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Application to become a Personal Assistant (PA)

Personal Details

Title

First name

Last name

Telephone number (no spaces)

Mobile telephone number (no spaces)

Email address

Address

Medical History

Please describe any medical conditions you have

Previous Applications

Have you applied to join the scheme before?

Work Restrictions

Any restrictions whilst working in UK?

Offences

Please note that if you have been convicted of any of the following offences your application will not be approved:

Any offence against children, young people or vulnerable adults
Murder
Offences involving serious violence or threats of violence
Offences involving serious theft or fraud where duties allow access to substantial financial resources
Sexual offences of any nature
Serious burglary or arson, where duties involve substantial responsibility for security of buildings or equipment
If you have been placed onto the following lists:
- DBS adults barred list
- DBS childrens barred list
- Section 142 of the Education Act (List 99)
For all other offences appointment is subject to a risk assessment

The role you are applying for is exempt from the provisions of Section 4 (2) of the Rehabilitation of Offenders Act 1974 by virtue of the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975.

This means you cannot withhold information about any conviction. All information given will be verified against a returned DBS check. The term “conviction” relates to a finding of guilt following a hearing in a court of law, including Courts Martial. Prospective employees for jobs exempt from the Rehabilitation of Offenders Act working with children or vulnerable adults will also be asked to declare official warnings, reprimands, registration as a sex offender, cautions, bind-overs and other relevant matters. If you are Approved, not disclosing such convictions could result in us taking you off of the Approved list. Any information given will be completely confidential and will be considered only in relation to an applicant for a role to which the Order applies.

Have you ever been subject to any police warnings, reprimands, cautions, convictions, bindovers and are any of these pending?

References

Approval cannot be confirmed unless we are in receipt of 2 references, as deemed satisfactory by Barnsley Metropolitan Borough Council.

Reference 1 full name

Reference 1 telephone number (no spaces) is required

Reference 1 email address

Reference 1 address

How do you know reference 1?

Reference 2 full name

Reference 2 telephone number (no spaces)

Reference 2 email address

Reference 2 address

How do you know reference 2?

Training, Skills and Qualifications

Have you undertaken an NVQ/Diploma Health and Social Care qualification?

Please provide more information

Please describe any specialist skills you have

Current Employment

Are you currently in employment?

if yes, do you want to continue in this employment if you are successful in gaining a position as an Approved PA?

Please provide further information such as working days and hours

Working Preferences

Are you available to work at short notice?

Do you drive?

Do you have use of a car for work purposes?

Would you like to work with children?

Would you like to work with adults?

Are there any areas of work that you are uncomfortable with?

Confirmation

If at any point you wish to withdraw your consent to the information on the application form being used, in order to progress further, you will need to contact Jane Beech on 01226 775891 or email janebeech@barnsley.gov.uk If approved, I agree to deliver services in accordance with the terms and conditions of the code of conduct