Disabled Job Applicants – Positive Action and Access Requirements
Wherever possible, we will make reasonable adjustments to ensure that disabled applicants are not disadvantaged in our recruitment and selection process. When we talk about reasonable adjustments, we mean making provisions or alterations to the test or interview to remove any barriers faced by disabled applicants.
If you are a disabled person, and you meet all the essential criteria for the post you are applying for, you will be guaranteed a test/interview. Tell us here about any access requirements you may have, or reasonable adjustments you would like us to consider, should you be invited for an interview or test for this post.
Access requirements / reasonable adjustments (if any)
Additional information (Access requirements)
Medical
Please also tell us if you have any Medical conditions at all, and if you think in your opinion they would affect your ability to work.
Medical conditions and impact on ability to work (if any)
Additional information (Medical)
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STEP 6 — VERIFICATION, DRIVING, DBS, REFERENCES & DECLARATIONS
VERIFICATION INFORMATION
Disciplinary Action
Have you ever been the subject of a formal disciplinary sanction or investigation in your current employment?
YES NO Are you in the process of on-going disciplinary proceedings or investigation in your current employment?
YES NO Have you ever been the subject of a formal disciplinary sanction or investigation in any previous employment?
YES NO Details (if YES to any above)
Additional information (Disciplinary)
Driving Licence
Do you hold a current FULL UK Driving Licence?
YES NO If NO, please state which type you do hold (e.g. provisional, PSV etc.)
Do you have access to a vehicle to get to work?
YES NO Do you have any spent/unspent motoring convictions?
YES NO Motoring conviction details (if YES)
Additional information (Driving)
Criminal Record
This position is exempt from the Rehabilitation of Offenders Act 1974. Therefore please list ANY cautions, reprimands, convictions etc.
Have you ever been cautioned or convicted by the Courts/Police for any criminal offence?
YES NO Have you in the past, or are you currently, the subject of any police investigation for any criminal offence or following allegations made against you?
YES NO Details (if YES to any above — include offences, penalties, dates, country, and any driving offences)
Additional information (Criminal record)
Disclosure and Barring
Have you ever been disqualified or barred from working with children and vulnerable adults?
YES NO Is there any reason you know of why you cannot work with children and vulnerable adults?
YES NO Details (if YES to any above)
Additional information (Disclosure & barring)
References (Three Required)
Please provide details of three people who are prepared to act as referees for you. References from family members will not be accepted.
First Referee (Current/Last Employer / Tutor)
Name
Relationship to you
May we contact prior to interview?
YES NO Position held by Referee
Organisation
HR Manager (if known)
Address
Postcode
Telephone no
Email
Second Referee
Name
Relationship to you
May we contact prior to interview?
YES NO Position held by Referee
Organisation
Address
Postcode
Telephone no
Email
Third Referee (Must not be related)
Name
Relationship to you
May we contact prior to interview?
YES NO Position held by Referee
Organisation
Address
Postcode
Telephone no
Email
Additional information (References)
Monitoring — Voluntary & Confidential
Media Source — Where did you see/hear about this vacancy?
Date of birth (optional)
Gender
Male Female Prefer not to say Under the DDA definition, do you consider yourself to be disabled?
Yes No Prefer not to say Do you consider yourself to be a disabled person as defined under the Social Model of Disability?
Yes No Prefer not to say Religion
—Please choose an option— Buddhist Christian Hindu Jewish Muslim Sikh None Other Prefer not to say
If "Other", please state
Ethnic Origin (choose the closest match)
—Please choose an option— British Irish Other White White & Black Caribbean White & Black African White & Asian Other mixed Indian Pakistani Bangladeshi Other Asian Caribbean African Other Black Chinese Other Prefer not to say
If selected "Other", please state
Additional information (Monitoring)
Applicant Signature
Signature of Applicant (type your full name)
Name in Block Capitals
Date
Right to Work (UK)
I confirm that I am legally entitled to work in the United Kingdom and, if interviewed, I will produce the required documents.
Declarations
Data Protection Notification & Authorisation
The information you have provided in completing this application form will be used to process your application for employment. The Company will keep the information you have supplied confidential, and will not divulge it to third parties, except where required by law, or where we have retained the services of a third party representative to act on your/our behalf.
Additional information (Declarations)
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