Application form

Position applied for:

Right to work in the UK:

I am legally entitled to work in the UK: YesNo

Unfortunately as you are unable to legally work in the UK we are unable to take your application further.

Age declaration:

Are you over 20 years of age: YesNo

Regulations require that we cannot recruit anyone under the age of 22 at Autonomy Plus. Unfortunately as you are currently below this age threshold we are unable to take your application further.

However, you are welcome to apply for suitable positions advertised in our other divisions. View current vacancies.

Personal details:

Title:

First name:	Last name:
Telephone number:	Email address:

Postal address including postcode:
Do you have a current DBS? YesNo

Are registered with the DBS update service? YesNo

What is the best time to call your regarding your application?

Do you hold a current, full driving licence?

*Please note, if you're applying for a domiciliary care role, holding a valid driving licence with access to transport is essential.

Rehabilitation of offenders:

Have you been convicted of a criminal offence which IS NOT spent under the Rehabilitation of Offenders Act 1974? YesNo

Please provide details:

Do you have any adult cautions (simple or conditional) or spent convictions that are not protected as defined by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (Amendment) (England and Wales) Order 2020? YesNo

Please provide details:

The amendments to the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (2013 and 2020) provides that when applying for certain jobs and activities, certain convictions and cautions are considered 'protected.' This means that they do not need to be disclosed to employers, and if they are disclosed, employers cannot take them into account.
If you do not disclose something in your application that could prevent you working with children this could result in you being referred to the police and/or DBS as it is a criminal offence for any person who is barred from working with children and/or vulnerable adults to apply for a role in a regulated activity.
If you have made a declaration in relation to a conviction that does not threaten the safety of the vulnerable people we support we will consider your application and explore further during the recruitment process.

Employment History and References:

As part of our regulatory responsibilities and in line with our safer recruitment commitment we are obligated to ensure we have full employment history with an explanation of any gaps.

Have you previously been employed by a service within Autonomy Care Group? YesNo

From:

To:

Please enter the name of service you worked for and your reason for leaving in the box below (if applicable)

We require a reference from your current and previous employer. There may be a requirement to obtain further references.

We require references for all roles, whether employed or voluntary, which have involved working with vulnerable adults or children and young people. Please continue to leave your referee details below when asked.

1. Present/last employer
Company name and address:

Position held, duties and responsibilities:

Dates of employment (to the nearest month):

From:

To:

Reason for leaving:

Reference:

Full name:

Email address:

Telephone number:

2. Previous employer Company name and address: Position held, duties and responsibilities: Dates of employment (to the nearest month):

From:

To:

Reason for leaving: Reference:

Full name:

Email address:

Telephone number:

3. Previous employer Company name and address: Position held, duties and responsibilities: Dates of employment (to the nearest month):

From:

To:

Reason for leaving: Reference (if applicable):

Full name:

Email address:

Telephone number:

References:

If you have any further employed and voluntary roles which involved working with vulnerable adults or children and young people please continue to leave your referee details below.
Reference details must include the following: Company Name, Referee Name, Telephone & Email, Dates of Employment and your reason for leaving.

Please tell us about all other relevant employment history and/or periods of non-employment:

Education:

Please give details of the School/College/University, dates attended and grades / qualifications achieved:

Please give details of any technical or professional qualifications and dates awarded:

Please give details of any further training courses attended that are relevant to your application:

Supporting statement:

Please provide details of any personal or professional experience to support your application, tell us about your values and what you would bring to the role / company.

General Data Protection Regulations

We need to collect and hold data about you in order to process your job application. We would like to obtain your permission (informed consent) to hold this data. Please indicate that you agree to us holding your data for a period of up to 12 months by ticking this box.
Please tick

For more information on your consent and the data we hold please tick here:View

Types of data, length of time held and why

Recruitment data
Includes: Previous employers, Types of job held at other companies, Skills and qualifications obtained.
Why we wish to hold: This will allow us to make a decision on your suitability for employment.
How long do we hold data: Unsuccessful applications 1 year. Appointed candidates 6 years from leaving date.

Equal opportunities monitoring data

Includes: Data relating to age, disability, gender reassignment, marriage or civil partnership, race, religion or belief, sex, sexual orientation that are classed as protected characteristics under the Equality Act 2010.
Why we wish to hold: To feed into the companies monitoring to allow for the delivery of the Equality and Diversity targets. This is not compulsory, forms are anonymous and are separated from application.
How long do we hold data: As soon as uploaded to spreadsheet within 1 month of completion.

Agreement to use my data

I hereby freely give my prospective employer, any company within the Autonomy Care Group Limited; Autonomy Life Limited, Autonomy Care Limited or Autonomy Plus Limited consent to use and process my personal data relating to my job application. In giving my consent:

- I understand that I can ask to see this data to check its accuracy at any time via a subject access request (SAR).
- I authorise the organisation to obtain references to support this application once an offer has been made and accepted and release the organisation from any liability caused by giving and receiving information.
- I understand that I can ask for a copy of my personal data held about me at any time, and this request is free of charge.
- I understand that I can request that data that is no longer required to be held, can be removed from my file and destroyed.
- I understand that if I am unsuccessful with my application my data will be destroyed after 12 months.

Disability:

The Equality Act 2010 defines a disability as a 'physical or mental impairment which has a substantial and long-term adverse effect on a person's ability to carry out normal day-today activities'. An effect is long-term if it has lasted, or is likely to last, more than 12 months.
Do you consider that you have a disability under the Equality Act (please tick)? YesNoPrefer not to say

Declaration:

I declare that to the best of my knowledge and belief the information contained in this application is correct. I accept that providing deliberately false or misleading information may result in my dismissal. I consent to this information being held on file and treated as part of any subsequent contract of employment. I agree to any company within the Autonomy Care Group to use and hold my data as detailed above and in line with legislation. Please tick

How did you hear about us?

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