Golden Valley Homecare Agency Job Application. Golden Valley Homecare Agency Ltd. Application Form

Transcription

1 Golden Valley Homecare Agency Ltd Application Form

2 Completion of Golden Valley Homecare Agency Application form indicates your interest in joining our team of caring, sensitive and knowledgeable people who take pride in delivering a quality homecare service. Instructions: If you require support to complete this form or there are reasonable adjustments we can make to assist in your application please contact our branch s Recruitment Officer. All sections of the application form are to be completed. If a section is not relevant this must be clearly stated on the application form. Please write clearly, completing this document in black pen and in CAPITAL LETTERS. ONLY INFORMATION PROVIDED ON THIS APPLICATION FORM WILL BE CONSIDERED You must outline clearly how you meet both the essential and desirable requirements. All information given will be treated with the strictest confidence. Continuation sheets are located at the back of the form for necessary use. DISABILITY DISCRIMINATION ACT 1995: If you require any special arrangements to be made to assist you if called for interview, please let us know in advance of the interview. Please read and sign the relevant Job Description for the post applying for STAGE 1: To be completed prior to Interview Applicants Details Title: i.e. Mr. Mrs. Ms Miss other Forename: Surname: Middle Name: Name usually known by: Gender: Date of Birth: National Insurance Number: Home Mobile Number: Current Address and (Please also complete form PR05a Address Continuation Sheet for DBS where necessary) How long have you lived at this address? Are you a car driver? Do you require a work permit? Where did you hear about us? Yes No Verified valid MOT and Car 2 P a g e

3 Applicant Declarations: Disclosure and Barring Service (DBS) Goldenvalley Homecare agency requests a criminal records check is processed through the Disclosure and Barring Service (DBS) as part of its recruitment process. Goldenvalley Homecare agency reserves the right for a person to reveal their full criminal history (including spent convictions). This is made possible by the Exceptions Order to the Rehabilitation of Offenders Act (ROA) Do you have any criminal convictions, or have you been subject to any conditional discharge, bindovers, warnings or cautions? Do you have any unspent criminal convictions, conditional discharge, bindovers, warnings or cautions? Please tick if you have supplied any additional information with this application. By signing this section of the application form you agree that the information provided is complete and true. You also understand that giving a false statement to obtain employment may result in the termination of your contract. Declaration signed: Date: Office Use: If the applicant has stated yes to any questions within this section, has a statement been taken from the candidate regarding the specified convictions, or conditional discharge, bindovers, warnings or cautions? If the applicant has stated yes to any questions within this section, has a DBS Risk Assessment [PR22] been completed with the candidate regarding the specified convictions, or conditional discharge, bindovers, warnings or cautions? 3 P a g e

4 Position held: Organisation Name: Organisation Please list chronologically, starting with your current or last employer address: Manager (full name): Employed from: Employed to: Reason for leaving: May we contact the Manager for a reference if you are invited for interview? Yes No Previous Employment Position held: Organisation Name: Organisation address: Manager (full name): Employed from: Employed to: Reason for leaving: May we contact the Manager for a reference? Referees will not be contacted without your prior approval. Yes No Previous Employment Position held: Organisation Name: Organisation address: Manager (full name): Employed from: Employed to: Reason for leaving: May we contact the Manager for a reference? Referees will not be contacted without your prior approval. Yes No 4 P a g e

5 Please list all other employment with most recent first, giving reasons for any gaps in employment. Use a continuation sheet if necessary. (Previous Employment Continuation Sheet) Employer Name and Address Position From (Month & Year) To (Month & Year) Reason for Leaving 5 P a g e

6 Qualifications and Experience Please use this space to tell us about yourself and your experience in relation to the job description attached. Please include why you think you are suitable for this position. Hobbies and Interests Please use this space to tell us about what you enjoy doing outside your working environment. This not only enables us to get to know you but will also assist us in pairing and ensuring compatibility for our service users. Education and Training Please list all formal and professional qualifications gained, beginning with the most recent. Use a continuation sheet if necessary (Education and Training Continuation Sheet) Name and Address of School, College or University From (Month & Year) To (Month & Year) Qualification 6 P a g e

7 Work References As part of our recruitment process we require 3 professional references. Please provide the names and addresses of three people who can act as referee. These should be your last three employers. Current / Last / Most recent Employer Referee Full Name: Capacity Known: Organisation Name: Postcode Previous Employer Referee Full Name: Capacity Known: Organisation Name: Postcode Previous Employer Referee Full Name: Capacity Known: Organisation Name: Postcode 7 P a g e

8 Character References Character References can be obtained in the absence of three work references. Character references must be completed by a professional person, which does not include family, friends or acquaintances. Character Reference 1 Referee Full Name: Capacity Known: Known for how long: Their profession: Postcode Referee Full Name: Capacity Known: Known for how long: Their profession: Character Reference 2 Postcode Referee Full Name: Capacity Known: Known for how long: Their profession: Character Reference 3 Postcode 8 P a g e

9 Next of Kin For health and safety purposes, please provide the details of two Next of Kin who we can contact in case of an emergency. Contact One Name: Relationship to you: Mobile Number: Name: Relationship to you: Contact Two Mobile Number: GP Details GP Name: Surgery Name: 9 P a g e

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11 Staff - Availability Agreement This agreement is to be signed before starting work and will not be altered within your probationary period. Any change in availability must be put in writing to your Branch Manager with a minimum of four weeks notice following successful completion of your probationary period. Name of Applicant: Branch: Agreement Signature: Work will be allocated according to the two week cycle you provide. Please tick the boxes below to show your regular availability or your available contracted hours of work within the company s shift patterns: 08:00-14:00; 20:00 08:00. Please indicate your choice of working routine Area / Location of Work (please indicate) Availability or Contracted Shift work (please indicate) Date: Week 1 Morning Lunch Tea Evening Night / Sleep In Mon Tue Wed Thu Fri Sat Sun Week one or week two must contain availability for the weekend and one evening between Monday Friday. Week 2 Morning Lunch Tea Evening Night / Sleep In Mon Tue Wed Thu Fri Sat Sun

12 Declaration Application Agreement I confirm that the information I have provided in support of this job application is complete and true. I understand that knowingly to make a false statement to obtain employment may result in the termination of my contract. Applicant Signature: Date: 12 P a g e