Application Form - ICS Community Services
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.
We are currently recruiting for 4–6 hour shifts across Devon.While 12-hour shifts may become available in the future, these are fully staffed at present, so applications should reflect availability for shorter shifts only.
Position applied for
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Preferred location
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Name
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First Name
Last Name
Previous Names or Other Names Used (write N/A if not applicable)
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A Copy of this will be requested at Interview
Place of Birth
Date of birth
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Day
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Month
Year
Phone number
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Email
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example@example.com
Address
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Street Address
Street Address Line 2
City
County
Post Code
Marital Status
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Gender
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Place of Birth
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Are you a United Kingdom (UK) National?
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Yes
No
Can you prove that you are legally entitled to work in the UK?
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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
Nationality
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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)
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If you are NOT a United Kingdom (UK) National , Please provide your UK government right to work share code - write N/A if this is not applicable
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What is your National Insurance number?
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Are you a driver?
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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?
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Yes
No
Please name the person you are related to and their role, and their relationship to you - write N/A if this is not applicable
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Are you aged over 21? (Required for some posts)
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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 - and how do you meet the person specification as outlined in the job description?
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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.
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Organisation
Role
Start Date
End Date
Reason For Leaving
Gaps in Employment
Most Recent Employer
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3
4
5
6
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9
10
References - we require a reference from your most recent employer and at least one other - Please note additional references will be required if you have worked in any care or education roles within the last 5 years.
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Organisation
HR Email
Phone Number
Address
Most Recent Employer
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3
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Professional Memberships / Registrations
Professional Memberships / Registrations
Name of Organisation
Registration Number
Renewal Date
Details
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2
3
I confirm I am happy for Involve Care Solutions to request my references
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Yes
No
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Education
Please ensure your original qualification certificates are provided at interview
Education (include School / College / University, Date From, Date To, Examinations, *: (All qualifications will be subject to a satisfactory check).
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Qualifications
Grade achieved
School / College / University
Date From
Date To
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2
3
4
5
6
7
8
9
10
What relevant training and qualifications do you?
Please ensure your original qualification certificates are provided at interview
Training Courses attended or completing (evidence of attending courses is required)
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Training Name
Training provider
online or face to face
date training completed
date training expires
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2
3
4
5
6
7
8
9
10
11
12
13
14
15
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Working Hours
I understand this role may include: shift work, unsociable hours and lone working.
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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
AVAILABILITY TO WORK (Mornings / Afternoons / Evenings) - Please note we are currently only recruiting for 4-6 Hour Shifts across the Devon Region
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Emergency Contact
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Next of Kin Name
Relationship to you
contact number
1
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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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