Application Form

Application Form

Please fill this application form to the best of your ability. Answer as many questions as possible. Most of the questions are mandatory and you will not be able to continue without answering them. It should take you around 20 Minutes.
Luminous Domiciliary Care LTD

36 Ber Street

Norwich

NR1 3EW

Owned and operated by:

Luminous Care Group Limited

36 Ber Street

Norwich

NR1 3EW
Position Applied For*
What is your level of experience?

I have never done any sort of work in the care sector beforeI have worked in this sector for less than 2 yearsI am highly experienced and I have been working in this sector for more than 2 years
Do you have training certificates to prove you are qualified to work in the position stated above?*

YesNo

Personal Details and Contact Information
Name*

TitleFirst NameMiddle NameLast Name
Gender*
Prefix
Mobile Phone Number*

Country CodePhone Number
Email*
example@example.com
Date of Birth *

DayMonthYear
Date
Do you have a NI (National Insurance) Number?*

YesNo
National Insurance Number (NI)
National Insurance Reference Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postcode
Next of kin (emergency contact) name: *
This person will only be contacted for emergency purposes.
Their relationship to you*
Next of Kin Phone Number*
Please enter a valid phone number.

Employment History

Please List Last 5 Years of Your Employment History
Current or most recent Job Title:*
Current or most recent Employer Name and Address:*
Current or most recent Employer Email:*
Current or most recent Employer Contact Number:*
Summary of roles and responsibilities *
Worked From*

DayMonthYear
Date
Worked To

DayMonthYear
Date
Summary of roles and responsibilities *
Worked From*

DayMonthYear
Date
Worked To

DayMonthYear
Date
Anything further you would like to mention regarding your previous roles:
Insert Previous Job Details

Add More
Previous Job Title*
Previous Employer Name and Address:*
Previous Employer Email:*
Previous Employer Contact Number:*
Summary of roles and responsibilities *
Worked From*

DayMonthYear
Date
Worked To

DayMonthYear
Date
Insert Previous Job Details

Add More
Previous Job Title*
Previous Employer Name and Address:*
Previous Employer Email:*
Previous Employer Contact Number:*
Summary of roles and responsibilities *
Worked From*

DayMonthYear
Date
Worked To

DayMonthYear
Date
Insert Previous Job Details

Add More
Previous Job Title*
Previous Employer Name and Address:*
Previous Employer Email:*
Previous Employer Contact Number:*
Summary of roles and responsibilities *
Worked From*

DayMonthYear
Date
Worked To

DayMonthYear
Date

Education (All qualifications are subject to a satisfactory check)
Add More
Education (All qualifications are subject to a satisfactory check)
Training Courses Attend or completing (Evidence of attending is required)
Add More
Training Courses Attend or completing (Evidence of attending is required)
Membership of Professional Bodies (if applicable):
Membership of Professional Bodies (if applicable):
Do you hold a valid Drivers License?*

YesNo
Do you own a car?*

YesNo
Bank Details:

References

We require two work related references from you. One professional and one character reference. By entering the details below, you are consenting to Luminous Care Group contacting the referees. We will email them with a reference form.
Reference 1*
Reference 2*

Convictions: Rehabilitation of Offenders Act 1974

Please read the act below and select one of the options.
The Rehabilitation of Offenders Act 1974 ('1974 Act') primarily exists to support the rehabilitation into employment of reformed offenders who have stayed on the right side of the law. Under the 1974 Act, following a specified period of time which varies according to the disposal administered or sentence passed, cautions and convictions (except those resulting in prison sentences of over four years and all public protection sentences*) may become spent. Thus, the offender is regarded as rehabilitated. For most purposes the 1974 Act treats a rehabilitated person as if he or she had never committed, or been charged with charged or prosecuted for or convicted of or sentenced for the offence and, as such, they are not required to declare their spent caution(s) or conviction(s), for example, when applying for most jobs or insurance, some educational courses and housing applications.

This means that you must declare to us any convictions or police cautions that you have received, even if they are ‘spent’ under that Act, other than a protected caution or protected conviction. Moreover, the act does not apply to certain posts in health h and social care where you will be involved in providing care to the vulnerable clients.

You must therefore disclose any convictions in detail all spent and unspent convictions. All applications will be treated with confidentiality and a detail assessment will be made, any disclose of convictions doesn’t mean that you are likely to be rejected.
I have convictions*

YesNo
Please provide a detailed account of those convictions:

Asylum and Immigration Act: 1996

Please read the act below and select one of the options.
Under the 2006 Act you have a duty to prevent illegal working by carrying out document checks to confirm if a person has the right to work in the UK. You should check and keep copies of original, acceptable documents before someone starts working for you. If a person has a time limit on their stay, then you should carry out repeat checks at least once every 12 months. If a person has a restriction on the type of work they can do and, or, the number of hours they can work, then you must not employ them in breach of these restrictions. You should also verify that a person has the right to work when certain documents or scenarios are presented to you. You can find out more about carrying out document checks in the section ‘Right to work document checks.

An illegal worker is defined as someone who is:
- subject to immigration control; and
- aged over 16; and
- not allowed to carry out the work in question because either they have not been granted leave to enter or remain in the UK or because their leave to enter or remain in the UK: – is invalid, – has ceased to have effect (meaning it no longer applies) whether by reason of curtailment, revocation, cancellation, passage of time or otherwise, or – is subject to a condition preventing them from accepting the employment.
Are you eligible to work in the UK?*

YesNo

Disability Discrimination Act 1995

Applicants with disabilities will be invited for interview if the essential job criteria are met.
Do you consider yourself to be a person with a disability as described by the disability discrimination act 1995? i.e. do you consider yourself to be someone who has a physical or mental impairment which has a substantial and long term adverse effect on your ability to carry out normal day to day activities?*

YesNo

DBS - Disclosure and Barring Service

You are required to have a DBS in order to work with us.
Do you have a DBS?*

YesNo
DBS Number
Please enter your DBS number as it is seen on your certificate.
Date of Issue

MonthDayYear
Date
Update Service Number (If applicable)
Uniform Size
Uniform Dress Size
Declaration by the Applicant

I confirm that the above information is true and accurate to the best of my knowledge. I understand that the qualification and experience mentioned in this application is true. I also understand that failing to provide accurate information will lead to this application not being processed and could even face termination and dismissal.
Signature. *

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Equal Opportunity Survey
Luminous Care Group Ltd are committed to equal opportunity and being an inclusive employer.

The law states that employers do not have to track how many job applications you receive from different groups of people, or the characteristics of the people working for you. If personal information (e.g. ethinicity, faith) about applicants staff, the data is to be stored securely. Candidates are not to be discriminated based on their personal information.

Under legislative requiremnt it is essential that all employers are required to provide monitoring information on: (i)employees (part and full time) (ii) applicants (iii) appointees (iv) apprentices (where relevant). This helps us make sure that we are an inclusive employer and to find out if our workforce is diverse.
What best describes your ethnic group: *
These options were the ethnic groups as decided by The Office For National Statistics who run the Census of England and Wales (2021).
Asian Please Specify:
Black Please Specify
Mixed Please Specify
White Please Specify
Other Please Specify
Please state your specific ethnicity as you would describe it:

Candidate Consent Form (GDPR)
I understand that the processing and sharing of my personal data is necessary for the purposes of recruitment, marketing and business development.
I, hereby give my consent to the company to process the following information:

Personal Data
·       Name
·       Date of birth
·       Contact details, including telephone number, email and postal address
·       Experience, training and qualifications
·       CV
·       National Insurance number
·       Driving license number
·       Bank details

Sensitive Personal Data
·       Disability/health condition relevant to the role
·       Criminal convictions relevant to the role

I consent to the company processing the above personal data for the following purposes:
·       For the company to provide me with permanent or temporary work finding services
·       For the company to process candidate information audits with prospective clients
·       Process my data for the purposes of maintaining internal records
The consent I give to the company will last for as long as necessary for the purpose it was collected and once the company no longer need it, it will be deleted or anonymized.

I am aware that I have the right to withdraw my consent at any time.
Name

PrefixFirst NameMiddle NameLast Name
Date

DayMonthYear
Date
Signature*

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Candidate Consent and Authorisation Form
I have applied for employment with Luminous Care Group and have provided them with information regarding my previous employment.

I hereby authorise Luminous Care Group to conduct a reference check with my present/previous employer(s). I understand that the reference information may include verbal and written information about my employment history.

My signature below authorises my present/previous employers and references to release information regarding my employment record with their organisation and to provide any additional information that may be necessary for my application for employment with Luminous Care Group whether the information is positive or negative.

I voluntarily release present/previous employers, references and Luminous Care Group from any and all liability arising from their giving or receiving information about my employment history and suitability for employment.

I also give Luminous Care Group authorisation to obtain feedback and references from my supervisors over the course of my employment. This form may be photocopied or reproduced, and these copies will be as effective as a release or consent as the original which I sign.
Name

PrefixFirst NameMiddle NameLast Name
Date

DayMonthYear
Date
Signature*

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Work Time Regulation - Employee Declaration
I understand that I can opt out to work beyond 48 hours per week, but with this declaration I agree to work more than 48 hours per week from time to time to meet the needs of client services.

This is without prejudice to the agencies general duty to ensure my health, safety and welfare at work.

I understand that I can withdraw from this agreement by giving 2 Week notice in writing that I am no longer willing to work beyond 48 hours per week.

For every week (Monday to Sunday) I am covered by this declaration I will keep an accurate record of the actual hours I work and will provide this information as required.

I understand that such records will be kept for two years.
I hereby Consent to Sign the Work Time Regulation

YesNo
Name

PrefixFirst NameMiddle NameLast Name
Date

DayMonthYear
Date
Signature*

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Application Form

Personal Details and Contact Information

Employment History

Work Preferences

References

Convictions: Rehabilitation of Offenders Act 1974

Asylum and Immigration Act: 1996

Disability Discrimination Act 1995

DBS - Disclosure and Barring Service

Declaration by the Applicant

Healthcare Questionnaire

Equal Opportunity Survey

Candidate Consent Form (GDPR)

Candidate Consent and Authorisation Form

Work Time Regulation - Employee Declaration