Please complete this application form in Block capitals and Black ink
- Your details
Title / Surname / First name/s
Your address
Contact information
Home phone number / Mobile phone number / Email address
Driving record
State what type of driving licence you have
State any details of current endorsements
Date licence is valid from and to
Are you a car owner?
Working rights
Are there any restrictions regarding your right to work in the U.K?
If yes please provide details on a separate sheet of paper.
Please note it will be a condition prior to employment that evidence regarding eligibility to work in the U.K is provided. This could include a birth certificate, P45, P60, National insurance card or endorsed passport.
Criminal record certificates
If the position you are applying for (whether paid or voluntary ) is listed in schedule 1, part 2 of the Rehabilitation of Offenders Act (Exceptions) order 1975, we are entitled to ask exempt questions as defined by section 113 (5) of the Police Act 1997 about you.
We are required by the Health and Social Care Act 2008 to acquire a Criminal Record Certificate in relation to any person who is a care manager or domiciliary care worker. This means that if your application is successful we will obtain from the Criminal Records Bureau a criminal record certificate relating to you before your appointment is confirmed.
Having a criminal record will not necessarily bar you from working with us. This will depend on the nature of the position and the circumstances and background of your offences. We observe the ‘Code of Practice for Registered Persons and other Recipients of Disclosure Information’ published by the Criminal Records Bureau on behalf of the Home office, and will provide you with a copy of it upon request.
CARERS AND COMPANIONS JOB APPLICATION FORM PAGE 2
- Employment history
Provide details of all employment, beginning with your most present or recent job first
Employer / Date started / Date left / Position held / Salary / Reason for leaving
Voluntary & community work experience
Organisation / Date started / Date left / Position held / Duties
Current commitments
Details of other work which you will continue to undertake if offered this position
Provide details of any outstanding holidays to be taken
Available to commence employment from
CARERS AND COMPANIONS JOB APPLICATION PAGE 3
- Education, training & professional development
Education centre Date from Date to Qualification gained
Secondary education (secondary school)
Further education (college/distance learning courses/NVQ’s/ work based learning courses)
Higher education(University etc)
- Personal statement
Use this space to provide details of experience, knowledge and skills you possess in relation to the job role. Provide details of your reasons for applying for this particular job role.
CARERS AND COMPANIONS JOB APPLICATION FORM PAGE 4
- Availability
Number of hours willing to work
Please use this space to comment on your availability
Tick the appropriate box/s as to what you are prepared to work
Day / 7.30 -11.30 / 11.30 – 13.30 / 15.00 – 18.00 / 18.00 – 22.00
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
CARERS AND COMPANIONS JOB APPLICATION FORM PAGE 5
- References
Provide details of 2 referees who we may approach with regards to this job application.
These referees must not be members of your family, and at least one must be your present or most recent employer.
Referee 1.
Name
Address
Postcode
Telephone number
Occupation
Relationship to applicant
Referee 2.
Name
Address
Postcode
Telephone number
Occupation
Relationship to applicant
- Declaration by job applicant
Any person, upon subsequent employment that is found to have knowingly supplied false or misleading information, or has deliberately withheld relevant information, will be summarily dismissed.
I have read and understood the information supplied to me in relation to this job position and the information requested in this job application form. I confirm that all information supplied by me is true and correct to the best of my beliefs.
I give the prospective employer the right to follow up all references and to make any other job – related enquiries as may be deemed necessary.
Signature / Date
Carers and Companions is committed to being an equal opportunities employer