Foster Carer Application Form

	1. Details of Applicant(s)
	Applicant 1	Applicant 2
Title:
Surname(s):
Any other name(s) used, and dates used:
First and middle name(s):
Address:
Postcode:
What is your local authority?:
Telephone number:
Mobile number:
E-mail address:
Date of birth:
Ethnicity:
Religion:
Languages spoken:
Nationality:
Are you a resident in the UK?:
Date of marriage(if applicable):
Details of previous marriages:

	2. Employment
Current occupation:
Proposed/current hours of work:
Name of employer:
Address of employer:
Start date of employment:
	Applicant 1 Employment History
	Please provide a history of employers and addresses since leaving education; including any period of unemployment. Previous employers may be contacted either by telephone,or to request a written reference.
Please include dates, your occupation and employer's address and telephone number:
	Applicant 2 Employment History
Please include dates, your occupation and employer's address and telephone number:

	3. Residence History
	Please give your addresses since birth; including dates.
Applicant 1:
Applicant 2:
	4. Details of Accommodation
Type of accommodation, flat/house etc:
Number of bedrooms:
Number of bathrooms:
Other facilities:
	5. Members of the Household
	Please include any other individuals living in your household. Including all children (use initials only for fostered children); other adults; students living away from home during term time; lodgers etc.
Please include name, gender, D.O.B, school/occupation and relationship:
	6. Any Children not living in the Household
Please include name, gender, D.O.B, address and relationship:
	7. Health
Would you describe yourself as being in good health?:
Do you have any disability or sensory impairment? If yes please give details:
Do you or have you ever, suffered from any serious physical or mental illness? If yes please give details:
Have any other occupants of your household suffered from any serious physical or mental illness? If yes please give details:
Are you currently taking any prescribed medication? If yes please give details:
GP details, including name, full address and telephone number:

	8. Additional Questions
Has anyone in your household ever applied to foster, adopt or be a childminder? If yes, please give details, including dates and the Local Authority involved:
If you have fostered before, have you asked for any of the fostered children to be removed from you care? If so, please give details:
	Has a child of your family, including those of whom you have assumed responsibility for as a relative; step-parent; or subject of a Residence Order, ever been the subject of:
A Child Protection Investigation, if yes plese give details:
An Emergency Protection Order, if yes plese give details:
Care or Supervision Proceedings, if yes plese give details:
A Child Assessment Order, if yes plese give details:
Taken into Police Protection, if yes plese give details:
Provided with accommodation by the Local Authority, if yes plese give details:
A Child Protection Plan? If yes plese give details:
Removed from your care? If yes plese give details:

	9. Cautions and Convictions
	1. Have you, or a member of your household, ever received a caution, had a criminal conviction or been the subject of a criminal inquiry? If so, please give details below, including dates:
The Rehabilitation of Offenders Act 1974: Spent convictions do not apply to people who will have access to children, so even minor offences, or those which took place a long time ago, must be disclosed. Not all convictions will disqualify you from caring for children
	2. Do you, or a member of your household appear on the ISA Barred List?:
An ISA Barred List is the Independent Safeguarding Authority who overlook the Vetting and Barring Scheme and comes into force on 12th October 2009
	10. Family Description
Please provide a brief description of your family and why you wish to become foster carers. What qualities do you possess that will assist you in the fostering task?
	11. Prospective Child(ren) for Placement
Please specify an age group and gender you are considering caring for. Also, what type of placement ie. Permanent Foster Care, Short Term Care, Respite, Emergency:
	12. Additional Information
Include any information that you think may be relevant or will need to be considered alongside your application eg. moving house, career/job, change etc. Please include details of any voluntary work with children or vulnerable adults:

	13. Personal Referees
	SWAN Fostering will contact six people who will be able to comment upon your suitability as prospective foster carers. Initially, we will contact the referees in writing asking themto complete a reference form.
	Subsequently, a social worker from the Agency will arrange to visit at least two of these in person.
	At least three of the referees will need to have known you for over two years and not be related to you. Include any previous or current employer if you have ever worked with vulnerable people eg. Children, elderly people, special needs etc. The remaining three referees should be members of your extended family.
	Please state your relationship to and a telephone number for each referee.
Referee's 1 and 2:
Referee's 3 and 4:
Referee's 5 and 6:
	You will be required to sign a declaration once your application has been processed further.

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Foster Placements With Positive Outcomes01462 433808