29
Dear Applicant Case Worker – DIAL It is exciting times at Gofal, as we have been successful in securing Big Lottery funding to deliver a unique and innovative project. The Dementia Integration and Link (DIAL) project will deliver support across two key delivery strands; these are supporting people with dementia, and supporting the carers of people with dementia. 1) Supporting people with dementia The DIAL project will deliver support to people with dementia in Cardiff and the Vale of Glamorgan. This includes older people with dementia and those with early onset dementia. The support will be aimed at reducing social isolation, increasing confidence and improving mental and physical wellbeing. This support will be delivered through the provision of ‘meaningful activity’ based on the individual interests and needs of the people being supported. All of the activities will be underpinned by the aims of encouraging social and community inclusion, promoting physical activity, stimulating the senses, facilitating reminiscence and preventing rapid deterioration of memory. Examples of the activities the project will provide include: walking, cookery, sports, reminiscence therapy, life history books, visits to familiar places, arts and crafts, gardening, yoga, outdoor activities, visiting a sensory garden, day trips etc. The support will be delivered in a variety of settings to make the service as accessible as possible. These settings, as identified through Gofal's scoping exercise, include: ward settings, day centres, community settings and in people's homes (including personal houses, care homes, extra care facilities etc). Activities will either be delivered to a group, or on a one-to-one basis depending on the preferences of the people being supported. 2) Supporting the carers of people with dementia The DIAL project will also support the carers of people with dementia and early onset dementia in Cardiff and the Vale of Glamorgan. This support will be delivered through: Case Worker Dial Page 1 of 29 April 2016

Our · Web viewTo work with beneficiaries and their carers to identify goals and aspirations. To liaise with other Gofal services and appropriate external organisations to identify

Embed Size (px)

Citation preview

Dear ApplicantCase Worker – DIAL

It is exciting times at Gofal, as we have been successful in securing Big Lottery funding to deliver a unique and innovative project. The Dementia Integration and Link (DIAL) project will deliver support across two key delivery strands; these are supporting people with dementia, and supporting the carers of people with dementia.

1) Supporting people with dementiaThe DIAL project will deliver support to people with dementia in Cardiff and the Vale of Glamorgan. This includes older people with dementia and those with early onset dementia. The support will be aimed at reducing social isolation, increasing confidence and improving mental and physical wellbeing.

This support will be delivered through the provision of ‘meaningful activity’ based on the individual interests and needs of the people being supported. All of the activities will be underpinned by the aims of encouraging social and community inclusion, promoting physical activity, stimulating the senses, facilitating reminiscence and preventing rapid deterioration of memory. Examples of the activities the project will provide include: walking, cookery, sports, reminiscence therapy, life history books, visits to familiar places, arts and crafts, gardening, yoga, outdoor activities, visiting a sensory garden, day trips etc.

The support will be delivered in a variety of settings to make the service as accessible as possible. These settings, as identified through Gofal's scoping exercise, include: ward settings, day centres, community settings and in people's homes (including personal houses, care homes, extra care facilities etc). Activities will either be delivered to a group, or on a one-to-one basis depending on the preferences of the people being supported.

2) Supporting the carers of people with dementiaThe DIAL project will also support the carers of people with dementia and early onset dementia in Cardiff and the Vale of Glamorgan. This support will be delivered through:

the provision of respite for the carer whilst the person with dementia is being supported the opportunity for inclusion of the carers in the activity sessions with the person they

support the facilitation of peer support groups for carers of people with dementia across Cardiff and

the Vale.

The aim of this support will be to improve the mental wellbeing of the carers, up-skill them to engage those that they care for in a wider range of activities and will enable them to benefit from mutual support and advice from people with similar caring experiences.

ResourcesThe DIAL project will be delivered through a combination of dedicated staff members and trained volunteers. The team will include:

A Project Coordinator, who will spend 50% of their time on the DIAL project

Case Worker Dial Page 1 of 22April 2016

Gofal2nd Floor, Derwen House,

2 Court Road, Bridgend, CF31 1BN

T: 01656 647722E:[email protected]

www.gofal.org.uk

A Senior Caseworker, who will work solely on the DIAL project and will report to the Project Coordinator

Two Caseworkers, who will work solely on the DIAL project and will report to the Senior Caseworker

A total of 35 trained volunteers (10 in year one, 15 in year two and 10 in year three) who will deliver the majority of the support sessions, reporting to the dedicated Caseworkers for the project.

A steering group, made up of key stakeholders, who will oversee the project at a strategic level and will ensure effective project delivery.

The project will also benefit from the support of Gofal’s central office functions including HR, Finance, IT, administration etc.

BeneficiariesThe main beneficiaries of this project will be:

People with dementia and early onset dementia (350 during project lifetime) Volunteers on the project (35 during project lifetime). Carers/family members of people with dementia (150 during project lifetime). Local organisations that deliver services to people with dementia, e.g. the hospitals and

care homes (10 during project lifetime).

Gofal

Gofal is a mental health and wellbeing charity providing a range of services to support people who are experiencing or who have experienced mental ill health – something that will affect 1 in 4 of us in our lifetime. We also lobby and campaign to improve mental health policy, practice and legislation and to increase public understanding and awareness of mental health and wellbeing.

Thank you for your interest in working for Gofal and please find enclosed the following:

1) Information on Gofal and the post you have applied for

2) Role Expectations, Person Specification and Competency Framework

3) Application Form

4) Equal Opportunities Monitoring Form

The closing date for receipt of your application is Monday 13th June 2016. Please do ensure you return your application by this date and time. Gofal cannot be responsible for any applications received late and any applications that arrive after the deadline will not be considered.

Shortlisting will take place week commencing Monday 13th June 2016. We will contact you as soon as possible after shortlisting to inform you of the outcome.

Interviews will be held week commencing 20th June 2016.

Applications will be considered against the person specification and shortlisted candidates invited to interview. We therefore recommend that you read our Guidance notes (available on our website) before you complete your application.

Once again, thank you for your interest in Gofal and we look forward to receiving your application.

Yours sincerely

Anna JohnsonHR Administrator

Case Worker Dial Page 2 of 22April 2016

Gofal2nd Floor, Derwen House,

2 Court Road, Bridgend, CF31 1BN

T: 01656 647722E:[email protected]

www.gofal.org.uk

About Gofal

Thinking differently about mental health and wellbeing

Gofal has been providing mental health and wellbeing services to people in Wales since 1990. We have come a long way since our first services opened in Bridgend, supporting the resettlement of people from the long stay psychiatric wards of Parc and Penyfai hospitals into homes in the community. We now operate across eleven local authorities in Wales and have a turnover in excess of £4million. We support over 2,000 people every year, employing around 130 people.

Our Vision

Good mental health and wellbeing for all

Our Mission

To have a positive lasting impact in all that we do by: Working together to provide services that we can be proud of Demonstrating outstanding practice in relation to staff mental health and wellbeing, learning

and development Challenging the way we all think about, talk about and respond to mental health and

wellbeing in all areas of our lives Using our profile, influence and voice to improve the lives of people living with or at risk of

experiencing mental ill health Increasing the range and reach of our services through targeted and sustainable business

growth Spending our money where it will have the maximum impact

Our Aspirations

Gofal aspires to: Work with integrity and dignity Inspire and support people to exceed their expectations Develop a culture that is embracing and respectful of difference Communicate honestly and openly Be an organisation that is ambitious, creative and determined Create environments that are collaborative, supportive and empowering Be respected for our knowledge and expertise

Case Worker Dial Page 3 of 22April 2016

GOFAL

DIAL Case Worker

DIAL Dementia Integration and Link Project

Location: Cardiff and the Vale of Glamorgan[with requirement for travel throughout other Gofal areas of operation]

Salary: £18685 per annum.

Contract: 3 years from start date (subject to probationary period)

Hours: 37 hours per week.

Holidays: 26 days annual leave plus bank holidays. Holidays increase by 1 day for each year of service up to a maximum of 30 days.

Pension: Pension in the form of a money purchase pension scheme:- 4.5% non-contributory employer contribution- 5.5% paid if employee contributes 1%- 6.5% paid if employee contributes 2% of more

Other Benefits: Income ProtectionLife Assurance Employee Assistance ProgrammeOpportunities for flexible workingTraining and personal development opportunities

Job Purpose:

To provide a range of social, emotional and practical support for people experiencing mental ill health and dementia, enabling them to manage their responsibilities and self-manage their mental health/ dementia and wellbeing to live independently.

Provide a range of one to one support to beneficiaries in furtherance of individual and project aims.

Work with the DIAL Project team to recruit, train, mentor, supervise and support a team of volunteers

Facilitate and support group work activities and provide advice on reminiscence activities to Service Users and Volunteers.

Case Worker Dial Page 4 of 22April 2016

GOFAL

Role Expectations

Post: Case Worker

Service: DIAL

Reporting to: Project Co-ordinator/ Senior Case Worker

Office Base: Cardiff office base with requirement for travel throughout areas of operation.

Date: May 2016

Role Expectations:

Service Delivery1. To receive/ promote referrals into the service and carry out initial assessments to ensure

suitability for the project.2. To assess, develop and review plans to support and promote mental health and wellbeing.3. To carry out assessments of need and develop and review activity plans to be used with

beneficiaries, including use of any adaptations.4. To provide support directly to beneficiaries as necessary and appropriate.5. To work with the team to ensure that volunteers and beneficiaries are appropriately

matched.6. To case manage all beneficiaries allocated to you and the volunteers you are supporting.7. To ensure that all relevant paperwork for beneficiaries and volunteers is maintained up to

date.8. To ensure appropriate support is provided to beneficiaries to help them achieve goals set,

and to review and update plans accordingly.9. To work within agreed models of support with particular reference to the recovery star.

Working with Volunteers1. To work with the team and external partners to recruit and train volunteers.2. To attend meetings and events to promote volunteering opportunities.3. To contribute own skills and knowledge of reminiscence based activities to induction and

further training of volunteers.4. To manage a case load of volunteers providing one to one and group support and mentoring to volunteers.5. To ensure all relevant paperwork relating to volunteers is complete.

Liaison1. To provide dementia appropriate activities and advice to Service Users and volunteers.2. To forge links with the LHB, care homes, day centres and similar settings in order to

develop partnership opportunities for running group based activities.3. To develop links with local charities, local businesses, training providers and other

specialist support providers in pursuit of project aims.4. To work with beneficiaries and their carers to identify goals and aspirations.5. To liaise with other Gofal services and appropriate external organisations to identify

opportunities to meet needs and aspirations of service user and carers6. To share knowledge and skills with other Gofal services and partner organisations as

appropriate.7. To identify and provide access to more specific advice and assistance as required.

Case Worker Dial Page 5 of 22April 2016

Administration and Quality1. To ensure that all case notes are maintained as accurate and up to date.2. To ensure that colleagues are kept up to date with all relevant information.3. To produce reports as requested within area of responsibilities.4. To ensure that key information and outcomes are recorded.5. To ensure that IT systems are used effectively and in line with organisational procedures –

eg. Use of e-mail and database systems.6. To provide all relevant information to head office and external organisations as required.

Organisation ExpectationsTo carry out all duties in a manner that reflects Gofal’s Aspirations:1. Work with integrity and dignity.2. Inspire and support people to exceed their expectations.3. Develop a culture that is embracing and respectful of difference.4. Communicate honestly and openly.5. Be an organisation that is ambitious, creative and determined.6. Create environments that are collaborative, supportive and empowering.7. Be respected for our knowledge and expertise.

Case Worker Dial Page 6 of 22April 2016

GOFALPerson Specification

Post: Case Worker – DIALEssential Desirable Assessed through

ExperienceExperience of working in the health and social care field, providing support, assistance and advice to individuals

Application/Interview

Experience of working with people affected by mental health problems

Application/ Interview

Experience of working with people with dementia

Experience of providing support to people in the community, including in people’s own homes.

Application

Experience of liaising with housing and health services

Application

Qualifications and skillsQualification relevant to the work – ie NVQ Level 3 Health and Social Care

Application

Full current driving licence and access to your own transport

Application

Ability to communicate in Welsh ApplicationIT skills including basic word processing and use of databases to input information

Application/ Interview

Knowledge and UnderstandingHow mental health problems can affect an individual’s life

Application/ Interview

The range of mental health and housing services available

Application/ Interview

The welfare/housing benefits system and how to apply for the various benefits

Application/ Interview

How health and social care services can contribute to people’s lives

Application/ Interview

Ways to involve service users in the further development of the project

Application/ Interview

CompetenciesRole model behaviours of integrity and dignity to other team members

Interview

Support the team to deliver at its best InterviewRole model behaviours underpinned by respect of difference

Interview

Adapt communication to the audience Application/ InterviewIdentify the best outcomes, solve problems and overcome barriers to achievement

Interview

Identify new opportunities to seek and share experience with others

Interview

Proactively identify own development needs and take action to meet them

Application/ Interview

Applicants for the post of Case Worker – DIAL will be required to demonstrate evidence of competency at levels 1 and 2; please refer to the Competency Framework below:Case Worker Dial Page 7 of 22April 2016

Competency FrameworkGofal aspires to: Work with integrity and dignity

Level 1: Demonstrate integrity and dignity in all interactions with others Maintain appropriate personal boundaries in all interactions with service users, colleagues and

external contacts Express opinions genuinely and honestly, while being mindful of the impact on others Take responsibility for reflecting on own behaviours Maintain confidentiality and be trustworthy in relationships with service users and colleagues Bring to the attention of line managers, any situations where standards of integrity or dignity are

believed to have been breached. Make every effort to deliver on commitments made.

Level 2: Role Model behaviours of integrity and dignity to other team members Give feedback to colleagues where behaviours are noticed which do not demonstrate integrity or

dignity Help others to understand their responsibilities to act with integrity and dignity Actively seek feedback to understand own personal impact on others, and use personal insights.

Gofal aspires to: Inspire and support people to exceed their expectations

Level 1: Support colleagues to deliver at their best Role model positive and constructive behaviours to service users and colleagues Share knowledge, skills and learning to help others to be at their best. Work in a way that supports and promotes the wellbeing of others. Participate openly and constructively in team meetings Work co-operatively with others, supporting colleagues to deliver their best to service users Actively engage in own supervision and appraisal, preparing and participating fully Maintain high quality standards in file and record keeping Notice and acknowledge great contribution from others

Level 2: Support the team to deliver at its best Demonstrate flexibility and adaptability to change Support colleagues in managing the emotional impact of their work Actively seek out information to share, which will help the team in its work Take a role in mentoring team members who need help or support Actively suggest ideas for improvement for the team Bring the great contribution of colleagues to the attention of others

Gofal aspires to: Develop a culture that is embracing and respectful of difference

Level 1: Demonstrate respect of difference in all interaction with others Have a reputation for being a great listener Demonstrate a commitment to the value of equality and respect for diversity Show an awareness of the different needs of people from different backgrounds, cultures and life

experiences Seek to understand the perspective of service users through genuine interest and questioning Demonstrate an open mind with people who may have a different viewpoint. Use language which is positive and non-judgmental towards others

Level 2: Role model behaviours underpinned by respect of difference Give support to others where they may be finding it difficult to deal with issues of equality or

Case Worker Dial Page 8 of 22April 2016

difference Share experiences and knowledge which can help others embrace difference in their work and

lives and take every opportunity to learn more about equality issues Challenge behaviour which does not demonstrate a respect of difference Work to resolve conflict where it is observed

Gofal aspires to: Communicate honestly and openly

Level 1: Communicate in a clear and concise way See communication as a two way process, actively seeking out communication, as well as actively

listening to the message delivered. Use a communication style which is appropriate to the listener Use words appropriately, communicating in language which matches the organisation’s values. Using observation, be able to judge the listener’s response and adapt communication accordingly. Use written and IT based communication to explain key points clearly and effectively, and in

appropriate detail. Role model honesty and openness in communication with others, using genuine care in the delivery

of messages and challenging colleagues to do the same.

Level 2: Adapt communication to the audience Think in advance about the most effective way to deliver the message, and adapt communication

accordingly. Simplify complex messages where necessary, so that others can understand key points. Use a variety of communication methods with confidence, and understand where each is most

effective. Represent the organisation externally, and be able to speak confidently about its work. Deliver difficult messages with honesty and compassion.

Gofal aspires to: Be an organisation that is ambitious, creative and determined

Level 1: Work with a flexible and adaptable approach to achieve agreed outcomes. Bring energy, passion and excitement into all your work Demonstrate dedication and commitment to the team objectives Have a commitment to ‘never giving up on a person’, even when they are challenging to you Use available time to achieve the best possible outcomes, and be flexible where priorities change Stay enthusiastic and remain positive through setbacks Work with colleagues and service users to come up with creative solutions Face change with a positive and constructive approach Ask for help and support where it is needed to ensure own wellbeing Use mistakes as a way to learn for the future

Level 2: Identify the best outcomes, solve problems and overcome barriers to achievement. Actively try out different approaches to tackling problems Generously share ideas for service improvement and better ways of working Build an outcome focus into all aspects of work Support service users and colleagues in positive risk taking, allowing them to overcome barriers

and achieve the best outcomes Help colleagues to deal with changes they may be facing in a way which is right for them Demonstrate resilience when facing challenges, seeking and using the support which you need

Gofal aspires to: Create environments that are collaborative, supportive and empowering

Level 1: Work effectively in partnership with others Build strong and constructive relationships with colleagues and service users

Case Worker Dial Page 9 of 22April 2016

Build and maintain trust with service users and other individuals outside the organisation Seek out contacts in other teams within the organisation, to share learning, support and

experience Be seen as a strong representative of the organisation with external contacts, and actively build

networks which can help in delivery of service Work positively through difference of opinion to get to the best outcome

Level 2: Identify new opportunities to seek and share experience with others Identify contacts inside and outside of the organisation who can support partnership working and

collaboration Share contacts across the organisation, where it may help other teams to develop their service Encourage other team members to make their own contacts inside and outside of the

organisation Take an active part in organising events which encourage others to come together to support

and share experience

Gofal aspires to: Be respected for our knowledge and expertise

Level 1: Regularly discuss own development needs with line manager, and attend training events identified.

Take responsibility for seeking out knowledge and finding out information to help own learning. Take an active part in own development, working with your Line Manager to identify your

development needs. Attend all training programmes identified, participate fully and discuss the learning with your Line

Manager afterwards. Reflect on new learning, and how to use it for the best outcome of service users.

Level 2: Proactively identify own development needs and take action to meet them. Identify any areas in your own performance where you need further development, and understand

how best to get the training or experience you need. Actively seek out others who may have the knowledge or skills you require, and ask for support for

your learning. Clearly understand the link between your learning and delivery of the best outcome for service users. Take on development which is stretching and challenging, where it will have the best results on your

own performance. Show a passion and commitment for keeping updated with new information which impacts on your

own performance and delivery of standards.

Case Worker Dial Page 10 of 22April 2016

Application for the post of: __Case Worker - DIAL

Closing date for the receipt of application forms is: _______________________________

This page will be removed from the application form before shortlisting, to enable us to shortlist candidates anonymously. Therefore please avoid using your name, elsewhere on the application.

PERSONAL INFORMATIONSurname

First Names

Address(including postcode)

Contact Telephone NumberE-mail address

REFERENCESAt least one of your references should be a present or most recent employer, tutor, volunteer work supervisor etc. If your most recent employer is not in a similar field but you have worked with a vulnerable client group within the last 5 years then we will also require a reference from this organisation.References will be requested after interview and Gofal reserves the right to contact any previous employer.

Name________________________________

Address: ______________________________

______________________________________

__________________Postcode____________

Telephone no: __________________________

E-mail: ________________________________

Relationship to yourself: __________________

Name________________________________

Address: ______________________________

______________________________________

__________________Postcode____________

Telephone no: __________________________

E-mail: ________________________________

Relationship to yourself: __________________

WELLBEINGCase Worker Dial Page 11 of 22April 2016

APPLICATION FORM

Gofal is committed to equality of opportunity and welcomes applications from all. When shortlisting applicants, the information used is that which relates to the person specification. Gofal upholds the commitments of the Disability Symbol. Where applicants meet all essential criteria then if a disability is declared an interview will be guaranteed and that applicant will not be further assessed against desirable criteria.

The Equality Act, 2010 defines a disability as:“A physical or mental impairment which has a substantial and long-term adverse effect on a person’s ability to carry out normal day to day activities.”

With reference to the above statement do you consider yourself to have any disabilities:

YES / NO (please delete as appropriate)

If YES, please highlight any additional support or special arrangements you would require if you are shortlisted and invited to interview.

Are you subject to any restrictions which would prevent you from taking employment in the United Kingdom? (Documentary Evidence will be required) YES/NO (please delete as appropriate)If YES please provide details:

CRIMINAL CONVICTIONS

Gofal aims to promote equality of opportunity for all with the right mix of talent, skills and potential and as such welcomes applications for employment from a diverse range of candidates, including those with criminal records.

Due to the nature of our work with vulnerable adults, some posts at Gofal are exempt from the provisions of the Rehabilitation of Offenders Act and as such will request information on all convictions including those that would be deemed to be ‘spent’ under this act. Checks are made with the Disclosure and Barring Service and any offer of employment is made subject to receipt of a satisfactory Disclosure.

A criminal record or conviction is not necessarily a bar to employment with Gofal and each case will be decided on the individual circumstances.The above is the policy statement of Gofal, if you wish to see our full procedure then please do contact the office in confidence and a copy will be sent to you.

ADDITIONAL INFORMATION

How much notice are you required to give? _____________________________

Case Worker Dial Page 12 of 22April 2016

How did you hear of this post? Please specify ______________________________

Are you to your knowledge, known to any Trustee or employee of Gofal? YES / NO* (please delete as appropriate)

Details: _______________________________________________________

I confirm that to the best of my knowledge the information given in this application is true and correct. I understand that if any false information is given it may result in the withdrawal of an offer or termination of employment should I be appointed.

Signed __________________________________ Date: ________________

Case Worker Dial Page 13 of 22April 2016

EDUCATION(Including secondary, further and vocational education)

Dates Establishment Qualifications and Grades

OTHER TRAINING ATTENDED

Dates Course Details – Title and length of course

Case Worker Dial Page 14 of 22April 2016

EMPLOYMENT

Please provide details of your work history, both paid and unpaid, in chronological order. Please ensure that you do not leave gaps unaccounted for. Gofal reserves the right to contact any of your previous employers

DATES PAID OR

UNPAID

EMPLOYER POSITION AND DUTIES REASON FOR LEAVING

Case Worker Dial Page 15 of 22April 2016

SUPPORTING STATEMENTPlease use this section to provide your supporting statement which should address the criteria outlined in the person specification. The information provided in this section helps us to determine who to invite for interview. Before completing it you may find it useful to read our Guidance Document for Applicants available on the recruitment section of our website www.gofal.org.uk.

Please attach additional sheets if required.

Please note that we do not accept CV’s in place of this section.

Supporting Statement of Applicant

Case Worker Dial Page 16 of 22April 2016

Case Worker Dial Page 17 of 22April 2016

DRIVING

Do you hold a current driving licence? YES/NO

Do you have your own transport, which you would agree to maintain and insure for work purposes?

YES/NO

WELSH LANGUAGE

Do you speak: Welsh as a 1st language ¨ 2nd language ¨ do not speak Welsh ¨

Thank you for completing the application form, please return by post or e-mail by the stated closing date.

By post: HR Department, Gofal, 2nd Floor, Derwen House, 2 Court Road, Bridgend, CF31 1BN

Or by e-mail to: [email protected]

Case Worker Dial Page 18 of 22April 2016

Gofal is striving to ensure equality in its employment policies and as part of this; we are monitoring our recruitment practices. This will help us to identify areas of under-representation in our work force and to assess areas where action is required.

Your co-operation in completing this form would be greatly appreciated. We should stress that any information you give will be strictly confidential to the personnel section.If you do not wish to answer any question (s) this will not affect your application in any way.

Post Applied For………………………………………… Date……………………….

Where did you see this post advertised…………………………………………..………………

Thank you for your time and co-operation in completing this form.

1. SEXAre you :-

¨ Male¨ Female

¨ Prefer not to say

1a. GENDER IDENTITYIs your gender identity the same as the gender you were assigned at birth?

¨ Yes¨ No

¨ Prefer not to say

Do you live and work full time in a gender opposite to that assigned at birth?

¨ Yes¨ No

¨ Prefer not to say

2. AGEMy age is:-……………………….

¨ Prefer not to say

3. RELATIONSHIP STATUSAre you:-

Case Worker Dial Page 19 of 22April 2016

EQUAL OPPORTUNITIES MONITORING FORM

¨ Single¨ Married¨ Divorced¨ Widowed¨ Co-habiting¨ Civil Union¨ Domestic partnership

¨ Prefer not to say

4. DISABILITIES

The Equality Act, 2010, defines a disability as:“A physical or mental impairment which has a substantial and long-term adverse effect on a person’s ability to carry out normal day-to-day activities”

Do you consider yourself to have disabilities?

¨ Yes¨ No

¨ Prefer not to say

Please specify:

¨ Physical impairment¨ Sight loss or partially sighted¨ Hard of hearing¨ Deaf (non BSL user)¨ Deaf BSL user¨ Learning difficulties¨ Mental and emotional distress¨ A health condition e.g. HIV, multiple sclerosis, cancer

¨ Prefer not to say

5. MENTAL HEALTHDo you have your own lived experience of mental ill health?

¨ Yes¨ No

¨ Prefer not to say

Do you have experience of providing care/support to a friend or family member experiencing mental ill health?

¨ Yes¨ No

¨ Prefer not to say

Case Worker Dial Page 20 of 22April 2016

6. SEXUAL ORIENTATIONI would describe myself as:-

¨ Bisexual¨ Gay¨ Heterosexual¨ Lesbian

¨ Prefer not to say

7. ETHNIC ORIGINI would describe my ethnic origin as:-

WHITE

¨ British¨ English ¨ Scottish ¨ Welsh ¨ Irish ¨ Traveller

Any other white background, please write…………………………………………………..….

MIXED

¨ White and Black Caribbean¨ White and Black African¨ White and Asian

Any other mixed background, please write in…………………………………………………..

ASIAN, ASIAN BRITISH

¨ Indian¨ Pakistani¨ Bangladeshi¨ Chinese

Any other Asian background please write in……………………………………………...……

BLACK, BLACK BRITISH

¨ Caribbean¨ African

Any other black background please write in………………………………..…………………..

Case Worker Dial Page 21 of 22April 2016

¨ Prefer not to say

8. RELIGION OR BELIEFI would describe my religion or belief as:-

¨ Buddhist¨ Christian¨ Hindu¨ Jewish¨ Muslim¨ Sikh¨ Any other religion or belief (please specify)…………………………………………¨ No religion

¨ Prefer not to say

9. LANGUAGE

¨ Welsh ¨ as a 1st language ¨ as a 2nd language

¨ English ¨ as a 1st language ¨ as a 2nd language

Any other please specify (include BSL)………………………………………………………………………

¨ as a 1st language ¨ as a 2nd language

¨ Prefer not to say

Please return with your application: By post: HR Department, Gofal, 2nd Floor, Derwen House, 2 Court Road, Bridgend, CF31 1BN

Or by e-mail to: [email protected]

This form will be immediately separated from your application form and it will not be seen by the recruitment panel.

Case Worker Dial Page 22 of 22April 2016