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Application form

Application For Employment

(In confidence)

Today's Date
Today's Date
One of which must be your MOST RECENT employer and returned on headed note paper.
Any relevant courses that you have completed. This is including mandatory training (First Aid, Moving & Handling, Infection Control, Safeguarding vulnerable adults, Medication Training, Food Safety Level 2 and any others). Please also include any NVQ's or the Care Certificate. Please list all your certificates, along with the date obtained and their renewal dates.
Previous Employment
For the last 8 - 10 years including an explanation for any gaps (start with the most recent and include your current job if applicable). Please list the employers name, location and nature of business; title of the position held; your salary; start and leave date and reason for leaving.
Assistance with Interview
Do you require us 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?
Capacity to Work in the UK
Are there any restrictions to your residence in the UK, which might affect your right to take up employment in the UK?
If you are successful in the application, would you require a work permit prior to taking up employment?
Supporting Information
Please answer honestly so we can find the best placement to suit you
2b) Can you cook home-cooked meals from scratch?
2c) From a variety of cultures and cuisines?
3) Would you be happy to work with challenging behaviour or mental health issues?
Would you be interested to work on the palliative, end of life team?
For example do you like to garden, do you read, enjoy the arts? Do you like to discuss politics? Are you interested in spiritual topics? Write a good description of your interests as this information is used to match you with our clients.
6) Do you have your driving license? *
7) Do you own a car?
8) Have you got business insurance so you can drive your clients?
9) Do you smoke at work?
10) Are you able to work with clients who have pets?
If invited to interview please bring the following documents:
• CERTIFICATES for RECENT TRAINING (last 3 years) • ORIGINAL DBS CERTIFICATE (IF YOU HAVE ONE) • PROOF of NATIONAL INSURANCE (e.g. NI Card, Payslip, P45 or P60) • PROOF of the RIGHT TO WORK / BIOMETRIC RESIDENCY CARD • Your PASSPORT and/or DRIVING LICENSE for photo ID • A recent BILL (Not a Mobile) or STATEMENT (within the last 3 months) with your current address for proof of address
Self Declaration Form
Are you under any investigation or involved in any proceedings, either in this country or abroad with regard to your fitness to practice? *
Have you ever been disqualified from practice in the past, either in this country or abroad? *
Is the information that you have given in this application correct to the best of you knowledge? *
Date *
Rehabilitation of Offenders Act 1974 (Exemptions) Order 1975
Under the above Act, applicants for a post in a health environment are required to complete a Criminal Records Bureau disclosure and be cleared for work with vulnerable adults. Information about any convictions will be treated in complete confidence and will only be considered in relation to this application. A risk assessment may be completed before a final decision is reached on suitability. It is a requirement that all spent and/or current convictions are disclosed at this point.
Have you ever had a Conviction? *
(Including ‘spent’ convictions within this meaning of the Rehabilitation of Offenders Act 1974)
I confirm that the above information is accurate and true
Date *