• CARE APPLICATION FORM

    CARE APPLICATION FORM

  • Please complete this application form in full, as we cannot accept CVs. No candidate will be unfairly discriminated against on the grounds of age, disability, ethnicity, gender, gender reassignment, marital or relationship status, pregnancy or maternity, race, religion or belief, sexual orientation, political beliefs, or trade union membership or activity.

  • Date:*
     - -
    2 digit day, 2 digit month, 4 digit year
  • Work preference:*
  • I understand that this role may include shift work, unsociable hours and lone working. Please indicate your availability below.*
  • Available days*
  • Available periods*

  • PERSONAL DETAILS

  • Date of birth:*
     - -
    2 digit day, 2 digit month, 4 digit year
  • Format: (000) 0000-0000.
  • Format: (000) 0000-0000.
  • Do you hold a current driving licence?*
  • Do you have your own transport?*

  • Languages

  • English proficiency:*

  • Next of kin (NOK) / Emergency Contact Details

  • Format: (000) 0000-0000.

  • GP Details

  • Format: (000) 0000-0000.
  • Do you have the legal right to work in the UK?*
  • Are you related to any current member of staff or person who uses our services?*

  • EQUALITY ACT 2010
    A disability is a physical or mental impairment that has a substantial and long-term negative effect on normal day-to-day activities. Further information is available at www.gov.uk/definition-of-disability-under-equality-act-2010.

  • Do you need any reasonable adjustments for the application or interview process?*

  • EDUCATION *(all qualifications will be subject to a satisfactory check).

  • 1

  • Date From*
     - -
    2 digit day, 2 digit month, 4 digit year
  • Date To*
     - -
    2 digit day, 2 digit month, 4 digit year
  • Would you like to add another Educational Record?*

  • 2

  • Date From*
     - -
    2 digit day, 2 digit month, 4 digit year
  • Date To*
     - -
    2 digit day, 2 digit month, 4 digit year
  • Would you like to add another Educational Record?*

  • 3

  • Date From*
     - -
    2 digit day, 2 digit month, 4 digit year
  • Date To*
     - -
    2 digit day, 2 digit month, 4 digit year
  • Would you like to add another Educational Record?*

  • 4

  • Date From*
     - -
    2 digit day, 2 digit month, 4 digit year
  • Date To*
     - -
    2 digit day, 2 digit month, 4 digit year
  • Would you like to add another Educational Record?*

  • 5

  • Date From*
     - -
    2 digit day, 2 digit month, 4 digit year
  • Date To*
     - -
    2 digit day, 2 digit month, 4 digit year
  • TRAINING COURSEs attended or completing (evidence of attending courses is required) (If None, Type "N/A")*
    Rows

  • EMPLOYMENT HISTORY:(Show last employment first.)

    Please record below the details of your full employment history beginning with your current or most recent first. Any gaps must be explained. Use a separate attached sheet if required; please sign the sheet(s)

  • EMPLOYMENT 1 - CURRENT OR MOST RECENT

  • Start date:*
     - -
    2 digit day, 2 digit month, 4 digit year
  • End date:*
     - -
    2 digit day, 2 digit month, 4 digit year
  • Format: (000) 0000-0000.
  • Would you like to add another Employment Record?*

  • EMPLOYMENT 2

  • Start date:*
     - -
    2 digit day, 2 digit month, 4 digit year
  • End date:*
     - -
    2 digit day, 2 digit month, 4 digit year
  • Format: (000) 0000-0000.
  • Would you like to add another Employment Record?*

  • EMPLOYMENT 3

  • Start date:*
     - -
    2 digit day, 2 digit month, 4 digit year
  • End date:*
     - -
    2 digit day, 2 digit month, 4 digit year
  • Format: (000) 0000-0000.
  • Would you like to add another Employment Record?*

  • EMPLOYMENT 4

  • Start date:*
     - -
    2 digit day, 2 digit month, 4 digit year
  • End date:*
     - -
    2 digit day, 2 digit month, 4 digit year
  • Format: (000) 0000-0000.

  • GAPS IN YOUR EMPLOYMENT

  • Please provide information on any gaps in Employment History (If None, Type "N/A")*
    Rows

  • REFERENCES

  • Please provide names, addresses and telephone numbers for referees below who we may approach for a reference. In line with CQC requirements, we require references (or other satisfactory evidence as the employer may determine) from all previous employers concerned with the provision of services relating to health or social care, or children or vulnerable adults which should include details of why their employment came to an end (note that this is not time limited). If your previous employment does not concern the provision of services relating to health or social care, or children or vulnerable adults, you must provide references from your two most recent employers. Please provide two character references if you are unable to obtain two professional references, e.g. in the case of a candidate who has been raising children for ten years. All will be contacted, therefore please inform the referees of the fact that you have used their name. If you are unable to provide the required references, please discuss the matter with us.

  • REFEREE ONE

  • Select Reference Type:*
  • Format: (000) 0000-0000.
  • May we contact them now?*

  • REFEREE TWO

  • Select Reference Type:*
  • Format: (000) 0000-0000.
  • May we contact them now?*

  • SAFEGUARDING AND CRIMINAL-RECORD DECLARATION

    This section will be handled confidentially by those involved in recruitment.

  • The Rehabilitation of Offenders Act 1974

    Woodberry Care Ltd aims to promote equality of opportunity and is committed to treating all candidates fairly regardless of ethnicity, disability, age, gender or gender re-assignment, religion or belief, sexual orientation, pregnancy or maternity and marriage or civil partnership. Woodberry Care Ltd undertakes not to discriminate unfairly against candidates on the basis of a criminal conviction or other information declared. Answering 'yes' to the question below will not necessarily prevent your employment. This will depend on the relevance of the information you provide in respect of the nature of the position and the particular circumstances.

  • Are you currently bound over or do you have any current UNSPENT convictions that have been issued by a Court or Court-Martial in the United Kingdom or in any other country?*
  • Do you have any current UNSPENT police cautions, reprimands or final warnings in the United Kingdom or in any other country?*

  • SUPPORTING STATEMENT

  • PRIVACY STATEMENT

  • We will only collect data for specified, explicit and legitimate use in relation to the recruitment process. By signing this application form, you consent to Woodberry Care Ltd holding the information contained within this form. If successfully shortlisted, data will also include shortlisting scoring and interview records. We would like to keep this data until the vacancy is filled. (We cannot estimate the exact time period, but we will consider this period over when a candidate accepts our job offer for the position for which we are considering you). When that period is over, we will either delete your data or inform you that we would like to keep it in our database for future roles.

    We have privacy policies that you can request for further information. Please be assured that your data will be securely stored by the Registered Manager and only used for the purposes of recruiting for this vacant post.

    You have a right for your data to be forgotten, to rectify or access data, to restrict processing, to withdraw consent and to be kept informed about the processing of your data. If you would like to discuss this further or withdraw your consent at any time, please contact the Registered Manager to discuss.

  • 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 Woodberry Care Ltd can seek clarification regarding professional registration details. Completing this form does not guarantee employment. Any offer is conditional on satisfactory references, identity and right-to-work checks, verification of relevant qualifications and the appropriate DBS and barred-list checks where the role is eligible.

  • Date:*
     - -
    2 digit day, 2 digit month, 4 digit year

  • DOCUMENTS WE NEED TO PROCESS YOUR APPLICATION

  • Please tick each document you are supplying with this form

  • We check the same documents for every candidate. Please do not post original documents, bring them with you when you are invited for an interview. Further processing: we will contact your referees and, where required, apply for an Enhanced DBS check. Successful candidates will be booked onto a training course, delivered either in person or online, followed by shadow training before starting work.

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