Adult Care Job Application Form

1. Your Personal Information

Name

Title

Address

Post Code

Email Address

Home Phone No.

Mobile Phone No.

Other Phone No.

Where did you hear about working with rolas child Minder & Adult Care

Local Press

National Press

Ad in a Shop

Job Centre

RCMAC Ltd Website

Other Website

From a Friend

National Insurance Number

Sex

Male

Female

Do you have any disabilities or health conditions that would affect your ability to do this job?

Yes

We welcome applications from people with disabilities, but if you answerd 'yes' above, please describe any extra help or support (if any) that you might need to enable you to do your job

Do you hold a Driving License valid in the UK?

Yes

Can you provide evidence that you are legally entitled to work in the UK?

Yes

If 'yes' what documents will you be providing to prove this?

2. Your Availability

We need to get an idea of the times and days that you may or may not be available to work.

I am normally available for work at the following days or times (tick all that apply)

Weekday mornings

weekday lunchtimes

weekday evenings overnights

Weekend mornings

Weekend lunchtimes

Weekend evenings

Is there anything else you would like to tell us about when you will be available to work?

3. Spoken & Written Languages

Please tell us about the (English) languages that you can speak or write (tick as appropriate)

Speak

Write

Level of skills for - Speak

Competent

Good

Excellent

Level of skills for - Write

Competent

Good

Excellent

4. Your Qualifications

Do you have any of the following?

NVQ3 in Care

NVQ4 in Care

NVQ5 in Care

Please tell us about any other relevant formal qualitfications that you may have achieved (including any Math's or English qualifications)

When did you leave full-time education?

Month

Year

5. Your Work History

# 1 Work History

Hidden

# 1 Work History

Start Date

End Date

Employee Name and Address

Your Job Position

Summary of Duties

Hidden

Why did you leave?

Resigned

Dismissed

Redundancy

N/A

Hidden

Section Break

Hidden

# 2 Work History

Start Date

End Date

Employee Name and Address

Your Job Position

Summary of Duties

Hidden

Why did you leave?

Resigned

Dismissed

Redundancy

N/A

Hidden

Section Break

Hidden

# 3 Work History

Start Date

End Date

Employee Name and Address

Your Job Position

Hidden

Why did you leave?

Summary of Duties

Why did you leave?

Resigned

Dismissed

Redundancy

N/A

Section Break

6. Your Referees

Please Provide details of two people to whom we may write for a reference
If you have been employed before, the first referee must be your most current or most recent employer as listed in your 'Your Work History' (section 5 above), unless you can provide a valid reason where indicated. If you cannot provide your current or most recent employer as your first referee, please give details of your next most recent employer as your first referee. If you cannot provide any previous employer as your first reference, you may give the name of a former teacher or tutor that knows you well. Failing that, you may give details of a person of standing in the community (e.g. a doctor, lawyer, recognized religious leader, teacher etc.) who knows you, either professionally or personally. Friends or relatives or colleagues not senior to you are not acceptable as referees.

# First Referee Name

Hidden

# First Referee Name

Name

Organization or School/College

Address

Post Code

Phone No

Email Address

Start Date of Employment/Study

End Date of Employment/Study

Hidden

Section Break

Hidden

# Second Referee Name

Name

Organization or School/College

Address

Post Code

Phone No

Email Address

Start Date of Employment/Study

End Date of Employment/Study

If one of these referees is not your most recent employer, please explain why:

Hidden

Section Break

7. Criminal Records Declaration

Please read the Appendix at the end of the form carefully and then answer the following questions.

Have you ever been convicted of a criminal offence?

Yes

Have you ever received any official cautions, reprimands or warnings?

Yes

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?

Yes

If your answer to either of the three previous questions was 'yes', please provide details

Note - Because of the nature of the work for which you are applying, the provisions of section 4(2) of the Rehabilitation of Offenders Act 1974 do not apply by virtue of the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975. You are, therefore, not entitled to withhold information about convictions which for other purposes ore 'spent' under the provisions of the Act, and in the event of employment, only failure to disclose such convictions could result in termination of your employment.

Appendix - Criminal Records Disclosures - Policy Statement
Before you are permitted to carry out personal care on behalf of our organisation, you will be required to undergo an enhanced Criminal Records Bureau Disclosure. Please read the following:

As an Organization using the Criminal Records Bureau (CRB) Disclosure Service to assess applicants' suitability for positions of trust, we comply fully with the CRB Code of Practice and undertakes to treat all applicants for positions fairly. It undertakes not to discriminate unfairly against the subject of a Disclosure on the basis of a conviction or other information revealed.
We are committed to the fair treatment of its staff, potential staff or users of its services, regardless of race, gender, religion, sexual orientation, responsibilities for dependents, age, physical/mental disability or offending background.
We have a full written policy addressing the recruitment of ex-offenders, which is made available to all Disclosure applicants at the outset of the recruitment process.
A risk assessment has indicated that a Disclosure request is both proportionate and relevant to the position of careworker. All application forms, job adverts and other recruitment briefs for careworkers contain a statement that a Disclosure will be requested in the event of the individual being offered the position.
Where a Disclosure forms part of the recruitment process (as for this position), we expect all applicants called for interview to provide details of their criminal record at an early stage in the application process. We guarantee that this information will only be seen by those who need to see it as part of the recruitment process.
We ensure that all those in our organisation who are involved in the recruitment process have been suitably trained to identify and assess the relevance and circumstances of offences. We also ensure that they have received appropriate guidance and training in the relevant legislation relating to the employment of ex-offenders, e.g. the Rehabilitation of Offenders Act 1974.
At interview, or in a separate discussion, we ensure that an open and measured discussion takes place on the subject of any offences or other matter that might be relevant to the position. Failure to reveal information that is directly relevant to the position sought could lead to withdrawal of an offer of employment.
We make every subject of a CRB Disclosure aware of the existence of the CRB Code of Practice and make a copy available on request.
We undertake to discuss any matter revealed in a Disclosure with the person seeking the position before withdrawing a conditional offer of employment. 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.

8. Declarations

Please read and confirm that you understand and agree to the following:

Data Protection Statement - The information that you provide on this form and that obtained from other relevant sources will be used to process your application for employment. The personal information that you give us will also be used in a confidential manner to help us to monitor our recruitment process.

If you succeed in your application and take up employment with us, the information you have provided will be used in the administration of your employment with us. We may also use the information if there is a complaint or legal challenge relevant to this recruitment process.

We may check the information collected with third parties, or against other information held by us. We may also use or pass to certain third parties information to prevent or detect crime, to protect public funds, or in other ways as permitted by law. By signing the application form, you consent to the processing of your sensitive personal data (as described above), in accordance with our registration with the Data Protection Commissioner.

Do you complete this application form yourself?

Yes

Do you understand and agree to this statement?

Yes

Untitled

General Statement - "I declare that the information I have given in this application is accurate and true. I understand that providing misleading or false information will disqualify me from appointment or, if I have already been appointed, may result in my dismissal."

Do you understand and agree to this statement?

Yes

What happens now?

If you received the form by post, return it in the pre-paid envelope provided along with your completed Equalities Monitoring Form. We will be in touch with you to notify you of whether you will be invited to an interview.
If you downloaded the form from the internet, post it to the branch from which you would like to work (you will find the relevant address at www.elederlycare-services.co.uk), making sure that you also download and complete the Equalities Monitoring Form. We will be in touch with you to notify you of whether you will be invited to an interview.
If you completed the form at one of our offices, hand the form back to the person that gave it to you,

Upload Your Resume

Max. file size: 4 GB.

Signed

Max. file size: 4 GB.

Signed Date

This page is for office use only: Decision to Interview:

Name of Person Assessing Application

Position

On the basis of the completed application form, is the applicant suitable to be interviewed for an interview?

Yes

If 'no', please provide reasons:

Applicant Rejection Letter sent to applicant (if unsuccessful)?

Yes

N/A

Consent

Applicant invited to interview (if successful)?

Signed

Max. file size: 4 GB.

Signed Date

Notes

rolascac