Application Form

Please note, from 1st March 2024, we will no longer be offering CoS sponsored employment opportunities.

Title*

Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityCounty

Post Code

Phone Number

Area CodePhone Number

Eligibility & right to work in the United Kingdom *

You will need to prove your right to work status before we can employ you. How you do this depends on your nationality and what kind of permission you have to work in the UK. Please see below for more information and provide us with your RTW share code if required.

https://www.gov.uk/prove-right-to-work

Please let us have your Share Code (if required)

National Insurance number and/or Biometric Residence Permit number*

Telephone number*

Email*

example@example.com

Language (Spoken)*

Rows	Fluent	Good	Fair
English

Language (Written)*

Rows	Fluent	Good	Fair
English

Other languages spoken

Education

Rows	School / College	From / To (dd/mm/yy)	Qualifications
1
2
3

Training - Please detail any training relevant to your application

Rows	Training provider	Course details	From / To (dd/mm/yy)	Qualification
1
2
3

Last or most recent Employer/Sponsor (We will contact them to provide a reference)*

Rows	* Must be answered in full
Company name
Your job role
Address
Manager name
Telephone No.
Email
Date employed from
Date employed to

Reason for leaving*

Previous employment history (please complete last 5 years)*

Rows	Company / Employer	Job title	Name of line manager	Contact email	Telephone Number	Date employed from:	Date employed to:
1
2
3
4
5
6
7
8
9
10

Please provide an explanation for any employment gaps

Areas of care work experience*

Rows	Experience	No experience
Elderly Care
Children & Young Adults
Supported Living
Live-in Care
Mental Health
Complex / Nursing care
Substance misuse

Please rate your skills in the following skills:

Rows	Beginner	Intermediate	Proficient	Advanced
Communication
Patience
Supporting with personal hygiene
Assisting and feeding
Medication Administration
Compassion
IT Skills (Computers AND phones)
Writing notes and reports
Time management

Skills & Experience - Tell us why you are applying for this job. Please refer to the Job Description. You should also show how you meet each requirement by providing details of your experience, skills and knowledge gained in employment, voluntary work or elsewhere*

YesNo

Personal reference, not former work colleagues or family members (We will contact them to provide a reference)*

Rows	* Must be answered in full
Name
Address
Relationship to referee
Telephone No.
Email
From / To (dd/mm/yy)

Personal / Academic reference (We will contact them to provide a reference)*

Rows	* Must be answered in full
School name
Address
Relationship to referee
Telephone No.
Email
From / To (dd/mm/yy)

Please tell us about your work preference*

Are you willing to work weekends? (alternate weekends)*

Availability (tick all that apply) - Please note – As we operate over 7 days, you are required to work alternate weekends*

Rows	Mo	Tu	We	Th	Fr	Sa	Su
Breakfast - 7am-11am
Lunch (11am-3pm)
Teatime (3pm-6pm)
Evenings (6pm-10pm)

Are you willing to work more than 48 hours within a 7-day week?

YesNo

CRIMINAL OFFENCES & REHABILITATION OF OFFENDERS

Your answer to the following question should include any ‘spent’ convictions, conditional discharges, bind-overs or cautions. The ‘Company’ actively promotes equality of opportunity for all as stated in its Equal Opportunities policy, which can be found in the staff handbook or at your local office. Making a false statement or any attempt to conceal information regarding this declaration will lead to the rejection of your application for employment with this company. Any details provided will be treated in the strictest confidence and will not automatically exclude anyone from being considered for any vacancy

This role is subject to a satisfactory DBS (adults & children) Please conform that you agree to completing a DBS check. The cost of which will be deducted from your first salary payment*

Have you ever been convicted of a criminal offence or received a Police Conditional discharge, bind-over, caution, warning or reprimand?*

Have you ever been issued with a Penalty Notice for Disorder?*

If you answered YES to the above, please provide details and dates of the offence(s) below – please continue on a separate sheet where necessary:

Please detail any pre-booked holidays

Rows	Date from	Date to
Date 1
Date 2

Declaration

Data protection - The Data Protection Act 1998 requires that any staff handling personal data on others must follow certain principles in relation to the data that they hold. Individuals have rights of access to data that is held on them and rights to claim for damages if various offences occur. This covers manual as well as computerised records. If you are unsuccessful in this application, we will keep this form on file for 6 months should you wish to be considered for other vacancies within the organisation

Rehabilitation of Offenders Act 1974 - The Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 and the Rehabilitation of Offenders Act 1974 (Amendment) Order 1986 provides that people in employment which is concerned with the provision of care or who carry out their duties wholly or partly on the premises where such provision takes place, are obliged to disclose any convictions which would otherwise be spent. The Regulations provide that people in employment which is concerned with the provision of care or who carry out their duties wholly or partly on the premises where such provision takes place are obliged to disclose any criminal convictions, conditional discharges, bind-overs or cautions that they have been subject to at any time in the past.

References - By submitting this application, I give permission for the Company to approach previous employers and educational/personal refrerenced detailed in the above application

DBS Check - This role is subject to applicants agreeing to a DBS check (Adults & Children)

Health Declaration - Any offer of employment is subject to completing a Medical Questionnaire and Health Declaration

Declaration - I confirm that all the information given is true and I understand that any false or misleading information may result in my removal from our register of applicants. I consent to the processing of sensitive personal data.

I confirm my understanding and agreement of the above*

Date

Application form