Play Worker Application Form
Templesprings Childcare Services Ltd.
How did you hear about the vacancy?
Templesprings website
Facebook
Job sites
Walked Past
Personal Information
Name
*
First Name
Last Name
Gender
Male
Female
Mobile Telephone
*
Email Address
*
Date of Birth
*
-
Month
-
Day
Year
Date
Address
*
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Employment / Educational Status
Please tick which applies
*
Unemployed
Working Part-time
Working Full-time
Self-employed
Part-time Student
Full-time Student
Name of Current Employer or College
*
Job Title or Course
*
Ethnic Origin
Please tick which applies
*
White (British, Irish or other)
Mixed (White and Asian, White and Black African)
Asian (Asian British, Indian, Pakistani, Nepalese or other)
Black (Black British, Black Caribbean, Black African, Black British or other)
Eastern European (British, European, other)
Chinese, (Chinese British, Chinese or other)
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References & DBS Checks
Please provide the names of two people who have known you for at least 12 months. We will accept one professional and one personal reference. Also, depending on the role you will be required to undergo a DBS Check.
Professional Reference Full name
*
First Name
Last Name
Telephone Number
*
Relationship
*
E.g Manager, HR
Email
*
example@example.com
Reference 2 - Personal
Personal Reference Full name
*
First Name
Last Name
Relationship
*
e.g Parent, Friend
Telephone Number
*
Email
*
example@example.com
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Your Role
Why do you want to work with Templesprings Childcare Services Ltd.?
*
What experience do you have as a play worker?
*
What experience do you have in working with children and young people?
*
What skills do you feel you can bring to your role?
*
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Psychological Wellbeing and General Health
Important Note: The questions on the next page are about your health, both physical and psychological. Please answer the questions honestly. There are no correct answers and no set issues that immediately disqualify you from participating. As we work with children and as part of our safeguarding policy, the information we request is important to maintain a safe environment. If there are any issues that are of concern to us, we shall discuss them with you. The information is held in confidence and will only be accessible to those people who need to know.
Psychological Well-Being
1. Have you ever been treated for depression?
*
No
Yes
If yes, when was this and what treatment did you receive?
2. Have you ever attempted suicide?
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No
Yes
If yes, when was this and how did you attempt suicide?
3. Have you ever experienced violence?
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No
Yes
If yes, when and from whom?
4. Have you ever been violent?
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No
Yes
If yes, when and towards whom?
5. Have you ever suffered with any other mental health/ psychological problem?
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No
Yes
If yes, what was this , when was this and what treatment did you receive?
6. Have you ever been to see a psychologist, counselor, therapist or psychiatrist?
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No
Yes
If yes, when was this, how long were you receiving treatment and why?
7. Have you ever been admitted onto a psychiatric ward?
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No
Yes
If yes, when was this; how long were you an in-patient? Why were you admitted and which unit were you admitted to?
8. Are you currently in any form of therapy, counselling, psychological or psychiatric treatment?
*
No
Yes
If yes, 1) why are you receiving treatment; 2) since when have you been receiving treatment; 3) who is treating you and 4) what is their contact details?
General Health
9. Do you smoke?
*
No
Yes
If yes, how many per day?
10. Describe your alcohol consumption?
*
Never
Occasional (several times a month)
Sometimes (2-3 times weekly)
Often (more than 3 times a week)
11. Do you use any drugs other than prescribed medications?
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No
Yes
If yes, what drugs and how often
12. How often do you exercise?
*
Never
Occasional (several times a month)
Sometimes (2-3 times weekly)
Often (more than 3 times a week)
Please upload your CV*
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Templesprings Childcare Services Ltd.
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