CARE WORKER APPLICATION FORM
Vacancy Title:
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Please tell us how you heard about the Vacancy
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Name
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First Name
Last Name
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How many years have you lived at this Address?
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Home Phone Number
Please enter a valid phone number
Mobile Phone Number
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Please enter a valid phone number
Email Address
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example@example.com
National Insurance Number:
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Do you hold a full, clean driving licence valid in the UK?
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Yes
No
Preferred Hours
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Full Time
Part Time
Please Tick when you are available:
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Monday, 07:00am - 14:00pm
Monday, 15:30pm - 11:00pm
Tuesday, 07:00am - 14:00pm
Tuesday, 15:30pm - 11:00pm
Wednesday, 07:00am - 14:00pm
Wednesday, 15:30pm - 11:00pm
Thursday, 07:00am - 14:00pm
Thursday, 15:30pm - 11:00pm
Friday, 07:00am - 14:00pm
Friday, 15:30pm - 11:00pm
Saturday, 07:00am - 14:00pm
Saturday, 15:30pm - 11:00pm
Sunday, 07:00am - 14:00pm
Sunday, 15:30pm - 11:00pm
Education/Qualifications: School Names (Primary and Secondary school)
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Education/Qualifications: Study Dates? (Primary and Secondary school)
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Education/Qualifications: Grades in subjects, e.g Maths, English, and Science (Primary and Secondary school)
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Education/Qualifications: College and University Name/s
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Education/Qualifications: Study Dates (College and University)
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Education/Qualifications: Grades/Qualifications obtained in subjects you have studied (College and University)
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Ongoing Professional Development? Dates and Grades?
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Current Membership of any Professional Body/Organisation?
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Employment History
Most Recent Employment Information
Name of Employer/Organisation?
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Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Position Held:
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Date Started:
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-
Day
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Month
Year
Date
Leaving Date:
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Day
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Month
Year
Date
Reason for Leaving?
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Salary on Leaving this post:
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Contact name of Line Manager for reference and Email address:
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Brief Description of Duties (Please mention email and contact details of employer):
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Employment History
Previous Employer
Name of Employer:
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Position Held:
Date Started:
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Day
-
Month
Year
Date
Leaving Date:
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Day
-
Month
Year
Date
Reason for leaving:
Salary on leaving post:
Contact name of Line Manager for Reference:
Brief Description of Duties (Please mention email and contact details of employer):
Name of Employer:
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Position Held:
Date Started:
-
Day
-
Month
Year
Date
Leaving Date:
-
Day
-
Month
Year
Date
Reason for Leaving?
Salary on leaving this post:
Contact name of Line Manager for Reference:
Brief Description of Duties (Please mention email and contact details of employer):
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Information to support your Application
Skills, abilities and experience
Please use this section to demonstrate why you think you would be suitable for the post by reference to the job description and person specification (and by giving examples and case studies). Please include all relevant information, whether obtained through formal employment or voluntary/leisure activities. Attach and label any additional sheets used. See guidance sheet for further information.
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Convictions/Disqualifications
To ensure the safety of our clients/members a DBS check must be completed for all positions. A criminal record will not necessarily be a bar to obtaining a position at Generate. If a check is returned and reveals any information, this will be discussed with the applicant. The Chief Executive will make a decision as to whether the offer of employment should be withdrawn. Rehabilitation of Offenders Act 1974 (Exceptions)(Amendment) Order 1986 We would draw your attention to the following statement:- “Because of the nature of the work for which you are applying, this post is exempt from the provisions of Section 4(2) of the Rehabilitation of Offenders Act, 1974, by virtue of the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 and the Rehabilitation of Offenders Act 1974 (Exceptions) (Amendment) Order 1986. Applicants are, therefore, not entitled to withhold information about convictions which for other purposes are ‘spent’ under the provisions of the Act”. Please provide details below if you have been convicted of a criminal offence or been the subject of a conditional discharge or probation order. (Past criminal proceedings are not necessarily an obstacle to taking up a post. This occurs only where the offence/s is/are deemed relevant. Any details will be discussed with you should you be the successful candidate based on your supporting statement, interview and tests).
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Signature
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Reasonable Adjustments/Arrangements for Interview
Are you subject to any conditions relating to your employment in this country? YES/NO
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If "yes" please use the space below to tell us what these are?
If you need us to make any adaptations for your interview to accommodate any disability you may have please tell us what these should be?
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Are you closely related or married to a staff or Board member of iCare? Yes/No If yes, please state the name of the staff or Board member and nature of this relationship below:
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If appointed when could you start? Give period of notice if applicable
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References
Please give the detail of two references – see guidance sheet for further information.
Name of Referee:
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Relation to you:
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Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email (of reference)
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example@example.com
Phone Number (of reference)
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Please enter a valid phone number
Second Reference:
Two reference will need to be provided
Name of Referee
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Relationship to you:
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Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email (of reference)
example@example.com
Phone Number (of reference)
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Please enter a valid phone number
Declaration: Statement to be Signed by the Applicant Please complete the following declaration and sign it in the appropriate place below. If this declaration is not completed and signed, your application will not be considered. I agree that iCare can create and maintain computer and paper records of my personal data and that this will be processed and stored in accordance with the Data Protection Act 1998. I confirm that all the information given by me on this form is correct and accurate and I understand that if any of the information I have provided is later found to be false or misleading, any offer of employment may be withdrawn or employment terminated.
Date
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Day
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Month
Year
Date
Additional Addresses - Up to 5 Years - please include date FROM and TO
Current Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date From MM/YYYY (When did you move in) - Please state if you current reside at this address.
Previous Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date From MM/YYYY (When did you move in)
Date Until MM/YYYY (When did you move out)
Previous Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date From MM/YYYY (When did you move in)
Date Until MM/YYYY (When did you move out)
Previous Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date From MM/YYYY (When did you move in)
Date Until MM/YYYY (When did you move out)
PLEASE NOTE: IF YOU HAVE LIVED AT MORE ADDRESSES, PLEASE LET THE MANAGEMENT TEAM KNOW.
Submit
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