Application Form - Mawson House
Involve Care Solutions Limited are committed to safeguarding and promoting the welfare of children, young people and vulnerable adults. All applicants will be subject to safer recruitment checks, including enhanced DBS clearance.
Name
*
First Name
Last Name
Previous Names (write N/A if not applicable)
*
Date of birth
*
-
Day
-
Month
Year
Date
Phone number
*
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Marital Status
*
Gender
*
Place of Birth
*
Role applied for
Are you a United Kingdom (UK) National?
*
Yes
No
Can you prove that you are legally entitled to work in the UK?
*
Yes
No
Do you require Sponsorship from this role in order to work? (Please note we are not able to offer Sponsorship at this time).
yes
no
If you are a UK national have you worked or lived abroad in the last 3 years ?
*
Nationality
*
If you are NOT a United Kingdom (UK) National , Please detail your current immigration status and the relevant visa currently held (including Visa number) - State N/A if not applicable)
*
What is your National Insurance number?
*
Are you a driver?
*
Please Select
Yes - with business insurance
Yes - however I don't hold business insurance, but I will ensure I obtain this if successful
No
Are you related to any of our current members of staff or Service Users?
*
Yes
No
Are you aged over 21? (Required for some posts)
*
Yes
No
Equality Act 2010 Under the Equality Act 2010 the definition of disability is if you have a physical or mental impairment that has a “substantial” & “long-term adverse effect” on your ability to carry out normal day-to-day activities. Further information regarding the definition of disability can be found at: www.gov.uk/definition-of-disability-under-equality-act- 2010. For the purposes of this application & interview stage only, is there anything you would like us to be aware of so that we can make reasonable adjustments during the process? (Type N/A if not applicable)
What attracts you to this role
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Employment History / Professional Registrations
It is required by law that you provide a full employment history and you must ensure that you provide full start end dates as well as reasons for leaving and any gaps (over 2 week) in employment..
*
Rows
Employer Name
Employer address
Role
Start Date
End Date
Email
Contract phone number
Reason for Leaving
Most Recent Employer
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3
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10
Explanation of Gaps Use this section to detail any gaps in employment and why
Professional Memberships / Registrations
Rows
Professional Memberships / Registrations
Name of Organisation
Registration Number
Renewal Date
Details
1
2
3
I confirm I am happy for Involve Care Solutions to request my references
*
Yes
No
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Education
Include the subject/qualification and grade gained
Education (include School / College / University, Date From, Date To, Examinations, *: (All qualifications will be subject to a satisfactory check).
*
Rows
Qualifications
Grade achieved
School / College / University
Date From
Date To
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10
What relevant training and qualifications do you?
Training Courses attended or completing (evidence of attending courses is required)
*
Rows
Training Name
Training provider
online or face to face
date training completed
date training expires
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3
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7
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15
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Working Hours
I understand this role may include: shift work, unsociable hours and lone working.
*
Yes
No
I agree that I may work for more than an average of 48 hours a week. If I change my mind I will give Involve Care Solutions one weeks written notice
Yes, I Agree
No, I do NOT agree
Type of contract you are applying for
Full Time Day Support Worker
Part Time Day Support Worker
Full Time Night Support Worker
Bank Support Worker
Responsible Individual
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Emergency Contact
please provide emergency contact details
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Declaration
The information in this application form is true and complete. I agree that any deliberate omission, falsification or misrepresentation in the application form will be grounds for rejecting this application or subsequent dismissal if employed. Where applicable, I consent that can seek clarification regarding professional registration details.
Yes
No
Signature
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