions, except that the elapsed time period is two years. Exceptions to the RulesSome offences will never be removed from a DBS Certificate. These include the most serious sexual and violent offences. You can view this specified list of offences at:www.gov.uk/government/publications/dbs-list-of-offences-that-will-never-be-filtered-from-a-criminal-record-checkFurther information is also available from:- www.gov.uk/government/organisations/disclosure-and-barring-serviceIf you are unable to access the internet please contact the school who will be able to send this information to you direct.You must provide details of any relevant criminal convictions that you may have. The disclosure of a criminal record may not necessarily prevent you from being appointed. The nature of the offence, how long ago it took place, your age at the time and any other relevant factors may be considered when a decision is made. Please note that some convictions are never considered ‘spent’ under the terms of the Act.PROFESSIONAL MISCONDUCTHave you ever been the subject of professional misconduct proceedings or suspensions from an employer, or such pending or threatened against you either in the UK or abroad? *YesNoIf yes please give details attached to this application OVERSEAS AND UK USE - DECLARATIONThe information you provide will be checked. If you are found to have provided false information your application will be terminated and you will be offered no assignments through SENCare Recruitment Ltd. Further action may be taken.I declare that all the information I have provided is accurate, complete and true. LayoutApplicants Signature *FirstLastDate of Signature *ACCEPTANCE OF POLICY STATEMENTS & TERMS AND CONDITIONSI have carefully read the Policy Statements published by and the Terms and Conditions and agree to be bound by them.LayoutApplicants Signature *FirstLastDate of Signature *DATA PROTECTION STATEMENTThe information that you provide on this form and on any CV given will be used by SENCare Recruitment Ltd to provide you work finding services. In providing this service to you, you consent to your personal data being included on a computerised database and consent to us transferring your personal details to our clients. We may check the information collected, with third parties or with other information held by us. We may also use or pass to certain third parties information to prevent or detect crime, to protect public funds, or in other way permitted or required by law. LayoutApplicants Signature *FirstLastDate of Signature *CANDIDATE DECLARATIONI hereby confirm that the information given is true and correct. I consent to my personal data and CV being forwarded to clients. I consent to references being passed onto potential employers. If, during the course of a temporary assignment, the Client wishes to employ me direct, I acknowledge that SENCare Recruitment Ltd will be entitled either to charge the client an introduction/transfer fee, or to agree an extension of the hiring period with the Client (after which I may be employed by the Client without further charge being applicable to the Client). LayoutApplicants Signature *FirstLastDate of Signature *Bank Account Details (For PAYE Candidates)LayoutName of bankName on AccountAccount NumberSort Code (00-00-00)SENCare Recruitment LTD - Registered Company Number: 12937860Submit