APPLICATION FORM

Fill this form to apply for a position with us

Application Form

WHAT ARE YOU APPLYING FOR?

Dropdown

PERSONAL DETAIL

Tittle

First Name

Middle Name

Last Name

Which of the following best describes you

Male

Female

Date of Birth

Current Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Phone

Other Phone

National Insurance Number

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How did you hear about this job?

Company website

Refer a friend

Google

Other search engine

Indeed

Word of mouth

Are you legally entitled to work in the UK?

What is your nationality?

Have you recently worked in a care home?

If you answered "yes"

Are you willing to relocate?

Hourly pay?

DRIVING HISTORY

Driving License

If Yes, Type of license

License Number

Any current endorsement?

Any monitoring prosecutions pending?

If yes, Type of endorsement

If yes, Type of pending prosecutions?

PREVIOUS EMPLOYMENT HISTORY

Please use this section to provide information about your previous employment starting with your current or most recent job.

EMPLOYMENT DETAIL 1

Company Name

Supervisor

Job Tittle

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Employment Start Date

Employment End Date

Responsibilities

Reason for Leaving

EMPLOYMENT DETAIL 2

Company Name

Supervisor

Job Tittle

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Job Start Date

Job Finish Date

Responsibilities

Reason for Leaving

EDUCATION

Please use this section to provide information about your previous education including the qualifications/certificates your have gained.

HIGH SCHOOL/COLLEGE

Name

Start Date

Finish Date

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Subject and Grades

UNIVERSITY

Name

Start Date

Finish Date

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Subject and Grades

REFERENCES

Please use this section to provide a list of three professional references.

WORK REFERENCE 1

Company

First name

Middle Name

Last Name

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

WORK REFERENCE 2

Company

First Name

Middle Name

Last Name

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

CHARACTER REFERENCE

First Name

Middle Name

Last Name

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

CRIMINAL RECORD

Care workers work with vulnerable people and we take our responsibility to protect them very seriously. Your appointment will depend on the satisfactory completion of a criminal records disclosure (see policy statement below), but at this stage, we need you to answer the following questions truthfully and honestly:

Have you received any convictions, cautions, reprimands or final warnings that are not ‘protected’ as defined by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975(as amended in 2013 by SI 210 1198)?

Yes

To your knowledge, are you currently the subject of any criminal proceedings (for example, charged or summoned but not yet dealt with) or any police investigation?

Yes

If you have answered YES to any of the questions above, please give further details.

Do you consent to our applying for an enhanced criminal records disclosure on you and to our retaining a copy of your disclosure certificate during the period of your employment or until a new disclosure is completed (whichever occurs first)?

Yes

NOTE

Once a criminal records disclosure has been completed, it is discovered that you have failed to accurately disclose the information requested above, the company reserves the right to terminate your employment without notice. Please be aware, however, that your having a criminal record will not necessarily mean we cannot employ you – if you would like to know more about our policy on the recruitment of ex-offenders, please ask.

CRIMINAL RECORDS DISCLOSURES – OUR POLICY

As an organization assessing applicants’ suitability for positions that are included in the Rehabilitation of Offenders Act 1974 (Exceptions) Order using criminal record checks processed through the Disclosure and Barring Service (DBS), we comply fully with the Code of Practice and undertake to treat all applicants for positions fairly. We will not discriminate unfairly against any subject of a criminal record check on the basis of a conviction or other information revealed. We can only ask an individual to provide details of convictions and cautions that we are legally entitled to know about. Where a DBS certificate at either standard or enhanced level can legally be requested (where the position is one that is included in the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 as amended) and where appropriate Police Act Regulations (as amended), we can only ask an individual about convictions and cautions that are not protected.

SUITABILITY FOR THE JOB

Please read the care worker job description and answer the following questions.

Have you read and understood the care worker job description?

Yes

The position for which you are applying requires physical effort (including sitting, standing, carrying, walking, moving and handling people), mental effort (including dealing with emergencies and short-notice changes to work in a fast-paced environment) and possible emotional/psychological effort (including dealing with bereavement and challenging behaviour in a potentially stressful environment)

Do you have any health conditions that would prevent you from meeting these intrinsic requirements for which the company might need to make reasonable adjustments? (If yes, please be aware that we may need to discuss these with you at your interview)

Yes

If you answered ‘yes’, please provide brief details

EQUAL OPPORTUNITY MONITORING

Would you describe your ethnicity as any of the following?

White Irish

Mixed White and Black Caribbean

Mixed other

Black other

Asian Pakistani

White British

Mixed White and Black African

Black Caribbean

Asian Bangladeshi

Asian Chinese

White other

Mixed White and Black Asian

Black African

Asian Indian

Asian other

Would you describe yourself to have any disability?

Blind/Partially sighted

Wheelchair use

Deaf