EXPLANATORY NOTES

Revised April 2013
EXPLANATORY NOTES
The application form is designed to ensure that applicants provide the necessary information to determine how they
meet the essential criteria, as well as providing additional information required at the various stages of the
recruitment process. Please see below for some useful tips on completing your application form. Remember it is
important that you allow sufficient time to submit your application form, ensuring that it is accurate and complete.
JOB APPLICATION FORM
You must complete all relevant sections of your application form in sufficient time to ensure that it is received on or
before the closing date and time as recorded on the top right hand corner of your form. If you have insufficient
space to record all your qualifications and experience on your application form, you may continue on a separate
sheet. Your application will not be considered if you only state „see separate sheet‟ or „see CV attached‟.
JOB DESCRIPTION
The job description describes the purpose, scope, main duties and responsibility of the job. Study the job
description before completing your application form, then indicate on your form how, in your opinion, your
experience and/or qualifications are relevant to the post you have applied for.
PERSONNEL SPECIFICATION
Study the criteria within the Personnel Specification carefully and ensure that you accurately record all of your
experience and qualifications that demonstrates that you meet the criteria.
The minimum criteria describe the essential requirements for the post but depending on the number of applicants,
the panel may decide to increase the criteria to include additional factors which are desirable. You should therefore
include a full record of your qualifications and experience and clearly demonstrate how you feel you meet the criteria
as detailed in the personnel specification. Failure to do so will result in your application not being shortlisted or being
rejected at a later stage in the process. Remember that the panel cannot make assumptions about your qualifications
or experience, therefore it is your responsibility to ensure that you have detailed all of the relevant information required
in order to demonstrate that you meet the criteria.
Please Note: The selection process may take the form of an aptitude test or tests, you may be required to attend
an assessment centre or submit a written paper on a specific topic or undertake other methods of assessment prior
to interview.
DISABILITY REQUIREMENTS
We ask on the application form if you require any reasonable adjustments, due to disability, to enable you to attend
the interview or undertake the duties of the post. Details of any disability are only used for this purpose and do not
form any part of the selection process. If you require any reasonable adjustments to be made throughout the
recruitment process, please contact the Recruitment & Selection Department to make arrangements for your
requirements in advance of your test, assessment centre or interview.
Completing the Criminal Convictions / Offences Section
Legislation requires you to tell us about any criminal convictions or offences that you may have. Within the HSC,
criminal convictions are never regarded as spent and therefore you must tell us about all previous or pending
convictions or offences, even if they happened a long time ago, this even includes motoring offences.
The Trust is committed to the equality of opportunity for all applicants, including those with criminal convictions.
Whilst the disclosure of information does not automatically prevent an individual from obtaining employment, it is
essential that all convictions are disclosed to allow us to adequately consider their relevance to the post in
question. We consider failure by an applicant to declare complete and accurate information about convictions to be
a serious breach of trust which will normally result in any withdrawal of offer.
Access NI Disclosure – The Trust operates in line with the Access NI Code of Practice. Further details can be
obtained from www.accessni.gov.uk
Revised April 2013
Data Protection
The information you provide will be processed in accordance with the Data Protection Act 1998.
EDUCATION
Below is an example of how you should record your qualifications:
Awarding
Body
C.S.E
Grade
Year
Awarding
Body
I
1986
R.S.A
B
1987
C
A
O
Level
G.C.S.E
Subject
Passed
Computer
Studies
English
Language
Mathematics
G.C.E
Mathematics
G.C.E
Leaving Cert.
Std
N.V.Q
Leaving Cert
Hons
N.V.Q
Business
Admin.
O
A
Business
Admin.
Stage/
Level
Part
Typewriting
II
1
Dist.
1990
R.S.A
Typewriting
II
2
Pass
1990
1989
R.S.A
II
1
Pass
1993
B
1989
R.S.A
II
2
Pass
1993
C
1990
R.S.A
III
1
Pass
1994
1992
R.S.A
III
2
Pass
1994
1992
O.C.R
2
2004
O.C.R
Text
Production
Word
Processing
Pass
1994
Word
Processing
Word
Processing
Audio
Transcription
Audio
Transcription
Text
Production
Text
Production
Pass
2004
II
III
B
Secretarial
Subjects
2
Grade
Year
It is important that you accurately record all qualifications e.g. if English Language is an essential subject required in
the criteria you will NOT be short listed if you only record English (except GCSE English), identifying double awards. It
is also essential that you accurately record all your typing qualifications including the relevant parts, for example Part I
& II for all stages.
Completing Your Current / Previous Employment Details
Ensure that full details are provided.
Be specific about all the dates that you provide, these should be stated in the following format DD/MM/YYYY.
Explain any gaps between periods of employment and include reasons for leaving each post.
Provide a list of key duties that you have been responsible for in current post / previous posts.
If you are employed on a “Bank” or “ As and When Required” capacity – please specify the days/hours per
week/month that you work.
For care posts please ensure that when entering details of the post and description of duties that you specify the
client group (e.g. Elderly, Mentally Ill, etc).
Completing the Medical History Section
This section requires you to tell us about any periods of sickness you have had in the last 2 years, whether you have
been in employment or not. Please ensure that you include all dates that fall within this time period giving relevant
details of the nature of the illness / absence. Your sickness absence record will be verified through the reference
checking process; therefore it is important that you give full and accurate information. Failure to disclose all periods
of sickness may affect your application.
Completing the Reference Section
Your references should normally cover previous employment, training and or education.
Ensure that you have provided the names of two referees (who must not be relatives).
One of your references should have knowledge of your present work / or most recent employment and be in a
supervisory/managerial capacity. If you are a student you should provide the name of your college tutor/lecturer
or teacher/principal.
Please note that where applicable, we will always seek a reference from your last HSC/NHS manager / employer.
Revised April 2013
Please see below for guidance:
Candidate Employment Position
Currently employed
Not currently employed
Never been employed
Previously employed in the HSC/NHS
Self Employed
Reference 1
Reference 2
From current employer
From employer prior to current
From most recent employer
From previous employer
Character* reference / relevant Academic** reference / Other
From current employer
From previous HSC/ NHS employer
Character reference*
From previous employer / relevant
Academic** reference / Other
*Character Reference – e.g. Accountant, Banker, HM Revenue & Customs, Solicitor, Client references or
voluntary organisation
**Academic Reference – e.g. school, college, university
This section must be completed in full, therefore be sure to include complete names, job titles, and addresses,
including email addresses for both of your referees.
Completing the Equal Opportunity Monitoring Form
Please note that this information is regarded as part of your application and you are strongly encouraged to
complete this section. This information is treated in the strictest confidence and is for monitoring /statistical
purposes only. Selection panels do not have any access to this information at any stage of the recruitment
process.
Submitting your completed form to the Recruitment & Selection Team
Your application must be received by the Recruitment & Selection Team by the stated closing date and time. Late
applications will not be accepted. Forms will also not be accepted if they are incomplete or have been
reformatted i.e. printouts of online applications only give a summary of your information and some information can
be omitted, this may lead to your application not going forward in the recruitment process. If you are applying
online you are required to submit your application online.
Please remember that the standard Application Form is the only acceptable method of application.
Application forms can be submitted through one of the following channels:
http://www.westernhealthjobs.com – full details on completing an on line application form are provided at this
web address. REMEMBER to not leave it until the last minute as something could happen to the internet at
either end
Posted to the Recruitment & Selection Department, Lime Villa, 12c Gransha Park, Londonderry, BT47 6WJ.
st
*Applicants using Royal Mail should note that 1 class mail does not guarantee next day delivery. It is the
responsibility of the applicant to ensure that sufficient postage has been paid to return the form to the address
above by the stated closing date and time.
Finally, please check to ensure that you have answered yes or no to the question on car driver.
Revised April 2013
WESTERN HEALTH & SOCIAL CARE TRUST
Recruitment Department
12C Gransha Park
Clooney Road
Londonderry
BT47 6WJ
Tel: (028) 7186 0616
An Equal Opportunity Employer
OFFICE USE
Applicant No _________________________________
Ack___________________ Appoint______________
S/L___________________ Reserve______________
Int Time_______________ Waiting List___________
Int Date_______________ Regret_______________
References Received and Checked
1
2
Please state clearly the details of the post you
wish to apply for. Failure to do so will result in
your application not being considered.
Post title:____________________________________
Ref. Number:_________________________________
Closing Date:_________________________________
FAILURE TO COMPLETE ANY PART OF THIS FORM MAY RESULT IN YOUR APPLICATION
NOT BEING CONSIDERED. CV’s ARE NOT ACCEPTABLE
1. PERSONAL DETAILS
Mr/Mrs/Miss/Ms/Dr
Surname
National Insurance No
Any Former Surname
Citizen of EC Country
Forenames
Non EC (Please State)
YES/NO
Address
Do you have access to a Motor Car
YES/NO
Do you possess a Current Full Driving Licence
YES/NO
Do you have a disability as defined in the
Disability Discrimination Act 1995?
Postcode
Do you require special arrangements to be made when
Tel No Home
attending interview / test / assessment centre?
Work or Other Contact No
Email Address
YES/NO
YES/NO
IMPORTANT: ALL CONVICTIONS MUST BE DECLARED INCLUDING MOTORING OFFENCES
Have you been at any time convicted of a Criminal Offence or Cautioned or do you have any Prosecutions Pending? Please see
Explanatory Notes for guidance.
YES
NO
If Yes please detail:……………………………………………………………………………………………………………….
PROTECTION OF CHILDREN & VULNERABLE ADULTS
NB Child Care / Learning Disability / Regulated Posts / Care Positions Only:
Have you ever had any involvement in or been the subject of any adult or child abuse investigations? YES
If YES please give dates, details and outcomes of all incidents on a separate sheet.
Please state all previous addresses. Continue on separate page if necessary:
NO
Revised April 2013
2.
EDUCATION
Your results - General Certificate of Education/Leaving Certificate/Senior Certificate/General Certificate of Secondary
Education, etc. please specify
A
Awarding
Body
Subject
Level
Grade
Year
Awarding
Body
Secretarial
Subjects
Stage
Part
Grade
Year
University Degree(s), Diploma(s), Technical Qualifications (or equivalent) Obtained with Dates
B
Qualification
University/College
Dates
C
Apprenticeship Details
Date Completed
3.
PROFESSIONAL QUALIFICATIONS
A
By Examination
Name of Professional
Body or Bodies
B
By Election (Give Details)
C
Registration Details
Examination Taken
Intermediate with date
Final with date and result
and result
Examination Yet
to be taken with
dates
(i) PROFESSIONS SUPPLEMENTARY TO MEDICINE / ALLIED HEALTH PROFESSIONALS
Type of Registration:
Date of Expiry:
Registration/Enrolment No:
(ii) NURSING
NMC PIN No:
Expiry Date:
Part(s) of live NMC Register:
(iii) MIDWIFERY POST:
Are you eligible to practise?
YES
NO
IF APPOINTED, YOU WILL BE REQUIRED TO PROVIDE ORIGINAL CERTIFICATES FOR ALL
EDUCATIONAL/PROFESSIONAL QUALIFICATIONS LISTED AND PROOF OF REGISTRATION
Revised April 2013
4. PRESENT EMPLOYMENT DETAILS (It is not necessary to record this again in Section 6.)
Present or most recent Employer
Name and Address
Title of Post Held & Grade/Band
Location/Base
Date appointed to this post
Present Salary
Period of notice required by present Employer
Brief description of current duties
5.
TRAINING / CONTINUING PROFESSIONAL EDUCATION
Please give details of any courses you have attended (with dates) and details of training and development received.
Revised April 2013
6.
EMPLOYMENT RECORD
Please list across column 1-5 your previous posts beginning with the most recent and indicate how in your opinion this experience has a bearing on your present application.
1.
DAY
DATES
FROM
MTH
YEAR
2.
DAY
TO
MTH
YEAR
3.
NAME AND ADDRESS
OF EMPLOYER
TITLE OF POST HELD/GRADE/BAND AND BRIEF
DESCRIPTION OF DUTIES
4.
REASON FOR
LEAVING
5.
SALARY
Revised April 2013
EMPLOYMENT RECORD (Continued)
Please list across column 1-5 your previous posts beginning with the most recent and indicate how in your opinion this experience has a bearing on your present application.
1.
DAY
DATES
FROM
MTH
YEAR
2.
DAY
TO
MTH
YEAR
3.
NAME AND ADDRESS
OF EMPLOYER
TITLE OF POST HELD/GRADE/BAND AND BRIEF
DESCRIPTION OF DUTIES
4.
REASON FOR
LEAVING
5.
SALARY
Revised April 2013
7.
ATTENDANCE RECORD
Number of days absent on sick leave in the past 2 years:
Number of sick leave episodes in the past 2 years:
This information may be subject to verification with your employer
8.
OTHER INFORMATION
Please give details of any information which you think may have a direct bearing on your application, e.g., voluntary work
or spare time activities
9.
REFEREES
Please name two referees, at least one of whom should have knowledge of your present work/or most recent employment and be in
a supervisory/managerial capacity. If you are a student you should provide the name of your college tutor, lecturer, teacher or
Principal. (Relatives should not be named as referees). If you have worked in the HSC/NHS, your last HSC/NHS Line Manager or
Employer must be one of these referees. Your references should normally cover your last 3 years of employment, education or
training.
1.
Name
2.
Name
Designation
Designation
Address
Address
Tel No.
Tel No.
E-mail
E-Mail
If you do not wish your Referees to be contacted prior to an offer of employment please tick here:
10.
MEDIA DETAILS
Please indicate how you became aware of this vacancy
Belfast Telegraph (M001)
Derry Journal (M402)
Londonderry Sentinel (M408)
Tyrone Constitution (M411)
Ulster Herald (M412)
Fermanagh Herald (M406)
The Impartial Reporter (M407)
Internet (M417)
Training & Employment Agency (M413)
Health & Social Services Trawl (M006)
Internal Trawl (M017)
Other Publications - Please Specify
Revised April 2013
11. DECLARATION
I declare that the foregoing information is true and correct to the best of my knowledge and belief. I understand that appointment
may be subject to satisfactory vetting and medical examination, and that canvassing will disqualify.
I am aware that I will be held responsible for the accuracy of this Declaration and that if any information is found to be false within
my knowledge or if any relevant fact has been wilfully suppressed, that the Trust may terminate my existing contract of
employment, or if appointed to this post my contract may be terminated or any offer of employment withdrawn.
I agree, if the post involves working with children, young people, persons with a learning disability, or is classed as a care position
or regulated post, that the Trust can request relevant information from the DHSSPS and the PSNI.
I understand that in submitting this application form and in any subsequent employment with this Trust, I consent to my
information being processed in accordance with the Data Protection Act 1998.
Signature
…………………………………………………..
Date
……………………………………………………….
The Trust will treat the information given in this application as confidential. Applicants are advised that legal processes may
require the Trust to disclose the form to certain statutory bodies.
Application form will not be acknowledged unless a stamped addressed envelope is received.
HAVE YOU COMPLETED YOUR MONITORING FORM?
Revised April 2013
EQUAL OPPORTUNITIES MONITORING
Reference No________________
The Health & Social Care (HSC) organisation is committed to equality of opportunity for all staff and job applicants.
The HSC organisation selects those suitable for employment and advancement solely on the basis of merit and is also
monitoring its activities to ensure that its equal opportunity policy is effectively implemented. Section 75 of the
Northern Ireland Act 1998 requires us to promote equality of opportunity on the basis of all nine categories. To assist
in this monitoring process it is necessary to ask you a number of questions.
/
/
(1)
Date of Birth:
(2)
Sex:
Male

Female
(3)
Marital Status:
Single

Married/Civil Partnership



Other
(4) Community Background: To demonstrate our commitment to equality of opportunity in employment we need to
monitor the community background of applicants and employees, as required by the Fair Employment and Treatment
(NI) Order 1998. We therefore ask you to indicate your community background by ticking the appropriate box below .
Please note that it is an offence under the Fair Employment and Treatment (NI) Order 1998 to give false
information to the Trust.
a)
I am a member of the Protestant community

b)
I am a member of the Roman Catholic community

c)
I am a member of neither the Protestant nor the Roman Catholic community

d)
We recognize that there may be occasions where religious belief differs from perceived community background.
In order that our records are correct, we therefore would ask you to indicate your religious belief by ticking one
box.
(5)
Muslim

Hindu

None

Other
(please specify) ________________________
Sikh

Jewish

Buddhist

Christian

To which of these ethnic groups do you consider you belong:
White
Chinese
Indian
Filipino




Black African
Irish Traveller
Black Caribbean
Black Other




Bangladeshi
Pakistani
Mixed Ethnic Group



Any Other Ethnic Group (please specify) _________________________
Please also specify your nationality:
(e.g. Latvian, Lithuanian, Polish, British, Scottish, Welsh, Irish, Portuguese etc.)
_________________________________
(6)
Do you have caring responsibilities for:
(tick each box that applies to your circumstances)
a child (or children)
a dependent older person
a person(s) with a disability
none of the above
(7)




Disability:
The Disability Discrimination Act 1995 defines disability as a physical or mental impairment which has a
substantial and long-term effect on a person's ability to carry out normal day-to-day activities. "Normal day-to-
Revised April 2013
day activities" listed in the Act are mobility; manual dexterity; physical co-ordination; continence; ability to lift, carry or
otherwise move everyday objects; speech, hearing or eyesight; memory or ability to concentrate, learn or understand;
or perception of the risk of physical danger.
Anyone diagnosed as having cancer, HIV or multiple sclerosis is automatically and immediately protected by the DDA.
(If you take medication, treatment or have a prosthesis to manage your condition, would you consider that
you had a disability if you were without these? If so, you should answer ‘yes’ below.)
Having read this definition, do you consider yourself as having a disability?
Yes


No

I do not wish to answer
If yes, please indicate which type of impairment(s) apply to you:
(please tick all that apply to you)
Physical Impairment, such as difficulty using arms or, mobility requiring a wheelchair or crutches

Sensory Impairment, such as blind/visual impairment or deaf/hearing impairment


Mental health condition, such as depression or schizophrenia
Learning disability, such as Down’s Syndrome, Dyslexia or Cognitive Impairment such as Autism


Illness, such as cancer, HIV or multiple sclerosis

Long standing illness, such as diabetes, chronic heart disease or epilepsy
Other ________________________________________________________________
(8) Sexual Orientation:
My sexual orientation is towards someone:
Of the opposite sex

I do not wish to answer
Of the same sex

Of the same sex and of the opposite sex


(9) Political Opinion:
Please tick the appropriate box to indicate your political opinion.
Broadly Unionist
Broadly Nationalist
Other
I do not wish to answer




(10) Are you currently an employee of the organisation to which you are applying (excludes agency workers)?
Yes

No

Access to this information will be strictly controlled. Monitoring will involve the use of statistical summaries of
information in which the identities of individuals will not appear. Whilst the HSC organisation will treat the information
given on this monitoring form as confidential, staff are advised that legal processes may require the HSC organisation
to disclose the information given to certain statutory bodies, and, in some circumstances, open Tribunal. Employees
should complete the form in the knowledge that it will be processed in line with requirements of the Data Protection Act
1998.
The information will subsequently be transferred to the monitoring system operated by the HSC organisation. There it
will be strictly controlled in accordance with an agreed Code of Practice.
Revised April 2013
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