Application Form

If you require help completing this form please get in contact with us.

SECTION 1

PERSONAL DETAILS

Title (required)
MrMrsMissOther

Forenames (required)

Surname (required)

Address (required)

Phone (required)

Mobile

Email (required)

National Insurance Number (required)

How Did You Hear About us? (required)

Can You Prove That You Are Legally Entitled To Work In The UK?
YesNoNot Sure

If Yes, What Documents Will you Provide To Prove This?

Have You Recently Worked In A Care Support Role?
YesNoNot Sure

SECTION 2

YOUR AVAILABILITY

What Is The Earliest Date You Can Start With Us?

Do You Have Use Of A Vehicle For Work?
YesNoSometimes

When Are You Available To Work?

Monday
MorningLunchtimeEarly AfternoonEveningNight ShiftLive InNot Available
Tuesday
MorningLunchtimeEarly AfternoonEveningNight ShiftLive InNot Available
Wednesday
MorningLunchtimeEarly AfternoonEveningNight ShiftLive InNot Available
Thursday
MorningLunchtimeEarly AfternoonEveningNight ShiftLive InNot Available
Friday
MorningLunchtimeEarly AfternoonEveningNight ShiftLive InNot Available
Saturday
MorningLunchtimeEarly AfternoonEveningNight ShiftLive InNot Available
Sunday
MorningLunchtimeEarly AfternoonEveningNight ShiftLive InNot Available

SECTION 3

YOUR SKILLS AND QUALIFICATIONS

Please Tell Us About The Languages you Can Speak And/Or Write?

English
I Can Speak This LanguageI Can Write This LanguageBasic LevelCompetent LevelAdvanced Level

Other Languages

Do You Have An NCF/QCF Level 2 (or above) In Health & Social Care?
YesNoStudyingOther

Have You Completed The Care Certificate (England Only)?
YesNoStudyingOther

Please Tell Us About Any Formal Qualifications You Have Achieved?

When Did You Leave Full Time Education?

SECTION 4
WORK HISTORY

We are required by law to make sure we know about the work you have done in the past, as well as the periods you may have spent out of employment. Therefore, please list your full employment history here, including any periods when you were not working (along with an explanation of what you were doing). Please use extra sheets if you need more space.

Please provide information as - Dates - Employer - Location - Job Role - Reason For Leaving

SECTION 5
YOUR PROFESSIONAL REFERENCES

Please provide the details of at least three people that we can write to for a reference. The first must be your most recent employer.
If you do not have the details of three previous employers, you may substitute one or more of these with a referee who was your tutor or teacher when you were in formal education.
If you do not have the details of a teacher or tutor, we may accept a personal reference from a person of professional standing (e.g a doctor, lawyer, accountant) who knows you, either professionally or personally.
You must not give the names of friends or family members. All references will be verified.

First Referee
Name - Position - Organisation - Address - Phone - Email - Dates Of Employment

Second Referee
Name - Position - Organisation - Address - Phone - Email - Dates Of Employment

Third Referee
Name - Position - Organisation - Address - Phone - Email - Dates Of Employment

SECTION 6
NEXT OF KIN

Name

Address

Phone

Mobile

Relationship

SECTION 7
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 record disclosure (see our policy statement below), but at this stage, we need you to answer the following questions with truth and honesty.

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 1198)?
YesNoUnsure

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?
YesNoUnsure

If you answered ‘yes’ to either of the two previous questions, please provide details:

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

Note that: if once a criminal records disclosure has been completed and it is discovered that you have failed to accurately disclose information requested above, the company reserves the right to terminate your employment without notice. Please be aware about our policy on the recruitment of ex-offenders, if you have any questions regarding this, please contact the office where a member of The Leading Care Company will be happy to help you.
Criminal records disclosures – The Leading Care Company Policy
As an organisation assessing applicants’ suitability for positions which are included in the Rehabilitation of Offenders Act 1974 (Exceptions) Order using criminal record checks processed through the Disclosure and Barring Service (DBS), The Leading Care Company complies 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 based on a conviction or other information revealed.
The Leading Care Company 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 (Exception) Order 1975 as amended) and where appropriate police Act Regulations (as amended), The Leading Care Company can only ask an individual about convictions and cautions that are not protected.

SECTION 8
SUITABILITY FOR THE POST APPLIED FOR

Please read the care worker job description and answer the following questions.
Have you read and understood the care worker job description?
YesNoUnsure

The position you have applied for 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 face-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 Leading Care Company might need to make reasonable adjustments? (If yes, please be aware that we may need to discuss these during your interview).
YesNoUnsure

If you have answered ‘yes’ to the above, please give brief details

SECTION 9
DECLARATION

Please read the following statements carefully. If there is anything you do not understand, please contact our office before signing the bottom of the page.
I, the job applicant named on the front of this form, confirm that the information I have given in this application is accurate and true to the best of my knowledge. I also understand and agree that:

The Leading Care Company may make checks to verify the information I have provided;

Providing misleading or false information in this form or at any time during the application process may disqualify me from appointment or, if I have already been appointed, may result in my dismissal.

The personal information I have provided in this form (and any other personal information that I or my referees may provide) is confidential and will be handled in line with the Data Protection Act 1998;

The Leading Care Company will use the personal information I have provided to decide if I am suitable for the position I have applied for;

Until I am employed, The Leading Care Company will not use my personal information for any purpose other that monitoring its own recruitment processes.

If my application is successful, my personal information will be used for legitimate purposes in relation to my work (my contract of employment, which I will sign before I start work, will include further details on how my information may be used);

The Leading Care Company may process my personal information for the purposes described above or as otherwise permitted or required by law in line with its registration with the information commissioner;

Any offer of employment will depend on the receipt of satisfactory employment references and the satisfactory completion of a criminal records disclosure (refer to section 7);

I will be required to complete a pre-employment induction training program prior to my starting work with The Leading Care Company;

By Clicking The Box Below I Understand That I Understand And Accept All Information Completed In This Application Form.
For The Purpose Of This Application It Is My Digital Signature.

Date Of Declaration