323 Roundhay Road, Leeds LS8 4HT

Please complete each of the sections and return completed application forms by email to: hr@care-repair-leeds.org.uk

Personal Details
First Name: Last Name:
Address:
Contact Number:-	Day: Evening:
Email Address:

References
Please give the name and addresses of 2 referees. One must be your present or most recent employer. Family members cannot be referees. Referees will be asked to comment on capability, reliability, timekeeping and absenteeism.
1.	2.
Please state in what capacity you are known by each referee.
1.	2.
Please state if you do not wish us to contact either referee prior to interview.

Employment Details
Are you currently employed?
Name and address of your current or most recent employer:
Date Appointed:
Date of Leaving (if relevant):
Job title and brief description of duties:
Current or most recent salary: Reasons for leaving (if relevant): Current number of hours working: (per week) No. of hours preferred to work: (per week)

Education and Professional Training
From	To	Educational/Training Establishment	Qualifications

Previous Employment
Please list other posts held starting with the most recent, including voluntary or other responsibilities you consider relevant. (No more than 10 years)
From	To	Employer	Position held and reason for leaving.

Additional Information
Full UK Driving Licence:	Yes	No
Access to a Vehicle:	Yes	No

Disclosure of Offences
This post involves dealing with vulnerable people and their information. We would therefore require you to disclose all convictions and cautions, no matter how long ago they occurred and regardless of whether the offences were committed as an adult or as a juvenile.
Do you have any convictions or cautions?	Yes	No
Are you currently subject to any criminal proceedings or police investigations?	Yes	No
If you have answered YES to either or the above questions, please give the details below. *Please note a DBS check will be carried out should you be successful in this role*
Date	Nature of Summons, charge or caution etc.	Court	Sentence or Order

Information in support of your application
Please refer to the employee specification for the post and answer each section. Please give examples and demonstrate clearly that you satisfy all the essential criteria. Please limit your answers to the box size only.
Describe your experience of working as a support worker or in an outreach role- provide details of your career journey, highlighting where your experience is relevant to the Breathe Easy role and what you feel you can add to the role
Give details on your experience of dealing with challenging family and social situations, describe how you have overcome initial lack of engagement and mistrust, provide examples where possible

Describe how you manage your own workload effectively and how you deal with conflicting priorities and demands on your time
Provide examples of when you have built, strengthened and maintained professional relationships with funders and partner organisations in order to achieve your job purpose.
Demonstrate your ability to be persistent and tenacious when dealing with obstacles to achieving your goals.
Give details of your previous experience and knowledge of IT & CRM systems and your ability to produce and present statistics via a number of different reporting methods.
Describe how you have improved processes in the past and the benefits realised from those improvements.
Provide detail of your knowledge and understanding of the requirements under the General Data Protection Regulations in handling confidential information.
Declaration
I declare that the information contained in this application form is a true statement.
Signed:	Date:

Equal Opportunities Monitoring Information
Care & Repair (Leeds) is committed to employing a workforce that reflects the community we serve. We will take all reasonable steps to ensure that we do not unlawfully discriminate. In order to monitor our progress, we ask you to answer the questions below. Information provided in this section will be used for monitoring purposes only, to monitor and check the fairness of our recruitment, and will play no part at all in the recruitment process. The information you provide will be kept confidential. If you do not wish to complete all or any part of this monitoring form, you do not have to do so.
Where did you see this post advertised?
What is your gender identity:	Woman Trans	Man Other	Non Binary Prefer not to state
Is your gender identity the same as the gender you were assigned at birth?	Yes No Prefer not to state
How do you identify your sexual orientation?	Bisexual Gay Heterosexual Lesbian Other Prefer not to state
Which age bracket do you fall into?	Under 18 18-24 25-34 35-44 45-54 55-64 65-74 75-84 Over 85
What is your ethnic background?	White British	White Irish
White Welsh	White Scottish	White Northern Irish
White English	Other White	Black African
Black Caribbean	Other Black	Bangladeshi
Indian	Pakistani	Chinese
Kashmiri	Other Asian	White & Black Caribbean
White & Black African	White & Asian	Other Mixed Background
Gypsy/Irish Traveller	Arab	Other ethnic group
Do you consider yourself disabled?	Prefer not to state	Yes	No
If “Yes”, which disability or disabilities do you consider yourself to have?	Learning Disability Physical disability or impairment	Mental Health Disability Sensory disability or impairment