Devoncare Application Form
Health Care Assistant
Thank you for you application
Thank you for your interest in joining the 4ME&ULTD T/A Devoncare team. Please complete the application form below and submit it to us as soon as possible. We aim to review all applications and respond within 2–5 working days. If you have any questions or need help completing the form, please contact our office on 01752 522522 and ask for Issie or Rhiann, alternatively Email info@devoncare.co.uk
By clicking next, you will begin your application with Devoncare.
Please allow enough time to complete the form in one go, as your progress will not be saved if you leave and return later. Application time is approximately 15 minutes. We look forward to receiving your application.
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Name
*
First Name
Middle Name
Last Name
Maiden Name
Previous Name(s)
Marital Status
*
Email
*
example@example.com
Phone Number
-
+44
Phone Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth
*
Place of Birth
*
Gender
Male
Female
Transgender
Other
Prefer Not to Say
*
National Insurance Number
*
Nationality
*
Do you hold a full UK driving licence?
*
Yes
No
If no, Do you plan on driving, or are you currently learning to drive?
Yes, I am currently learning
Yes, I plan to start learning
No
Do you have your own personal tranport
*
Yes
No
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Are you a United Kingdom (UK) National
*
Yes
No
Are you seeking Sponsorship?
*
Yes
No
If no, please detail your current immigration status and the relevant visa currently held (including Visa Number)
Are you related to any of our current members of staff or Service Users?
*
Yes
No
The Equality Act 2010 defines a disability as a physical or mental impairment that has a substantial and long-term adverse effect on your ability to carry out normal day-to-day activities.Using this definition, do you consider yourself to have a disability?
*
Yes
No
Prefer not to say
For the purpose of this application and interview stage only, is there anything you would like us to be aware of so that we can make reasonable adjustments during the process?
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Education
All stated qualifications will be subject to a satisfactory verification check
School / College / University
*
Examinations, Qualifications
*
Please list all qualifications obtained from the same School, College, or University in this section. Include the dates attended and the qualification outcome for each.
School / College / University
Examinations, Qualifications
Please list all qualifications obtained from the same School, College, or University in this section. Include the dates attended and the qualification outcome for each.
School / College / University
Examinations, Qualifications
Please list all qualifications obtained from the same School, College, or University in this section. Include the dates attended and the qualification outcome for each.
School / College / University
Examinations, Qualifications
Please list all qualifications obtained from the same School, College, or University in this section. Include the dates attended and the qualification outcome for each.
Additional Information
Please add anything additional here
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Training & Professional Development
Please list all training courses you have attended or are currently completing. Evidence of attendance will be required.
Location
*
Subject, Course & Details
*
Please list all Training & Professional Development obtained from the same location in this section. Include the dates attended and the qualification outcome for each.
Location
Subject, Course & Details
Please list all Training & Professional Development obtained from the same location in this section. Include the dates attended and the qualification outcome for each.
Location
Subject, Course & Details
Please list all Training & Professional Development obtained from the same location in this section. Include the dates attended and the qualification outcome for each.
Location
Subject, Course & Details
Please list all Training & Professional Development obtained from the same location in this section. Include the dates attended and the qualification outcome for each.
Additional Information
Please add anything additional here
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ProfessionalMemberships / Registrations
Name of Organisation
Registration Number, Renewal Date & Details
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Employment History
Please provide your full employment history, starting with your current or most recent job, including dates, job titles, employers, key responsibilities, and reasons for leaving, and explain any gaps
Current / Most recent employer
*
Employer Name
*
Job Role
*
Reason for leaving
*
Start Date
*
End Date
Current Salary
Contact Name
*
Employers Email Address
*
example@example.com
Employers Telephone Number
*
-
Area Code
Phone Number
Employers Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Your Duties
*
Employment History
Please provide your full employment history, starting with your current or most recent job, including dates, job titles, employers, key responsibilities, and reasons for leaving, and explain any gaps
Previous Employment - Please include, all previous employers, Start and end dates, employer names, reason for leaving and address, any contact details such as telephone and email addresses.
*
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References
Please provide the names, addresses, and telephone numbers for your referees below. In line with CQC requirements, we require references from all previous employers involved in the provision of services relating to health or social care, or work with children or vulnerable adults. These references must include confirmation of why your employment ended. There is no time limit on this requirement. If your previous employment does not relate to health or social care, or work with children or vulnerable adults, you must provide references from your two most recent employers. Please note: Only professional references will be considered. Character references will not be accepted. All referees will be contacted, so please ensure they are aware you have listed their details. If you are unable to provide the required references, please discuss this with us.
Contact Name
*
Business Name
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: 00000000000.
Email
*
example@example.com
Capacity in which know?
*
Reference Two
Contact Name
*
Business Name
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: 00000000000.
Capacity in which know?
*
Additional Information
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Safeguarding / Ex-Offenders Declaration:
Please note this sectionwill only be seen by those involvedin the recruitment processand will be treated with the strictest confidence.
The Rehabilitation of Offenders Act 1974 aims to promote equality of opportunity and is committed to treating all applicants fairly regardless of ethnicity, disability, age, gender or gender re-assignment, religion or belief, sexual orientation, pregnancy or maternity and marriage or civil partnership. 4ME&U Ltd T/A Devoncare undertakes not to discriminate unfairly against applicants 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?
*
Yes
No
Do you have any current UNSPENT police cautions, reprimands or final warnings in the United Kingdom or in any other country?
*
Yes
No
Additional Information
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 us holding the information contained within this application 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.
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Continue
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Working Time Regulations Confirmation
Please read the following statement and indicate your agreement. I confirm that I have read and understood the requirements of the Working Time Regulations 1998. I understand that the average working week is limited to 48 hours unless I voluntarily agree to opt out of this limit. I acknowledge that my decision regarding the Working Time Regulations will not affect the outcome of my application.
Please Select One:
I agree to work in accordance with the Working Time Regulations (48-hour average weekly limit applies)
I voluntarily agree to opt out of the 48-hour average weekly working limit and understand that I may withdraw my consent by providing the required notice in accordance with the Working Time Regulations.
I do not wish to opt out of the 48-hour average weekly working limit
Name
*
First Name
Last Name
Signature
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.
Name
*
First Name
Last Name
Signature
*
Should be Empty: