Reference No: HR10

Page 1 of 8

reallifeoptions
APPLICATION FOR EMPLOYMENT
Please complete fully, using black ink and send it to the address provided in the letter sent with this form Post Ref:
For any queries relating to this form please ring 01977 781800

PERSONAL DETAILS
Surname ………………………………………….………………...…. Forename(s) …………………..………….………………...……………………………………

Any Previous or other name(s) …………………………………………………….…………………………….………...……………………………………………………

Preferred Name …………………………………………………………………………………………………….………………………………………………………………………..

Address ………………………………………………………………………………..………………………………………………………………………….….……….………………

……………………………………………………………………………………… .… Postcode ……………….......................

Day time telephone number ……………………………..…… ………. Evening telephone number: ………… .. …….………….

Do you hold a drivers licence?: Full/Provisional/None Do you have any motoring convictions? YES/NO if yes specify:
…………….…………………..…………………………………………………………….. National Insurance number ……………………………………………
Applicants should be aware that if invited to interview we will need to see documentation confirming right to work in the
United Kingdom. This applies to all candidates regardless of ethnic origin or place of birth.
……….
GENERAL INFORMATION
Have you been employed by RLO before? YES NO

If yes, please tell us the approximate dates of your employment and in what capacity ……….………………………………………………….

………………………………………………………………………………………………………………………………………………………………………………………………….…….
Do you wish to apply for: a full time post YES NO a part time post YES NO

To the best of your knowledge, are any relatives or family members employed by Real Life Options? YES/NO

If yes, what is your relationship to them? ………………………………………………………………………………………………………………………………….

EDUCATIONAL, VOCATIONAL AND PROFESSIONAL QUALIFICATIONS

Please use separate sheet if necessary
Details of qualification Awarding body Registration number where
applicable

JOB RELATED TRAINING UNDERTAKEN WITHIN THE LAST 5 YEARS

Details of the training undertaken Certificates or qualification Date of training
gained

Issue Date: May 2008

 Reference No: HR10
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EMPLOYMENT HISTORY
We need to know your employment history for the last 10 years (please include overseas employment)
Your current or most recent employment details
Name and Address of your employer Dates employed from …… / ……. to …… / ……

Job Title

Present Salary

Post code Notice Period

Brief description of duties and responsibilities What is your reason for leaving

Previous employment
Please include any part time or voluntary work and provide explanations for any gaps in employment (ie bringing up a family/
unemployed / further education etc and use a separate sheet if necessary
Dates Name and Address of employer Job title and summary of Why did you leave?
duties
FROM

…….….. / ………..

TO

…….….. / ………..
FROM

…….….. / ………..

TO

…….….. / ………..
FROM

…….….. / ………..

TO

…….….. / ………..
FROM

…….….. / ………..

TO

…….….. / ………..
FROM

…….….. / ………..

TO

…….….. / ………..
FROM

…….….. / ………..

TO

…….….. / ………..

Issue Date: May 2008

 Reference No: HR10
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DISCLOSURE OF CRIMINAL RECORDS
Because of the nature of some posts it is important that you complete this section carefully and accurately. Applicants for
posts working with or having access to Vulnerable Adults will have to have a check carried out through the Criminal
Records Bureau (England) or Disclosure Scotland (Scotland).

Because the position for which you have applied may be covered by the Rehabilitation of Offenders Act 1974 and the Care
Standards Act 2000, you are required to disclose all convictions and cautions no matter how long ago they occurred
and regardless of whether the offence was committed as a juvenile or adult.

DO YOU HAVE, OR HAVE YOU EVER HAD, ANY CONVICTIONS, CAUTIONS, ADMONISHMENTS,
REPRIMANDS OR FINAL WARNINGS? YES NO

ARE YOU CURRENTLY THE SUBJECT OF CRIMINAL PROCEEDINGS OR POLICE INVESTIGATION? YES NO

IF EITHER ANSWER IS YES, PLEASE GIVE DETAILS HERE

DATE NATURE OF SUMMONS, CHARGE, CAUTION, SENTENCE OR ORDER
ALLEGATION

If you would like a copy of our policy on the employment of people with a criminal record or
to discuss any aspect of this please contact our HR Department on 01977 781800

REFERENCES
We will need to take a minimum of two references, one of which must be from your most recent employer. Your second
referee should not be from the same organisation and may be a character reference. References will not be accepted from
family members. RLO retains the right to seek references from a previous employer where that employment is
relevant to the position for which you have applied, particularly if more recent employment has been in other
types of work ie not care related.
Applicants for management posts should provide 4 referees, of which 3 will be employment related (please use an
additional sheet)

Your present or last Employer Second reference

References should be provided by a person with the authority
to give a reference on behalf of the employer

Name and position held Name, position held and

your relationship with this person

Organisation Organisation

Address Address

Postcode

Postcode

Telephone Telephone

May we approach the above prior to interview? Yes/No May we approach the above prior to interview? Yes/No

Issue Date: May 2008

 Reference No: HR10
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SUPPORTING INFORMATION
After reading the person specification and job description please use this section to tell us more about yourself
and highlight any knowledge, experience or skills that you would bring to the post

You can use an additional sheet if necessary

DISABILITY
RLO is a holder of the Employment Service ‘Positive about Disabled People’ symbol and has a positive
approach to the employment of people with a disability. As a Symbol user RLO is committed to
interviewing all disabled applicants who meet the minimum (essential) criteria.
Do you consider yourself to have a disability as defined by the Disability Discrimination Act? (The Act defines a
disabled person as a person with ‘a physical or mental impairment which has a substantial and long term adverse
effect on a person’s ability to carry out normal day to day activities’). YES / NO
If you do consider yourself to be disabled, please give details and tell us what adaptations or adjustments you
think you would require to carry out the duties of the job as detailed in the job description.

……………………………………………………………………………………………………………………………………………………………………………………..
………

…………………………………………………………………………………………………………………………………………..
…………………………………………………
If you are invited to interview in respect of this application are there any special requirements you would need us
to provide?

…………………………………………………………………………………………………………………………………………………………………………………………
……

APPLICANT DECLARATION

I declare that the information I have provided and the statements I have made, including those relating to the disclosure of
any criminal record and medical information, are both true and complete and that I am both mentally and physically fit to
undertake the post as detailed within the job description. This information will form the basis of my employment and
become a part of my Contract of Employment. Should it subsequently be proved that any information is false, misleading
or has been withheld I understand that any offer of employment may be withdrawn or, should I be in employment with
RLO, that I may be dismissed.
I accept that information within this application form will be used by RLO for the purpose of processing my application.
Further, should my application be successful and I am employed by RLO, information about me, including that relating to
my ethnic origin and health, will be retained and processed for the purposes of monitoring and employment procedures in
accordance with the Data Protection Act 1998.

SIGNATURE …………………………………………………………...............… DATE ………………………………………………………………….

Real Life Options

Issue Date: May 2008
 Reference No: HR10
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Visit our web site at www.reallifeoptions.org

For any queries relating to this form please ring 01977 781800
Please see covering letter for return address

Issue Date: May 2008

 Reference No: HR10
Applicant Information Page 6 of 8

reallifeoptions - the organisation

RLO is a national not-for-profit voluntary organisation committed to continuous quality improvement in delivering
services to people with learning disabilities in both England and Scotland.
Our service base includes supporting people in their own home and provision of respite, vocational, domiciliary and
outreach services. We are passionate about empowering and supporting people with severe disabilities in
developing valued lifestyles within their own homes and community.
We are a ‘values-led’ organisation with our service provision based very strongly on our core principles, as set out
in our values statements. Copies of these can easily be obtained by calling our head office on 01977 781800 or
accessing our web site.
Our first services were established in north London in 1993 but since then we’ve grown and developed services
across Yorkshire, the north east of England, central and southern Scotland and in the Midlands.
We value the contribution that staff teams and individual employees make to the quality of our services and have
opportunities for people regardless of age (although you must be over 18), experience and qualifications.
What is important is that you share our values, are enthusiastic and committed, with a good sense of humour and a
practical approach to working with people with severe disabilities.

reallifeoptions - the employer

RLO strives to be an equal opportunities employer and will not condone any form of discrimination. We
have people management policies and procedures which support our commitment to equality of
opportunity. We are a user of the Employment Service’s Positive about Disabled People symbol, which
recognises that the organisation is committed to employing people with disabilities.
Our Conditions of Service are comparable to many other national voluntary organisations. Salary structures are
agreed regionally and all salaries are reviewed annually. We offer
 Holiday entitlement of 28 days including customary holidays (pro rata for part time staff)
 Enhanced payments for working customary holidays
 Company Sick Pay Scheme
 Attendance Incentive Scheme
 Comprehensive induction and training programme
 Support to obtain S/NVQ to level IV
 Flexible working patterns
 Structured system of support
 Additional payments for sleeping in duties
The hours of work for most full time operational staff are 39 hours a week, according to the shift rota in operation
for each service. Many of our services provide support to individuals 24 hours a day 7 days a week. This means
that rotas can include late and early shifts, along with weekend working. You may also be required to work on
customary holidays, but enhanced rates are paid. Because of the nature of our services, actual hours of work in
each week may vary.
Sleep-in duties can be a feature of some roles, for which an allowance is paid. You may also be asked to
accompany service users on holiday and, again, allowances are paid.
Real Life Options’ designated Stakeholder Pension Provider is Norwich Union.

reallifeoptions – committed to developing of its workforce

 We will ensure that you are provided with every opportunity to maintain and develop your skills and
competence.
 All operational employees must complete the national Common Induction Standards and we have our own
team of learning and development officers and specialist trainers to deliver our training programmes.
 We are committed to employees achieving S/NVQ recognition and established programmes and support
networks are active throughout RLO.
 As an RLO employee you will receive regular structured supervision from your line manager.
 To support our work with service users we have a comprehensive range of policies, practices and procedures
in place.
 Real Life Options achieved the Investors in People Standard in 1997. At reviews in 2000 and
2003
RLO was again acknowledged to be exceeding its requirements in many areas of the Standard .

Issue Date: May 2008

 Reference No: HR10
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RECRUITMENT MONITORING

Name: Job Reference:

After filling in the next two pages please place them in a sealed envelope and send them to
us with your completed application form with your name on the front. They will not be
available to the short-listing panel.

YOUR HEALTH
If we have any concerns about your fitness for work, it may be a condition of your employment that
we obtain a medical report or that you undergo a medical examination. A health problem does not
preclude a person from being considered for employment and we need to be sure that, should your
application be successful, appropriate support is provided to you to enable both yourself and others to
work safely and to ensure the welfare of service users is not put at risk.

1. How many days have you been off work because of ill-health or incapacity in the last two years? .………………………………

2. Please provide details of the nature of your illness or incapacity, dates and approximate length of these absences
…………………………………………………………………………………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………………………………………………………………………

3. Have you undergone any hospital treatment during the past five years? YES/NO If yes please provide brief details

…………………………………………………………………………………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………………………………………………………………………
4. a) Do you suffer from

Diabetes YES / NO Frequent Headaches YES / NO Ear problems YES / NO

High blood pressure YES / NO Heart problems YES / NO Eye problems YES / NO

Asthma YES / NO Migraine YES / NO Rupture YES / NO

Arthritis YES / NO Hay fever or Allergies YES / NO Depression YES / NO

Epilepsy/fits YES / NO Varicose veins YES / NO Stress or anxiety YES / NO

Skin rashes/eczema YES / NO Back pain YES / NO

b) How does this affect you at present? ………………………………………………………………………………………………………………......

…………………………………………………………………………………………………………………………………………………………………………………………

5. Do you have any other illness or medical condition that might affect your attendance or performance at work? YES/NO

If yes, please tell us about it ………………………………………………………………………….…………………………………………………………….……

……………………………………………………………………………………………………………….………………………………………………………………………….……
6. If you are receiving medical treatment at present, what is the nature of this treatment?

………………………………………………………………………………………..……………………………..………………………………………………………………………

7. Do you take medicine or tablets regularly? If yes, please tell us what for

…………………………………………………………………………………………………………………………………………………….………………………….………………

…………………………………………………………………………………………………………………………………………………………………………………………………

Issue Date: May 2008

 Reference No: HR10
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RECRUITMENT MONITORING
EQUAL OPPORTUNTIES
Real Life Options seeks to be an equal opportunities employer and give a fair deal to people within every section
of the community. We would be grateful if you could answer the following questions, which will be treated in a
confidential manner so that we can monitor our progress towards that aim. They will not be referred to in
considering your application, unless the nature of the post being applied for is deemed to be exempt from either
the provisions of the Sex Discrimination Act 1975 and the Employment Act 1989 or the Race Relations Act 1976.

Are you: Male Female

What is your date of birth? ………. / ………. /………………..

How long have lived in the UK …………………………………………

How did you find out about this job? Publication / Website / Job Centre / Other (please state) …………………………………………

How would you describe your race or cultural origin?

Please choose ONE section from A to F and tick the box that indicates your background

A White

British
Irish

White other, please write in

B Mixed Race
White and Black Caribbean
White and Black African
White and Asian
Any other mixed background, please write in

C Asian, Asian British

Indian
Pakistani
Bangladeshi
Any other Asian background, please write in

D Black, Black British

Caribbean
African
Any other Black background, please write in

E Chinese, Chinese British or Other Ethnic group

Chinese

F Any other background, please write in

The information you have provided (but not your name) may be used to provide statistical analysis so that we can
monitor our compliance with best practice in terms of equal opportunity and non-discrimination.

Issue Date: May 2008