Please enable JavaScript in your browser to complete this form. - Step 1 of 5First Name *Please give us your full legal first name - we will use it when we undertake the DBS/police check Family Name *Please give us your full legal family name - we will use it when we undertake the DBS/police check Preferred name - is there another name you prefer to be known by? *NoYesAddress *Address Line 1Address Line 2CityState / Province / RegionPostal CodeAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryTelephone *Email *ReferencesPlease give us the names and contact details of two people who know you well (for at least 6 months) and would be happy to answer a few questions about you. They should be an academic tutor or employer. If you have only been in the UK for a short time, we can take up references from people based outside the UK.Reference 1 Name *Reference 1 Email *Reference 1 TelephoneHow do you know this person? *When did you last have contact with them? *Reference 2 Name *Reference 2 Email *Reference 2 TelephoneHow do you know this person? *When did you last have contact with them? *NextPlease answer the following questions:Why do you want to do this role and what do you think would make you good at it? *Have you any experience of working or volunteering with refugees, asylum seekers or migrants? If yes, please describe your experience. *Do you speak any languages other than English? If yes, please list them. *How did you find out about Salusbury World and about this project? *NextSupport and Health NeedsSalusbury World welcomes applicants with a range of abilities for the skills they bring. We aim to create a positive environment that enables all staff to realise their full potential. In order that we can consider any appropriate adjustments to the work environment and better support you in your role, please give details of any disabilities or health issues. *Is there anything you need us to do or provide to enable you to work with us? *YesNoNextEqualities and MonitoringSalusbury World recognises and values people’s differences and will assist them to use their talents to reach their full potential. We welcome applications regardless of age, sex, race, nationality, ethnic origin, religion, disability or sexual orientation. You do not have to complete this part of the form but if you would like to do so the information will be very helpful to us in understanding where we need to target recruitment. This is to help better support the refugees and migrants we work with.What is your gender?FemaleMaleI describe my gender in another wayPrefer not to sayWhat are your preferred pronouns? *She/herHe/himThey/themEthnicityWhite BritishWhite IrishAny other White background (please specify)MixedWhite and Black CaribbeanWhite and Black AfricanWhite and AsianAny other Mixed BackgroundAsian or Asian BritishIndianBangladeshiPakistaniSri Lankan TamilSinhaleseAny other Asian background (please specify)Black or Black BritishBlack CaribbeanBlack GhanaianBlack NigerianBlack SomaliAny other Black background (please specify) (copy)Other Ethnic GroupsChineseFilipino KurdishArabAny other background (please specify) (copy) (copy)NextFile Upload * Click or drag a file to this area to upload. Please attach your CV.GDPR Agreement *I consent to having this website store my submitted information so they can respond to my inquiry.Mailing ListKeep me up to date with all the latest news and events from Salusbury World! By ticking this box, I consent to Salusbury World adding me to the mailing list.Keeping Children SafeWe are committed to protecting the children, young people and families we work with and keeping them safe. We select, check and manage our staff to make sure that we are able to do this. // Criminal Record and Disqualifications A criminal record is not necessarily a bar to working with us but, due to the nature of the role, any criminal record will need to be disclosed to us. You must include all convictions you've ever had – even if they're now spent, or if you were a juvenile at the time. Please, therefore, answer the following questions: Have you ever been convicted of any criminal offence or cautioned, reprimanded or given a final warning by the police (spent or unspent)? *YesNoAre you disqualified from working with children or vulnerable/protected adults? *YesNoAre you aware of any police enquiries, following an allegation made against you, which may have a bearing on your suitability for the role? *YesNoDetails of any offences, penalties and/or police enquiriesIf yes, please give all details of all offences, penalties and/or police enquiries to Sarah Reynolds, Director of Salusbury World. You can email Sarah at sarahreynolds@salusburyworld.org.uk. This information will be kept confidential. // DBS: You do not need a recent Disclosure and Barring Service Check (or even to know what one is) to volunteer with Salusbury World – we will sort this out for you, if one is needed. If, though, you do have a recent DBS and are registered with the Update Service, please let us know. Data Protection Act: Staff Consent In order for Salusbury World projects to work efficiently we may need to record your details. These details may contain your personal and sensitive data. // What is personal and sensitive data? Personal data is data which can be used to identify you. This may include your name, date of birth, address, telephone number etc. Sensitive data is information related to any of the following: racial or ethnic origin, political opinions, religious beliefs, trade union membership, health, sexuality or sex life, offences and/or convictions. // Where will you store my data? Your data will be stored in an electronic case management system accessed by members of staff at Salusbury World. Paper copies of your data may also be stored securely by Salusbury World. To comply with the Data Protection Act 2018 we must tell you how we use this data and ask for your permission. By signing this form you are providing your permission for us to process your data for the purposes below. 1) Permission to store your data: I/We give my/our consent to Salusbury World to record sensitive personal information about me/us. *I/We consent.I/We do not consent.Name *Signature *Clear Signature2) Permission to share your data with relevant agencies and to receive data from relevant agencies. Everything you tell us will be treated confidentially. However for the safety and welfare of yourself and children in your care, we may need to share your data. I/We give my/our consent to Salusbury World to record sensitive personal information with other relevant agencies. *I/We consent.Name *Signature *Clear SignatureWhat is a Data Controller? A Data Controller is someone who is responsible for your data and who must make sure that your data is processed according to the law. For example, they are responsible for making sure that the information held about you is accurate and that it is kept secure. // What does Data Controller in common mean? For the purpose of the Data Protection Act the members of the Salusbury World are Data Controllers in common. This means that the members of Salusbury World are responsible jointly for your data. // Can I withhold or revoke my consent? Yes we will not record your information unless you provide your consent. We will not share your information with anyone else without your consent unless required to do so by law. If you require us to delete your data, please notify us in writing and we will do so within 14 days // Data Access: request please notify us in writing and we will let you know all the data that we store on you within 14 days // Complaints handling procedure: Salusbury World has a complaints handling procedure. Full details of the complaints procedure are available on request.DeclarationI confirm the following: The information given on this form is correct and complete to the best of my knowledge. I understand that if this application leads to a work placement, that false or misleading information given in this form or in my interview may result in the termination of the work opportunity. Salusbury World can contact the referees detailed on this form. I am not banned or disqualified from working with children nor subject to any sanctions or conditions imposed by the Disclosure and Barring Service or any other regulatory body. I understand that photographs and video/film material may be taken of me and I give my consent for such material to be used by Salusbury World, and organisations they work with, in newsletters and reports, on websites and on social media.Signature *Clear SignatureDate *PhoneSubmit