Bir Dp Employment Wassell

Bir Dp Employment Wassell

SILK

HEALTHCARE

APPLICATION FOR EMPLOYMENT

TO BE COMPLETED BY ALL CANDIDATES INCLUDING VOLUNTEERS

NB.All information provided will be treated in strictest confidence; the information will not be seen by anyone otherthan management. None of the information will be disclosed to any third party without your permission. However, the National Care Standards Commission, whose requirements you will have to satisfy (including those imposed by the Care Standards Act 2000 and related Regulations and National Minimum Standards), have the right to scrutinise all recruitment paperwork including this form.

POSITION APPLIED FOR: Please specify;
PERSONAL DETAILS Title (Mr, Mrs, Miss, Ms):
Surname: Forenames:
Address:
Telephone no: home work mobile
E-mail:
Resident in the U.K for / years/months.Are you eligible to work in the U.K? yes/no
Pin Number: (Qualified Nurses Only) Expiry date:
National Insurance Number:
Do you have a full current Driving Licence (please circle) Yes / No
Is your Licence free of Endorsements (please circle) Yes / No
How many years have you held a full current Driving Licence
Have you any experience of driving people carrying vehicles Yes / No
If Yes, please specify
SUMMARY OF QUALIFICATIONS
School attended from age 11:
Please give details of examinations passed/grades:
FURTHER EDUCATION
College/University attended:
Please give details of examinations passed/grades:
Care qualifications:
Have you completed the Care Certificate: Yes / No
If yes please attach a copy to this application.
All new employees must complete the 12 week Care Certificate unless they can produce evidence of having done this. A Training Agreement must be signed by the employee so that in the event of the employee leaving Silk Healthcare within a specified time then the employee will be charged for the cost of this training. This Training Certificate is portable and the employee may take this to another employer.
Other specific training courses provided will also require a Training Agreement.
Other qualifications:
Relevant courses attended:
EXPERIENCE
What experience have you had in caring for frail elderly persons, elderly persons with mental health problems?
Where?
When?
What other relevant training and experience do you have relating to this vacancy?
EMPLOYMENT
Please give the name and address of present (or most recent) employer including the start date month and year:
PREVIOUS EMPLOYMENT HISTORY SINCE LEAVING SCHOOL HIGHLIGHTING AND EXPLAINING ANY GAPS IN EMPLOYMENT.
Dates from and to / Employer / Position held and key duties / Reasons for leaving
This organisation operates a policy on working with relatives. Do you know of any person currently in employment by this company? If so who are they and what is their relationship to you?
PLEASE GIVE DETAILS IF YOU HAVE BEEN SUBJECT TO ANY DISCIPLINARY, GRIEVANCES OR SUSPENSIONS.
COMMUNITY / VOLUNTEER EXPERIENCE
ASSISTANCE WITH INTERVIEW AND ASSESSMENT:
Do you require is to make any special arrangements in order for you to participate in the recruitment process? For example; large print forms? Or additional time to complete forms?
YES/NO
If Yes, please give details:
GENERAL
Interests/hobbies (please give details of any musical instruments you play, pastimes, sports etc):
PLEASE GIVE ANY FURTHER INFORMATION YOU THINK MIGHT BE HELPFUL TO YOUR APPLICATION:
REFERENCES
Please give the names and addresses of two people willing to give you a reference and state the capacity in which you are known to them (not family). One reference must be the current or last employer. No approach will be made to your employer without your permission. Can we have your permission?
Yes / No (please circle).
Please note that your application cannot be processed without a reference from your present/most recent employer
Name
Address
Post code
Telephone number Email:
Friend/Employer/Other
Name
Address
Post code
Telephone number Email:
Friend/Employer/Other
Are you aware of any health issues or any event that would prevent you fulfilling the role you are applying for now or in the future?
Yes/No (please circle) Details: …..……………………………………......
………………………………………………………………………………………………………….
………………………………………………………………………………………………………….
Have you ever had any disciplinary action taken against you? If Yes please give details and outcome: Yes / No
Details:
How many days absence have you had in the past two years?
Details:
General information. Silk Healthcare’s Policy dictates that:
  • Body art to be covered whilst at work
  • Arms should be bare below the elbows.
  • Only small stud earrings and a wedding band can be worn. No additional piercings to be worn.
  • No extreme hair colours or styles, hair must be neat and tied back off the face. Nails short and free from varnish.
  • Footwear - flat black shoes

HAVE YOU EVER HAD ANY CRIMINAL CONVICTIONS OR CAUTIONS
YES/NO (please circle) Details:
Signed ……………………………………….. Dated …………………………….
REHABILITATION OF OFFENDERS ACT 1974 - EXEMPTION FROM SECTION 4(2).
This vacancy is exempt from the above and staff are not therefore entitled to withhold information about "spent" convictions. If you have ever been convicted of any offence by a court of law, please give details of the offences with dates below. If you have ever been cautioned by a constable in respect of any offence and at the time you were cautioned you admitted the offence(s) please give details of the offences with dates below. You are obliged to give this information and sign as to the truth of your answers. If you have not got any convictions and/or cautions please write "no convictions and/or cautions" as appropriate. If your name is on a Protection of Vulnerable Adults (POVA) Register this must be declared. The failure to declare any conviction and/or caution is sufficient grounds for instant dismissal.
Signed……………………………………Dated……………………………………….
PERMISSION FOR A DISCLOSURE & BARING SERVICES SEARCH (THIS DECLARATION MUST BE SIGNED)
I hereby give my permission for the management of Silk Healthcare to implement a search via the Disclosure and Baring Services to see whether I have any record, criminal or otherwise, which would preclude them from employing me. I acknowledge that after 180 days of employment I will be reimbursed the cost of undertaking the DBS check and that if the application does not proceed to employment that I will not be reimbursed.
Signed:……………………………………Dated:……………………………….
I declare that the information provided on this application form is true and complete to the best of my knowledge. I give my consent to Silk Healthcare processing the personal data included on this form for the purpose of their equal opportunities monitoring policy and for the purpose of the recruitment process and, if applicable, my future employment with them. I understand that any false statements or deliberate misrepresentations will be regarded as grounds for disciplinary action and/or termination of my employment.
Signature Date of application:
  • I declare that the information given in this document is true and complete to the best of my knowledge.
  • I consent to a medical interview/examination if necessary.
  • I agree to accept any immunisations to undertake the duties of the post relevant details and results of any tests may be sent to my GP.
  • I agree to report to the Manager if I have any contact with, or suffer from any personal illness/disorder which could present a health hazard to anyone with whom I work (i.e. resident or member of staff).

EQUAL OPPORTUNITIES
It is Silk Healthcare policy to recruit the most suitable person for the job without any regard to sex, marital status, race or, subject to the legal requirements of the Care Standards Act 2000, disability. To help us monitor this policy we would be grateful if you would provide the following details. However, this is purely voluntary and if you choose not to do so, it will not affect your application in any way. Please  the appropriate box.
Female / Male / Married
Your age range / Under 30  / 30 to 50 yrs.  / Over 50 
Ethnicity / White / Black African / Black Caribbean  / Black Other
Pakistani / Bangladeshi / Chinese / Indian 
Other (please specify):
Disabled (If yes please give details)

OCTOBER 2015

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