Application for the position of
Care & Support Worker
If you prefer to complete your application off-line, please download our PDF Application Pack...
Online Application For Employment
You are applying for the post of Care & Support Worker.
Personal Details
Please ensure that all sections of the following form are completed before proceeding...
Surname (current family name):
Forename(s):
Previous Surnames (if applicable):
Home Telephone :
Work Telephone :
Mobile Telephone:
Email Address :
National Insurance Number :
Home Address:
Postcode (Home):
Previous Address:(
If you have lived at your current address for less than 5 years
)
Postcode (Previous):
No
Yes
Do you require a Work Permit?
No
Yes
If yes, do you hold one?
No
Yes
Do you hold a Full Valid Driving License?
No
Yes
If yes, do you have your own transport?
If you are successful you will be required to supply evidence prior to your appointment.
Rehabilitation of Offenders Act 1975
Please give details of any court convictions, outstanding summonses or prosecutions (including SPENT convictions as due to the nature of the work that you have applied for the post is EXEMPT from the provision of the act (Section 4(2)), by virtue of the Rehabilitation of Offenders Act 1974 (Exemptions Orders 1975). Any false statement will disqualify you from employment, or, if employment has commenced, will render you liable to summary dismissal.
No
Yes
Have you ever been convicted of a criminal offence, bound over by any court or cautioned by the police?
Applicants should not that providing false information to obtain employment is a criminal offence (S16 Theft Act 1968)
Application for the position of
Care & Support Worker
If you prefer to complete your application off-line, please download our PDF Application Pack...
Online Application For Employment
You are applying for the post of Care & Support Worker.
Previous Employment
Please give details of your FULL employment history; starting with the most recent and explaining ALL gaps in employment. Please state the month and year for all dates.
References
Please provide details below of at least two referees, one of whom must be your current, most recent or most relevant employer and have direct knowledge of your work, the other should also be a past employer. If you have not been employed, or only had one employer during the past 10 years, then two character references will be accepted.
Character references should, where possible, be professional people, i.e. teacher, medically or legally qualified person. Friends and relatives are not acceptable referees. If you have more than one current employer you must give reference details of both.
Reference Name / Title :
Job Title :
Address :
Postcode :
Telephone :
Fax :
In what capacity do you know this referee?
May we contact this referee
prior to interview?
Yes
No
Reference Name / Title :
Job Title :
Address :
Postcode :
Telephone :
Fax :
In what capacity do you know this referee?
May we contact this referee
prior to interview?
Yes
No
Reference Name / Title :
Job Title :
Address :
Postcode :
Telephone :
Fax :
In what capacity do you know this referee?
May we contact this referee
prior to interview?
Yes
No
Application for the position of
Care & Support Worker
If you prefer to complete your application off-line, please download our PDF Application Pack...
Online Application For Employment
You are applying for the post of Care & Support Worker.
Education and Qualifications
Please give details of your education and the qualifications obtained. Include details of any qualification you are currently studying for.
Training
Please give details of any further training you have received which supports your application. Include any on-the-job training as well as formal courses.
Personal Statement
Use this section to demonstrate how you meet all of the criteria for the job as set out in the enclosed job description and person specification. Draw on all aspects of your education and experience, including paid and unpaid employment.
Abilities, skills, knowledge and experience …
Availability
Tick all times you are available to work - alternate weekends are normally worked :
Declaration
I declare that the information contained in this application is correct to the best of my knowledge.
I agree that Direct Health Group, may take reasonable steps to verify the information.
I understand that any false statement will disqualify me from employment, or, if discovered after employment has commenced, may render me liable to summary dismissal.
I also understand that any offer of employment will be subject to satisfactory references and Enhanced Criminal Records Bureau Disclosure.
In accordance with the Data Protection Act 1998, I understand that the information provided on this form will be used in the recruitment and selection process and will form the basis of the personnel record for the successful candidate. It will also be held on a database and used for Equal Opportunities monitoring purposes.
Application for the position of
Care & Support Worker
If you prefer to complete your application off-line, please download our PDF Application Pack...
Equal Opportunities Monitoring Information
You are applying for the post of Care & Support Worker.
It is our policy to recruit staff on the basis of their ability and their suitability for the position for which they are applying.
As part of our equal opportunities policy we welcome applications from all parts of the community. It would help us if you would answer these questions, which assist us to monitor the effectiveness of our policy.
We treat the information you give us in confidence. This information does not form part of the selection process.
Please specify your gender:
Male
Female
Your Title:
Mr
Mrs
Miss
Ms
Other
Please Specify:
Name:
Date of Birth:
Position Applied For:
How would you describe your ethnic origin ? Please tick relevant box...
Do you consider yourself to have a disability?
Yes
No
If yes, please give brief details below...
The Disability Discrimination Act 1995 says ‘a person has a disability if they have a physical or mental impairment which has a substantial and long-term adverse effect on their ability to carry out normal day-to-day activities’.
The meaning of long-term is lasting, or being likely to last, at least 12 months. Disabilities may involve difficulties with moving around; holding and manipulating objects; physical co-ordination; incontinence; lifting, carrying or moving everyday objects; speech; hearing or eyesight (except if this is corrected with spectacles or contact lenses). It may also involve mental abilities such as memory, concentration, learning and understanding.
Application for the position of
Care & Support Worker
If you prefer to complete your application off-line, please download our PDF Application Pack...
I hereby declare that the information given is full and true to the best of my knowledge. I understand that if, at a later date, it is discovered that I have knowingly withheld medical information, disciplinary action may be taken against me that may include summary dismissal.
Application for the position of
Care & Support Worker
If you prefer to complete your application off-line, please download our PDF Application Pack...
Important documents relating to your application...
You are applying for the post of Care & Support Worker.
Before submitting your application, please confirm that you have read and fully understand the following documents. You will also need to print and complete the CRB Disclosure document, which you will then need to bring with you, along with your supporting identification as part of our recruitment process.
