Sankofa Care Solutions Employment Application
Fill the forms below accurately indicating your potentials and suitability for the job you are applying for.
Name
First Name
Last Name
Date of Birth
Phone Number
*
Email Address
example@example.com
National Insurance Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Nationality
Do you require a permit to work in the UK?
Please Select
Yes
No
What is your work permit number?
Passport number (applicants from United Kingdom and Northern Ireland)
Do you hold a current UK driving licence ?
Please Select
Yes
No
Do you have a Current DBS ? ( This is Required if you are applying for a job in healthcare)
Yes
No
Awaiting Certificate
If yes What is your DBS number?
If Yes , have you registered DBS on the update service?
Yes
No
If no, are you happy for us to apply for a DBS on your behalf?
Yes
No
Next of Kin
Next of Kin
First Name
Last Name
Next of Kin Contact Number
*
Relationship to you
Prepared to work
Full Time
Part Time
Day Shift
Night Shift
AVAILABILITY AND PREFFERED HOURS
Details of any other job which you will continue to undertake if offered this position
Available to take up employment from
-
Month
-
Day
Year
Date
EXPERIENCE (please tick where applicable)
care of the elderly
use of hoists
feeding
learning disability
incident reporting
care plans
domicilliary care
residential care
moving and handling
meal preparation
food handling
personal care
observing
bed bathing
nursing home
Please list any Professional qualifications you have achieved and dates completed
Work History
Company Name 1
Role/Position
From
To
Responsibilities
Reason For Leaving
Company Name 2
Role/Position
From
To
Responsibilities
Reason For Leaving
Company Name 3
Role/Position
From
To
Responsibilities
Reason For Leaving
*
Have there been any proceedings of medical negligence or professional misconduct against you that lead to suspension or dismissal?
*
Yes
No
If yes please provide details
BANK DETAILS
Account holder name
Name of Bank
Account number
Sort Code
CRIMINAL BUREAU
If the position you are applying for (whether paid or voluntary) is listed in Schedule 1, Part II of the Rehabilitation of Offenders Act (Exceptions) Order 1975, we are entitled to ask Exempted Questions as defined by Section 113(5) of the Police Act 1997 about you. We are required to acquire a Criminal Record Certificate in relation to any person who is a Care Manager or Care Worker. This means that if your application is successful we will obtain through the Disclosure & Barring Service (DBS) an Enhanced Criminal Record Certificate relating to you before your appointment is confirmed. Having a criminal record will not necessarily bar you from working with us. This will depend upon the nature of the position and thecircumstances and background of your offences. We observe the “Code of Practice for Registered Persons and Other Recipients of DisclosureInformation” published through the Disclosure & Barring Service on behalf of the Home Office, and we will provide you with a copy of it upon request.
CONVICTIONS
Do you have any unspent criminal convictions ?
*
Yes
No
If yes please give details
WORKING TIME DIRECTIVE
The working time regulations are guidelines of Health and Safety at work measures stipulating safe working hours set by the European Union in the Time Directive of 1993 and these regulations came into effect in October 1998. The current limit for an average working week is 48 hours and no one is under any obligation to accept to work more than the stipulated hours and under any circumstances will anyone be compelled to do this unless they wish to do so. Please could you sign below as proof that you have read and understood the above regulations and whether or not you will be willing to work more than 48 hours, if further clarification is required please speak to one of our consultants who will supply you with more information regarding this regulation. A copy of this form will be given to you for your records.
Do you wish to work more than 48 hours per week?
Yes
No
Signature
DISABILITY/HEALTH ISSUE
The information in this section will be disclosed to the Recruiting Manager if you are short listed for interview. Under the Disability Discrimination Act 1995, a person has a disability if he or she has a physical or mental impairment which has a substantial and long-term adverse effect on his or her ability to carry out normal day-to-day activities
Do you have any known disability/health issue
Yes
No
If yes , Please give details including disability number if applicable
EQUAL OPPORTUNITIES
Sankofa Care SolutionsLtd operates an equal opportunities policy aimed at giving everyone the same privileges and opportunities. All employees will be judged on their capabilities rather than gender, race, religious or political beliefs. At Sankofa Care Solutions Ltd we will take seriously any complaints or allegations of discrimination in any form against any of our staff or clients. We will investigate and notify authorities and take appropriate action where necessary. The questions are designed in helping us to monitor our workforce and implement any way possible to allow us to be a representative of the community as a whole by targeting any deprived or misrepresented groups. Please take a few moments to fill in the information required below.
Please indicate your Ethnic origin
White
Mixed
Black or Black British
Asian or Asian British
Other Ethnic
I do not wish to disclose my ethnic group
CONFIDENTIALITY AND DATA PROTECTION
Sankofa Care Solutions Ltd complies with all Codes of Conduct set aside by the Government and all other relevant organizations, we also adhere to the Data Protection Act of 1998 and the release of any personal details concerning you, client or any work related matter without the consent of the relevant individuals is strictly prohibited. The data provided on this form will be stored in compliance with the Data Protection Act 1998 and you will be able to access the information through the Subject Request Procedure
How did you get to know us? *
Indeed
Twitter
Employee referral
Facebook
Walk-In
Gov.uk website
Other (Please specify)
Others:
Upload Resume: *
Browse Files
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References
Please list two (2) references that are familiar with your work life.
Reference 1 ( Must be your most recent employer )
Name
First Name
Last Name
Phone Number
*
Company / Institution *
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Position *
Date Employed from : mm/yy
Date Employed To : mm/yy
Years Known:
Please Select
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
Email
example@example.com
Reference 2
Name
First Name
Last Name
Phone Number
*
Company / Institution
Position
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Date Employed from : mm/yy*
Date Employed To : mm/yy
Years Known:
Please Select
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
Email
example@example.com
DECLARATION
I confirm that all the information and statements l have provided above are all true to the best of my knowledge and do understand that any misrepresentation by myself knowingly on any part of the application will result in it being invalid and if employed could result in my dismissal. I am prepared for the Agency to carry out any checks necessary including a Police check.I hereby give Sankofa Care Solutions Ltd access to my personal files as part of any official audit or client compliance procedures. Proof of identity will be viewed and photocopied in accordance with the requirements of the data protection act 1998.
NAME ( please print):
Signature
Submit
Submit
Should be Empty: