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Personal details
Answers given in this part of the form are to help the Recruitment Centre to manage your application.
If you have any difficulty completing this form please ask someone to help you.
We would like to take this opportunity to thank you for applying.
Personal details
Title Miss
Forename Rimsha Kausar
Middle name(s) Ullah
Surname Akhtar
Work telephone
Mobile telephone 07594353248
Home telephone 01616376033
UK National Insurance number PX385561B
First available date for employment Any
Disclosure of information
Before you can be considered for appointment we need to be satisfied about your character and suitability
Pennine Care NHS Foundation Trust aims to promote equality of opportunity and is committed to treating all applicants for positions fairly and on merit regardless of
race, gender, marital status, religion, disability, sexual orientation and age. We undertake not to discriminate unfairly against applicants on the basis of a criminal
conviction or other information declared.
If you are applying for a post involving access to persons in receipt of health services, your offer of employment may be subject to a satisfactory disclosure from the
Disclosure and Barring Service. Failure to reveal information relating to any convictions could lead to withdrawal of an offer of employment.
Have you any unspent criminal convictions or bindovers, or any cautions, warnings or reprimands?
No
If yes, please give details
The position you are applying for has been identified as being an 'eligible position' under the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 [the
Exceptions Order] and, in certain circumstances, the Police Act 1997. As such, it meets the eligibility criteria for a standard or an enhanced disclosure to be
requested through the Disclosure and Barring Service (DBS).
As such you are required to declare any convictions, cautions and reprimands that are not covered by the 'filtering' rules.
Please read the guidance available here BEFORE completing this section.
Have you at any time received or had pending a criminal conviction, caution, warning, reprimand or bind-over (known as a spent conviction) that is not
covered by the 'filtering' rules?
No
If yes, please give details
Before being given access to the online application form, the applicant was asked the following.
Declaration
I confirm that the information that I have provided in this application and in any accompanying documents is to the best of my knowledge correct and complete. I
understand and accept that if I withhold information or provide false or misleading information this may result in my application being rejected, or if I am appointed,
to disciplinary action and /or dismissal.
In addition I acknowledge that the canvassing of a member or senior officer of Pennine Care NHS Foundation Trust, failure to disclose a relationship with a member
or employee of Pennine Care NHS Foundation Trust and/or the provision of false information either expressly or implicitly will also result in disqualification or
dismissal.
All new staff may be required to provide proof of any of the matters set out in their application form and Pennine Care NHS Foundation Trust reserves its right to
make appropriate additional checks in respect of the information provided by you.
In addition if you are successful you may be required to complete a declaration of interests form and provide proof of identity and nationality before your first day of
employment. If acceptable evidence is not provided or if the declaration of interest form indicates there is a potential for an unacceptable conflict of interest, which
cannot be resolved, then any appointment cannot commence.
Please note: Your documentation i.e. Passport, Visa, (photographic) Driving Licence will be checked by a 'Document Authenticator' to confirm their validity should
you be shortlisted and invited for assessment and/or interview.
Please note: if you wish to withdraw your consent at any time after completing this Declaration Form, please contact the Recruitment Centre.
Application questions
Details entered in this part of the form will be made available to the shortlisting panel. Please make sure that you have read the job description and person
specification before completing the application form, and ensure that your answers clearly and honestly demonstrate how your skills and experience are relevant to
the post for which you are applying.
Place of study The Health & Well-being College NHS Foundation Trust
Please give details of other formal training courses attended and dates
Professional registration
Professional body
Registration no
Expiry / renewal date
NMC revalidation date
Any other information relevant to your registration such as sections of register or restrictions on
practice.
Please include all periods of employment, unemployment, study, travel etc as necessary to cover a minimum period of the last 3 years. There should be no gaps in
your activity history for the last three years.. You may also add as many other periods of employment, unemployment, study, travel etc as you wish which took place
prior to the last three years. If you have other current part time jobs please add these first
Supporting information
Please read the job description and person specification carefully and make full use of this section, to provide further information in support of your application.
Supporting information
I approached the volunteering services provided by Penine Care with the passion to help others most specifically within the mental health sector having had
personal experience and the yearning to raise awareness in this regard. Currently I intend to dedicate my time to studying the psychology of mental health and
acquiring skills to expand my understanding and help others along the way. I am a confident speaker and compassionate listener. Having worked with children and
young people in most of working life and having the responsibilities of maintaining contact with parents etc I have attained valuable skills of effective communication
which I believe will assist in this role. I am creative person in my personal space, I like to paint ,write poetry , read, continue to mentally grow and utilise my time in
promoting the wellbeing of myself and those around me. I have always been passionate about bringing positive change and contributing of my skills to my
surroundings both personal and professional hence it would be an honour for me to assist in this role and not only gain valuable insight and experience but also
being a smile to the patients on ward and help promote thier recovery. I have studied legislation within the field of teaching assistance hence understand the
sensitive guidelines of equality and confidentiality which equally apply in this work setup. I am currently studying health and well being courses at The Health and
Well-being College to assist my understanding of mental health, anxieties and psychology of thoughts etc which I believe along with my personal experience of a
deep encounter with mental health will allow me to empathize and communicate positively with patients. I have an enhanced certificate of DBS issued in October
2016. I look forward to joining the team and working with the NHS.
If you currently work in the NHS and your application for this post is successful it will speed up the pre-employment checks process and help to ensure that you are
paid from the correct grade if you are prepared to give your consent to the Trust obtaining details of your previous NHS continuous service records via Inter Authority
Transfer process. (This will only be done if you are offered a post)
Do you give consent to the Trust obtaining details of your previous NHS continuous service records via the Internal Authority Transfer Process?
Not applicable - I am not currently employed in the NHS.
Pre-screening questions
This is an unpaid voluntary role, you will receive no payment for your time. Do you wish to continue with your application?
Yes
References
If you are successful, prior to appointment, we will take up as many references as needed to cover all activities, including periods of employment and full
time education, that you have undertaken over the past three years. Any offer will be subject to these being satisfactory. Please ensure that you provide full
contact details for your Employer/Line Managers or Course Tutors for each activity. Please include their work email address where possible to avoid any
unnecessary delays.
If during the last three years you have any periods in which you have not been in either employment or full-time education please provide details of someone who can
provide a character reference for you to cover this period. Character references should be provided by a person of standing in the community such as a Teacher,
Health Care Professional (i.e. Doctor, Physiotherapist, Registered Nurse), Minister of Religion, Police Officer or Solicitor. Character references should only be used
in EXCEPTIONAL circumstances to cover periods of time when you have not been in either employment or education.
Please use the "Add another" button below to add as many referees as required to meet the above requirements. Periods that referees cover may overlap
but there should not be any gaps over the past three years.
Referee's title Mr
Referee's first name(s) Saeed
Referee's surname Qadodia
Referee's organisation name Madrasa Arabia
Job title Teacher/ Management
How do they know you? Employer / Line Manager
Address 1 Richmond Hill
Address 2 321 Katherine Street
Address 3
City / Town Ashton Under Lyne
County / State Lancashire
Country United Kingdom
Postcode OL7 0AL
Telephone no. +447845425517
Mobile no.
Fax no.
Email address
Can the referee be approached prior to the Yes
interview?
Period this reference covers from: September 2015
Period this reference covers to: September 2017
Declaration
I am making an online application and confirm that the information that I have provided in this application is to the best of my knowledge correct and
complete. I understand and accept that if I withhold information or provide false or misleading information this may result in my application being
rejected, or if I am appointed, to disciplinary and/or dismissal. By marking this box I indicate that I agree with the above declaration and that I will sign
printed copies of this application form upon request. I understand that if I wish to withdraw my consent at any time after completing this declaration I
can do so by contacting the Recruitment Centre
Yes
Equal opportunities
Equal opportunities
As a large, public employer we have a legal duty to monitor our recruitment and selection processes to ensure that all applicants are treated fairly.
The information that we collect is stored in a secure database and is only used for statutory monitoring purposes. Please note that any monitoring reports produced
from the database do not include any data that will link to named individuals. Furthermore, our staff involved in the recruitment and selection process do not have
access to this part of your application form.
There are two exceptions to the above. The first relates to some of the information about disabilities, and this is explained below. The second is that for successful
applicants some of the monitoring information will be stored against their permanent staff record. This information is recorded for all of the organisation's employees
to ensure that the profile of the staff we employ reflects the community in which we are based.
The Equality Act 2010 protects people against discrimination on the grounds of:
The Equality Act 2010 also protects people who are married or in a civil partnership.
General questions
Gender Female
Marital status Single
Date of Birth 07/08/93
Ethnic Origin
Ethnic origin does not mean nationality, but normally refers to the people or culture with which a person's immediate family identify.
Do you have a sexual orientation towards: I do not wish to describe my sexual orientation.
Do you now or have you ever identified as No
trans or transgender?
Please indicate your religious belief: Islam
Disability
The answer to the question about the Guaranteed Interview Scheme is presented to the lead short-lister before they make the final decision on who to invite to
interview. This is done so that we can meet our obligation as a 'Two Ticks' employer to invite to interview any applicant, who has a disability, who meets the essential
criteria for a post that they have applied for. If you are invited to interview you will need to let us know if you will need any special help or adaptations.
• Physical impairment, such as difficulty using your arms or mobility issues which means using a wheelchair or crutches
• Sensory impairment, such as being blind/having a serious visual impairment or being deaf/having a serious hearing impairment
• Mental health condition, such as depression or schizophrenia
• Learning disability/difficulty, (such as Down's syndrome or dyslexia) or cognitive impairment (such as autistic spectrum disorder)
• Longstanding illness or health condition such as cancer, HIV, diabetes, chronic heart disease, or epilepsy
• Other is anything that does not fall into one of the categories detailed above
If you are selected for interview you will have the chance to let the recruitment centre know about any particular needs you have. This will enable us to offer you a
fair interview if, for example, you have a speech difficulty or need a wheelchair accessible room.
I would describe my main disability as:
None / Not Applicable
If you have a disability, do you wish to be considered under the Guaranteed Interview Scheme if you meet the minimum criteria as specified in the
Person Specification?