Please fill out this application form as accurately as possible ensuring that you complete as many boxes as you can.

Fields marked with * are required.

Personal Details
First Name *
Middle Name(s)
Last Name *
Date of Birth *
Address Line 1 *
Address Line 2
City *
Postcode *
Telephone*
Mobile *
Email *
National Insurance Number *
Transport
Are you a driver? *
Please list any endorsements? (if any)
What kind of vehicle have you got access to?
Permission to work in the UK
Do you have the right to work in the UK? *
Are you able to evidence that you have the right to work in the uk?
When is your visa valid until?
Comments
Upload
Please upload any documents relating to your right to work in the UK

Education
In chronological order please list your qualifications including year of completion, full name of course / qualification and grade achieved
Work Experience

Please give details of your last 3 employments, you will need to provide 5 years checkable work history, including any gaps.


Work Experience 1
Employer Name
Job Title
Start Date
End Date
Description of duties and responsibilities including reason for leaving
Work Experience 3
Employer Name
Job Title
Start Date
End Date
Description of duties and responsibilities including reason for leaving
Work Experience 2
Employer Name
Job Title
Start Date
End Date
Description of duties and responsibilities including reason for leaving
Any gaps in your employment ?
Health Information
Do you have any health issues or a disability relevant which may make it difficult for you to carry out functions which are essential for the role you seek?
Criminal Convictions
Do you have any unspent criminal convictions? *

* Failure to declare a conviction may require us to exclude you from our register or terminate an assignment if the offence is not declared but later comes to light.

Comments
How can we contact you?
Next of Kin
Relationship to you
Name
Address
Telephone
Mobile
Reference Details

Please give details of two referees, one of whom must be your current or most recent employer or, if this is an application for your first job, your school teacher or higher or further education lecturer. Referee should be someone that has known you for a minimum of 2 years and should not be a relative.


First Referee
Name
Company Name
Email
Relationship
Start Date
End Date
Is this your previous /current employer?
Can we contact this reference?
Second Referee
Name
Company Name
Email
Relationship
Start Date
End Date
Is this your previous /current employer?
Can we contact this reference?
Other Information
Why do you want to work in social care?
What would you do, if you were unable to attend a shift?
If you have just started working with a new service user, what is the first thing you should do?
What is your understanding of safeguarding adults?
What would you do if you disagreed with something in risk assessment regarding a service user?
What would you do if there are no labels on chemical bottle, would you use product or not?
What would you do if noticed carpet in a room was a tripping hazard?
If a service user was only eating fast food, who would you talk to, and what would you be concerned about?
If you had supported a service user for several months, and you noticed the service user appeared to be a low in mood, what would you do?
Are you able to support people with personal care?
Upload
Please upload any documents relating to your training
Candidate Declaration

I hereby confirm that the information given is true and correct. I consent to my personal data and CV being forwarded to clients. I consent to references being passed onto potential employers. If, during the course of a temporary assignment, the Client wishes to employ me direct, I acknowledge that we will be entitled either to charge the client an introduction/transfer fee, or to agree an extension of the hiring period with the Client (after which I may be employed by the Client without further charge being applicable to the Client).

Data Protection Statement

The information that you give will be used by us to provide you suitable employment. . In providing this service to you, you consent to your personal data being included on a computerised database and consent to us transferring your personal details to our clients. We may check the information collected, with third parties or with 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 way permitted or required by law.


I accept this statement
Date
Digital Signature (full name) *


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