Application form

Application form
Thank you for your interest in joining Maximus Support Services Ltd!

Before starting this form, please ensure you have the following information to hand:
- National Insurance number
- Details of your education history (including end dates)
- Two appropriate reference contacts including their contact information and email address (emails must be professional email addresses and not personal). This should include a contact from your most recent employment (where available).
- A full and complete employment history including start & end dates (covering from education to the present day).
The information we obtain in this form is required to meet regulatory standards, and we appreciate you taking the time to complete this form.

DATA PROTECTION: Using your personal information
Personal information supplied to us will be used in several ways, for example:
- To identify you and your application from others under review
- To contact you about the recruitment process
- To make recruitment decisions
- We may share your information with, and obtain information about you, from previous employers and referees.
We will not disclose your information to any third parties except where we are obligated to do so to fulfil statutory or regulatory requirements (i.e. CQC, Local Authority Safeguarding) or as part of a criminal investigation.

Personal details
Title
Name

First NameLast Name
Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Email
example@example.com
National Insurance Number
Address

House Name / Number

Street

TownCounty

Post Code
Mobile phone number

Area CodePhone Number

What is your preferred method of communication

Rows	Yes	No
Email
SMS Message
WhatsApp
Telephone call

Contracted hours you are requesting
Which role are you applying for?
Are you are driver
At Maximus we require our contracted employees to provide the following - Full time: 5 days availability per week including alternate weekends / Part time: 3 or 4 days per week (dependant on hours) including alternate weekends. Are you able to meet these requirements?
If you are unable to meet this, please detail your working limitations
Right to Work
Can you confirm you are 18 or over?
What is your UK Right to Work Status
Do you require a visa sponsorship in order to work in the UK
Are there any restrictions to your right to work in the UK?
If you are not a UK citizen please provide Right to Work in the UK details

https://www.gov.uk/prove-right-to-work/get-a-share-code-online
Right to Work share code
Date of birth

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Education
What was the name of your secondary school?
What year did you leave secondary education?
Did you attend further education?
Name of Further education attended
Date of leaving further education
How many years were you in further education
Please list the highest level of qualification you have achieved

Care Background
Do you have experience working in a care setting?
How many years care experience do you have?
Do you have experience of supporting individuals with behaviours that may challenge?
Are you comfortable supporting individuals who may present with behaviours that challenge
After training, would you be comfortable supporting with personal care needs?
Job Skills and Training
Who is your most recent employer
What position did you hold here?
What was the start date of this employment?

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Please list your duties and responsibilities in this role
Are you still in this employment?
If no, what was your employment end date?

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
If applicable: What was your reason for leaving this employment?
Who is your second most recent employer?
What position did you hold there?
When did you start this job?

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
When did you leave this job?

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate

Please list any additional employment

Rows	Company	Start Date	End Date	Position Held
1
2
3
4
5
6
7

Please list any employment gaps you have had since leaving education: In order to meet CQC requirements, we must obtain a full and complete employment history covering the time you left education to the present day. We understand that most people have had breaks in employment for one reason or another, so we just need that reason from you.

Rows	Start Date	End Date	Reason
1
2
3
4
5

References
Please list two references.
- Your first should be your most recent employer
- Ideally your second reference should be from additional employment, or someone you know in a professional capacity.
References from professionals must be company emails: we are unable to accept personal emails for these.

If you have not had any employment, please list a tutor from your most recent education.

Please note, we don't accept references from family members, partners or household members
Reference 1
Name

First NameLast Name
Email
example@example.com
Contact Number

Area CodePhone Number
How do you know them?
Where do you know them from?
Can we contact this referee before a job offer is made?
CQC requires that we seek to obtain references from all employment that is related to care. As you have stated you have previous experience in care, are you happy for us to contact the relevant care homes (etc) for a reference?
Reference 2
Name

First NameLast Name
Email
example@example.com
Phone Number

Area CodePhone Number
How do you know them?
Where do you know them from?
Can we contact this referee before a job offer is made?
Are there any restrictions to your PERMISSION TO WORK IN THE UK
DECLARATION
If you do not agree to this declaration, we will not be able to consider your application.

Please re-read the declaration carefully. If you have any problems or concerns, please contact hr@maximussupport.co.uk or call 01983 241100
Please add any further comments you wish to make
Should be Empty:

Application form

Personal details

Right to Work

Education

Care Background

Job Skills and Training

References

Reference 1

Reference 2