Lifeline Tameside
111-113 Old Street
Ashton under Lyne
OL6 7RL
www.lifeline.org.uk
Dear Applicant,
Thank you for applying for the post of:
Education, Training and Employment (ETE) Worker
Pt 20 £19,048 – Pt 29 £25,440
Please complete the application form as fully as possible.
Please address the questions in the order they are listed.
You may attach additional sheets but please try to keep your response to a maximum of 4 A4 sides of
paper. Please sign and date each sheet.
Please demonstrate your ability to meet the requirements of the job by explaining your
experience/abilities and giving clear and concise examples.
It is your application form we use for short listing; we do not use CVs or information given in covering
letters, these are separated and discarded on receipt of applications.
Please return your completed Application Form, Additional Information Form and Monitoring Form
by email or to the address below.
Address: Vivienne Holtom, Lifeline Tameside, 111-113 Old Street, Ashton under Lyne, OL6 7RL
Email: tameside.transition@lifeline.org.uk
The closing date for completed application forms is: 5.00 pm, 14th September 2015
Interviews will take place on w/c 21st September 2015
If you have any questions or would like to discuss your application prior to submitting it please do not
hesitate to contact me at tameside.transition@lifeline.org.uk or on 07739 983078.
Yours sincerely,
Vivienne Holtom
Project Officer
North West Directorate
Registered Office: Unit 14/15, Third Floor, 12 Hilton Street, Manchester, M1 1JF
Registered in England: Charity No: 515691 Company No: 1842240
Lifeline welcomes applications regardless of race, colour, nationality, ethnic origin, gender, sexual orientation, marital status, disability or age. All
applicants are considered on the basis of their merits and abilities for the job
Lifeline Project: Application Form
August 2015
Application Form
Post:
Education, Training and Employment (ETE) Worker
Place of Work:
Tameside
Salary:
Pt 20 £19,048 – Pt 29 £25,440
Closing Date:
14th September 2015
Interview Date:
w/c 21st September 2015
This post may be exempt from the Rehabilitation of Offenders Act 1974.
Please read the information on this included in the Application Pack.
Please Note: as part of our Equal Opportunities procedures, the only information we take into account
when processing an application is the information included in this form. Therefore, please complete the
form as fully as possible and note that we do not accept CV’s as part of an application or use them in
the selection process. If at any point you need to use additional sheets for continuation information
please do so.
Personal Details
Surname:
Initial(s): Please do not put your full name
Address:
Post code:
Email:
It is important that you give us a contact telephone number, as the time between short listing and
calling for interview is often limited.
Telephone (daytime):
Telephone (evening):
National Insurance Number:
Yes 
Do you hold a current full driving license?
No 
Where did you see this post advertised?
For office use:
Shortlisted:
Yes 
Interview time:
Confirmed:
Reference 1:
Reference 2:
Disclosure:
No 
Registered Office: Unit 14/15, Third Floor, 12 Hilton Street, Manchester, M1 1JF
Registered in England: Charity No: 515691 Company No: 1842240
Lifeline welcomes applications regardless of race, colour, nationality, ethnic origin, gender, sexual orientation, marital status, disability or age. All
applicants are considered on the basis of their merits and abilities for the job
2
Lifeline Project: Application Form
August 2015
Education and Qualifications
Professional Qualifications, Courses and Training (Details of any courses or training, relevant to this
application, including dates and duration)
Qualification / Course / Training
Duration
Year
Grade/result
Duration
Year
Grade/result
Year
Grade/result
Year
Further and Higher Education (please give a BRIEF summary)
College, University etc
Academic, professional
and other qualifications
Grade/result
General Education (please give list ‘A-levels’ or equivalent)
School
Qualifications
General Education (please give list ‘GSCE’s / O-levels’ or equivalent)
School
Qualifications
Registered Office: Unit 14/15, Third Floor, 12 Hilton Street, Manchester, M1 1JF
Registered in England: Charity No: 515691 Company No: 1842240
Lifeline welcomes applications regardless of race, colour, nationality, ethnic origin, gender, sexual orientation, marital status, disability or age. All
applicants are considered on the basis of their merits and abilities for the job
3
Lifeline Project: Application Form
August 2015
Employment History
Most recent employment
Name & address of most recent employer
Post held:
From (mm/yy)
To (mm/yy)
Main duties:
Reasons for leaving if applicable:
Current/last salary:
Notice period required:
£
Previous employment and/or voluntary work (please put most recent experience at the top):
Employer and
place of work
Post held
Main Duties
From
(mm/yy)
To
(mm/yy)
Registered Office: Unit 14/15, Third Floor, 12 Hilton Street, Manchester, M1 1JF
Registered in England: Charity No: 515691 Company No: 1842240
Lifeline welcomes applications regardless of race, colour, nationality, ethnic origin, gender, sexual orientation, marital status, disability or age. All
applicants are considered on the basis of their merits and abilities for the job
4
Lifeline Project: Application Form
August 2015
Rehabilitation of Offenders Act 1974
Due to the nature of the work, this post may be exempt from the rehabilitation of offenders act 1974 and,
if so, all convictions must be declared. Lifeline is entitled to check with the Disclosure and Barring
Service (DBS) for the existence and content of any criminal record of the successful applicant. Failure to
declare a conviction may disqualify you from appointment, or result in summary dismissal if the
discrepancy comes to light.
Yes 
Do you have any convictions, cautions or bind-overs? Still sign & Date
No 
If yes, please give details of the offence, sentence and date:
Date
Offence
Sentence
Signed:
Date:
References
Please give the names of two persons to whom reference may be made. One of these should be your
present or most recent employer. References will be taken up if you are offered the post.
Referee number one:
Referee number two:
Name:
Name:
Telephone:
Telephone:
Relationship to you:
Relationship to you:
Email:
Email:
Address:
Address:
Postcode:
Postcode:
Declaration: To the best of my knowledge, the information I have given is correct and complete. I
understand that including misleading statements or information that is incorrect would be sufficient
grounds to cancel any agreements entered into.
Signed:
Date:
Registered Office: Unit 14/15, Third Floor, 12 Hilton Street, Manchester, M1 1JF
Registered in England: Charity No: 515691 Company No: 1842240
Lifeline welcomes applications regardless of race, colour, nationality, ethnic origin, gender, sexual orientation, marital status, disability or age. All
applicants are considered on the basis of their merits and abilities for the job
5
Lifeline Project: Application Form
August 2015
Additional Information
All criteria are essential unless otherwise indicated (please see Person Specification for assessment
criteria)
Experience (through paid or voluntary work)
Delivery of ETE support to individuals engaged in drug and/or alcohol treatment
Experience of contributing to specific areas of service development or initiatives within a health and/or social care
setting
General and Special Knowledge
Knowledge of liaison with external partners (e.g.Job Centre Plus, educational establishments) to enhance positive
outcomes for education, training and employment opportunities.
An in-depth understanding and knowledge of the harmful effects associated with drug misuse in relation to health,
social welfare, housing, employability and personal and family relationships.
Registered Office: Unit 14/15, Third Floor, 12 Hilton Street, Manchester, M1 1JF
Registered in England: Charity No: 515691 Company No: 1842240
Lifeline welcomes applications regardless of race, colour, nationality, ethnic origin, gender, sexual orientation, marital status, disability or age. All
applicants are considered on the basis of their merits and abilities for the job
6
Lifeline Project: Application Form
August 2015
An understanding/awareness of current national policies on substance misuse, the recovery agenda and the
strategies that influence the priorities of treatment services.
An in-depth knowledge and understanding of the treatments and interventions available to substance misusers in
recovery and to their families, carers and concerned others
An understanding of harm minimisation, recovery, and treatment principles in line with best practice and national
guidance
A knowledge and understanding of policies related to the safeguarding of children and vulnerable adults and how
these influence practice.
An understanding of models of recovery, and the role of the community in supporting recovery.
Registered Office: Unit 14/15, Third Floor, 12 Hilton Street, Manchester, M1 1JF
Registered in England: Charity No: 515691 Company No: 1842240
Lifeline welcomes applications regardless of race, colour, nationality, ethnic origin, gender, sexual orientation, marital status, disability or age. All
applicants are considered on the basis of their merits and abilities for the job
7
Lifeline Project: Application Form
August 2015
Qualifications and Training
NVQ level 3 in Health and Social Care, and/or equivalent professional qualification (e.g. Health Care, Nursing,
Social Work, equivalent overseas qualification). (Desirable)
Knowledge of National Policy frameworks that underpin interventions with substance misusers i.e National
Strategy, NICE Guidelines, Models of Care, Routes to Recovery, QuaDS and DANOS.
Skills & Abilities
A keen interest in developing experience in employment and training/ advice and guidance
Experience of substance / alcohol treatment and related issues (housing, ETE, offending, etc)
Registered Office: Unit 14/15, Third Floor, 12 Hilton Street, Manchester, M1 1JF
Registered in England: Charity No: 515691 Company No: 1842240
Lifeline welcomes applications regardless of race, colour, nationality, ethnic origin, gender, sexual orientation, marital status, disability or age. All
applicants are considered on the basis of their merits and abilities for the job
8
Lifeline Project: Application Form
August 2015
Excellent written and oral communication skills
Excellent team working and interpersonal skills, and ability to adopt a highly flexible approach to supporting
colleagues in achieving the organisation’s objectives
Ability to form positive and productive working relationships with external customers and partners
Registered Office: Unit 14/15, Third Floor, 12 Hilton Street, Manchester, M1 1JF
Registered in England: Charity No: 515691 Company No: 1842240
Lifeline welcomes applications regardless of race, colour, nationality, ethnic origin, gender, sexual orientation, marital status, disability or age. All
applicants are considered on the basis of their merits and abilities for the job
9
Lifeline Project: Application Form
August 2015
Additional Factors
A commitment to equality of opportunity and anti-discriminatory practice that is reflected in professional
relationships with service users, colleagues and the general public.
A non-judgmental attitude towards people affected by substance use.
Willing and able to work flexibly to cover evening and weekend duties to meet the demands of the service.
Registered Office: Unit 14/15, Third Floor, 12 Hilton Street, Manchester, M1 1JF
Registered in England: Charity No: 515691 Company No: 1842240
Lifeline welcomes applications regardless of race, colour, nationality, ethnic origin, gender, sexual orientation, marital status, disability or age. All
applicants are considered on the basis of their merits and abilities for the job
10
Lifeline Project: Application Form
August 2015
Job Description
Job Identification
Job Title
ETE (Education, Training and Employment) Development Worker
Reports To
Throughcare and Aftercare Team Leader
Location
Tameside
Hours
35 hours per week
Salary
Pt 20 £19,048 – Pt 29 £25,440
Job Purpose
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To work within Lifeline’s Tameside Service providing support and access to Education, Training and
Employment in order to support reintegration and sustainable long term recovery.
To deliver services that support service users to achieve recovery goals, positive outcomes and community
re-integration, maximising engagement and retention in an abstinence focused model.
To provide a range of effective and creative interventions to support individuals recovery needs focused on
achieving sustainable recovery and re-integration.
To ensure that the service’s key elements (recovery planning and support, therapeutic recovery group
programmes, activities, housing/employment/training/education services, peer support/mutual aid and
aftercare) are delivered to a high standard.
To work effectively and flexibly with colleagues under the direction of the Throughcare and Aftercare Team
Leader, and other managers, to ensure that high standards of performance are maintained.
To provide ETE training and support to colleagues within the Throughcare and Aftercare Team.
To work collaboratively with other services to provide interventions to support and motivate service users and
meet their needs through all stages of their individual recovery journey.
To work within a strengths-based, recovery-orientated, change and outcomes focused approach which
promotes service users and communities as responsible co-producers of health, well-being and recovery.
Main Duties and Responsibilities
Service provision:
 To research and map the local area for Education, Training and Employment support and provision and build
effective links.
 To establish effective partnerships with local education, training and employment agencies including
formalised pathways for service users in recovery.
 To contribute to recovery plans with ETE plans that develop and maximise service users’ personal strengths,
social networks and recovery capital (social, physical, human and cultural) at the change, completion and reintegration/recovery support stages.
 To develop and deliver programmes that address barriers to and prepare individuals for education, training
and employment and that support ETE reintegration e.g. employability programmes, basic numeracy and
literacy, IT skills, job clubs, benefit advice etc…
 To work with service users to identify suitable employment, work placements, training schemes or college
courses as appropriate.
 To support service users with all required applications including electronic, paper and telephone.
 To provide services that support service users to find work/training/education, to include putting together a
CV, interview skills,
 To support service users with employability grants to enable service users to obtain equipment, clothing etc..
as necessary to gain placements, employment, training or education.
Registered Office: Unit 14/15, Third Floor, 12 Hilton Street, Manchester, M1 1JF
Registered in England: Charity No: 515691 Company No: 1842240
Lifeline welcomes applications regardless of race, colour, nationality, ethnic origin, gender, sexual orientation, marital status, disability or age. All
applicants are considered on the basis of their merits and abilities for the job
11
Lifeline Project: Application Form
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August 2015
To ensure appropriate holistic training support is available, and where necessary develop support pathways to
fill gaps including the development of work experience placements and opportunities.
To advise and guide service users with aspects of benefit and work programme queries.
To build excellent working relationships with the Job Centre Plus and the providers of the work programme.
To accompany clients to local services where appropriate.
To provide support with better off in work calculations, living skills and money management
To act as an advocate for the ETE provision and its service users.
To liaise closely with training providers and employers to provide ongoing support once service users have
moved into training or employment.
To ensure that work with service users around ETE is appropriately integrated into the general operation
To ensure the service’s key activities around structured recovery support: group interventions (generic,
offending-related, stimulant specific); abstinence and aftercare support; family therapies and support; welfare,
benefits and housing support; community integration and involvement; access to counselling; access to
recovery communities, assets and peer networks, specialising in one or more of these areas.
To deliver ETE activities and interventions alongside external agencies, peers and volunteers.
To involve service users in the ongoing development and evaluation of provision and maintain a high level of
customer service.
To cooperate with the Team Leader in the evaluation and assessment of the project
To provide written and verbal reports on the development of client activities within the project including the
facilitation and processing of client feedback.
To ensure effective communication with Throughcare and Aftercare Workers overseeing individual recovery
plans.
To maintain effective information systems internally and to develop a thorough knowledge of local training,
employment and drug service provision.
To cooperate with the Throughcare and Aftercare Team Leader, attend team meetings and liaise with partner
organisations to ensure all relevant people are kept informed of developments relevant to project delivery.
To provide training and ETE support to colleagues and ensure the team have accurate and up to date
information regarding the ETE sector.
To undertake any training needed to carry out the duties outlined in the job description.
Performance and personal management:
 To work flexibly to provide adequate cover for all aspects of the service.
 To work alongside and provide support and supervision to volunteers and peer mentors as required.
 To work within, and contribute positively to, an appropriate culture of established values and expectations
embracing and implementing change.
 To be responsible for performance management at an individual level through: self-management; delivery of
goals and tasks set; delivery of contractual requirements, targets and outcomes; and reporting progress.
 To actively engage in opportunities for learning and development at an individual and team level.
 To comply with operational management systems of supervision, objectives, appraisal and induction.
 To work collaboratively, creatively and flexibly, to empower, challenge and change service users.
 To develop competencies to effectively deliver a range of psychosocial and other interventions required at the
change, completion and re-integration (recovery support) phases, undertaking training matched to the role as
required.
 To comply with data collection procedures and reporting to ensure effective recording of performance
monitoring, outcomes and service user information including identifying areas of attrition.
 To adhere to the implementation of risk management procedures (including child and adult safeguarding
protocols) taking personal responsibility for keeping up to date on the requirements of these procedures.
 To contribute to the continuous improvement of quality and performance of recovery support interventions
Service development:
 To take a lead in specialist ETE service developments.
 To form productive working relationships with external agencies and professionals, existing and new, to
ensure that service users have access to a wide range of recovery and community resources.
 To provide service users with on-going opportunities to consult on service development working jointly to
develop and deliver services, as appropriate, under the direction of management.
 To contribute to the sustainability of Lifeline’s growth through the delivery of best practice and quality services
and achieving targets and lasting outcomes for its beneficiaries.
Registered Office: Unit 14/15, Third Floor, 12 Hilton Street, Manchester, M1 1JF
Registered in England: Charity No: 515691 Company No: 1842240
Lifeline welcomes applications regardless of race, colour, nationality, ethnic origin, gender, sexual orientation, marital status, disability or age. All
applicants are considered on the basis of their merits and abilities for the job
12
Lifeline Project: Application Form
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August 2015
To ensure an appropriate level of strategic awareness at industry, local, organisational and service levels.
General duties
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To read and comply with all published Lifeline policies and procedures, at the start of employment and
whenever they are added to or changed
To present a professional appearance, maintain an orderly working environment, and act at all times to
uphold the good reputation of Lifeline Project, leading by example
To proactively maintain own professional knowledge, development and practice, and contribute effectively to
team meetings and supervision
To work within professional boundaries, maintaining safety and appropriate confidentiality at all times
To promote, contribute to, and implement corporate initiatives as required
To demonstrate clear commitment to Lifeline’s Mission, Vision, Values and Strategy,
To work flexibly within the organisation to undertake such other reasonable duties and responsibilities of an
equivalent nature, as may be determined by the post holder’s Line Manager
To not act in a prejudicial or discriminatory towards service users or employees, to be aware of the
Company’s Equal Opportunities Policy and to be vigilant with regards to oppressive, prejudicial or
discriminatory issues
To inform the Company of any matter concerning them, which might impair their ability to perform the duties
outlines. This includes matters which might adversely affect either the post holders or Company’s reputation
To ensure that the working environment is adequately maintained in line with Lifeline’s Health and Safety
Policy in relation to the identification of hazards, risk assessment and reduction
Job Holder’s Signature: .................................................................... Date: ..............................
Line Manager’s Signature: ................................................................... Date: ..............................
This is an outline job description and may be subject to change according to the needs of the job, in consultation with the post
holder.
Continued over page...
Registered Office: Unit 14/15, Third Floor, 12 Hilton Street, Manchester, M1 1JF
Registered in England: Charity No: 515691 Company No: 1842240
Lifeline welcomes applications regardless of race, colour, nationality, ethnic origin, gender, sexual orientation, marital status, disability or age. All
applicants are considered on the basis of their merits and abilities for the job
13
Lifeline Project: Application Form
August 2015
Person Specification
Assessment Criteria
All criteria are Essential unless otherwise indicated
A: Application – assessed at application stage
I: Interview – assessed at interview stage
Experience (through paid or voluntary work)
A/I

Delivery of ETE support to individuals engaged in drug and/or alcohol treatment
A/I

Experience of contributing to specific areas of service development or initiatives within a health
and/or social care setting.
A/I
General and Special Knowledge

Knowledge of liaison with external partners (e.g.Job Centre Plus, educational establishments) to
enhance positive outcomes for education, training and employment opportunities.
A/I

An in-depth understanding and knowledge of the harmful effects associated with drug misuse in
relation to health, social welfare, housing, employability and personal and family relationships.
A/I

An understanding/awareness of current national policies on substance misuse, the recovery agenda
and the strategies that influence the priorities of treatment services.
A/I

An in-depth knowledge and understanding of the treatments and interventions available to
substance misusers in recovery and to their families, carers and concerned others
A/I

An understanding of harm minimisation, recovery, and treatment principles in line with best practice
and national guidance
A/I

A knowledge and understanding of policies related to the safeguarding of children and vulnerable
adults and how these influence practice.
A/I

An understanding of models of recovery, and the role of the community in supporting recovery.
A/I
Qualifications and Training

NVQ level 3 in Health and Social Care, and/or equivalent professional qualification (e.g. Health
Care, Nursing, Social Work, equivalent overseas qualification) (Desirable)
A/I

Knowledge of National Policy frameworks that underpin interventions with substance misusers i.e
National Strategy, NICE Guidelines, Models of Care, Routes to Recovery, QuaDS and DANOS.
A/I
Skills and abilities

A keen interest in developing experience in employment and training/ advice and guidance
A/I

Experience of substance / alcohol treatment and related issues (housing, ETE, offending, etc)
A/I

Excellent written and oral communication skills
A/I

Excellent team working and interpersonal skills, and ability to adopt a highly flexible approach to
supporting colleagues in achieving the organisation’s objectives
A/I

Ability to form positive and productive working relationships with external customers and partners
A/I
Additional Factors

A commitment to equality of opportunity and anti-discriminatory practice that is reflected in
professional relationships with service users, colleagues and the general public.
A/I

A non-judgmental attitude towards people affected by substance use.
A/I

Willing and able to work flexibly to cover evening and weekend duties to meet the demands of the
service.
A/I
Registered Office: Unit 14/15, Third Floor, 12 Hilton Street, Manchester, M1 1JF
Registered in England: Charity No: 515691 Company No: 1842240
Lifeline welcomes applications regardless of race, colour, nationality, ethnic origin, gender, sexual orientation, marital status, disability or age. All
applicants are considered on the basis of their merits and abilities for the job
14
Lifeline Project: Application Form
August 2015
Statement of Policy about Relevant Convictions
Introduction
The Lifeline Project is wholeheartedly committed to the principle of equal opportunity both in its capacity
as an employer and as a provider of services to others. Lifeline is determined to make all efforts to
prevent discrimination or other unfair treatment against any of its staff, potential staff or users of its
service, regardless of race, gender, class, religion, ethnic or national origin, sexual orientation,
responsibilities for dependants, age, physical disability, HIV status, offending or drug using background.
Lifeline is opposed to racist, sexist and homophobic practices and attitudes, and is committed to
translating this into all aspects of its everyday work.
Lifeline recognises that specific and positive programmes of action are necessary to ensure that the
aims of its equal opportunities policy are achieved. Lifeline further recognises that the progress towards
fulfilling these aims requires the participation and commitment of all our staff and management
committee members to the policy, as well as the development of procedures and structures.
We will treat all employees with dignity and respect. Lifeline is committed to developing and maintaining
a working environment free from unlawful discrimination or harassment. To further and preserve this
objective we will not tolerate acts, which breach the terms of this policy and will investigate and discipline
anyone within our employment who does so.
Equal opportunities in Staff Recruitment and Advancement
We recognise the rich diversity and creative potential that employees of differing sex, race and physical
abilities can bring to their work. Recognising this diversity helps all employees develop their own skills
and contribution to the Lifeline Project’s success as a provider of services to others.
Recruitment procedures are applied equally to internal and external applicants. These procedures and
practices shall be monitored constantly as a management priority to ensure their proper operation.
All staff should have a genuinely equal opportunity to progress within Lifeline, including the opportunity
to participate in training to develop their full potential.
All employees are responsible for ensuring that their behaviour supports and contributes to the
implementation of these policies. Any questions, which relate to this policy, should be addressed to your
line manager.
Equal opportunities in the provision of Services
Lifeline is committed to providing services which are relevant, attractive and accessible to all those who
might wish to use them. Staff are required to be fully aware of their responsibilities in this respect and to
ensure that systems of recruitment or referral to our services do not operate to exclude or discourage
participation and that projects are welcoming and attractive to all potential participants.
These aims are a priority in the provision of staff training and the allocation of resources.
Monitoring of all services should be carried out in order to identify any inequalities in content or
participation and to determine the steps needed to rectify them. This includes attention to publicity,
environment, referral processes and the links with outside organisations and individuals involved in the
provision of our services. Every effort is made to ensure that, in maintaining these links, our policies and
Registered Office: Unit 14/15, Third Floor, 12 Hilton Street, Manchester, M1 1JF
Registered in England: Charity No: 515691 Company No: 1842240
Lifeline welcomes applications regardless of race, colour, nationality, ethnic origin, gender, sexual orientation, marital status, disability or age. All
applicants are considered on the basis of their merits and abilities for the job
15
Lifeline Project: Application Form
August 2015
priorities are not compromised. Lifeline should communicate its equal opportunities policy to black
organisations with concern for drug users and promote the development of such organisations.
The job for which you are applying involves regular contact with young people under the age of eighteen
years and/or vulnerable adults and is exempt from The Rehabilitation of Offenders Act (1974). You are
required therefore to declare any convictions, cautions, reprimands and final warnings you may have,
even if they would otherwise be regarded as “spent” under this Act.
The disclosure of a criminal record will not debar you from appointment unless it is considered that the
conviction renders you unsuitable for the job in question. In making this decision, consideration will be
given to the nature of the offence, how long ago and what age you were when it was committed and
other factors which may be relevant including appropriate considerations in relation to Lifeline’s Equal
Opportunities Policy.
The information you give will be treated in the strictest confidence.
All applicants who are offered employment will be subject to a criminal records check by the Disclosure
and Barring Service before an appointment is confirmed.
Failure to declare a conviction may disqualify you from appointment, or result in summary
dismissal if the discrepancy comes to light.
If you would like to discuss any criminal offences conviction you have in relation to applying for this post,
you may telephone the Human Resources Department on: 0161 200 5486 where you can ask someone
for advice in confidence.
Registered Office: Unit 14/15, Third Floor, 12 Hilton Street, Manchester, M1 1JF
Registered in England: Charity No: 515691 Company No: 1842240
Lifeline welcomes applications regardless of race, colour, nationality, ethnic origin, gender, sexual orientation, marital status, disability or age. All
applicants are considered on the basis of their merits and abilities for the job
16
Lifeline Project: Application Form
August 2015
Monitoring Form
Dear Applicant
The Lifeline Project is determined to be an equal opportunities organisation. This means that we believe that
everyone in society is entitled to a fair deal, and that we will make every effort not to discriminate against you. So
that we can see how effective our policies are, and make changes if they are not effective, we need to monitor all
applicants seeking employment with us. We are therefore asking for your co-operation in completing this
monitoring form. Without your co-operation it will be difficult to establish whether our commitment to equal
opportunities is working. The information requested is confidential and anonymous and will be used purely for
monitoring purposes. It will not be used as part of the selection or recruitment procedure.
The form will be separated on receipt of your application
The recruitment panel will not see this form. Do not put your name on this form
If you do not wish to answer any of the questions, please leave the space blank
Please tick or circle the appropriate answer:
Post applied for:
Gender:
MF
Age:
yrs
Caring Responsibilities: In the past people, (particularly women), who are responsible for the care of children,
elderly relatives or others have been discriminated against in job applications
Yes 
No 
Are you heterosexual?
Yes 
No 
Are you a gay man, a lesbian or bisexual?
Yes 
No 
Do you have major responsibility for the care of any dependants?
Sexuality
Disability: A disability or health problem does not preclude full consideration for a job at Lifeline, unless stated in
the job description. Applications from people with disabilities are welcome
Yes 
Do you have a disability?
No 
Ethnic Origin: The object of ethnic monitoring is to ensure that racial discrimination does not take place. Ethnic
origin refers to members of an ethnic group who share the same cultural identity. This does not mean country of
birth or nationality. I would describe my ethnic origin as:
Asian Other 
Black African 
Black Caribbean 
Black Other 
Chinese 
Indian 
Pakistani 
Mixed White & Asian 
Mixed White & Black African 
Mixed Other 
White British 
White Irish 
White Other 
Other 
Other Information: Please feel free to provide any additional information you wish. You may, for example, want to
provide information about previous discrimination
Advertising: Lifeline wishes to make sure that all jobs are advertised as widely as possible.
Could you please say how you heard about this post:
Thank you for taking the time to complete this application
Registered Office: Unit 14/15, Third Floor, 12 Hilton Street, Manchester, M1 1JF
Registered in England: Charity No: 515691 Company No: 1842240
Lifeline welcomes applications regardless of race, colour, nationality, ethnic origin, gender, sexual orientation, marital status, disability or age. All
applicants are considered on the basis of their merits and abilities for the job
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