Interview Form

Interview
Interview Type
Where did you hear about this role?
Applicant Name

First NameLast Name
Person Interviewing

First NameLast Name
Managers Email / Person Interviewing
example@example.com
Position Applied
Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Branch or Extra Care Scheme
Date of Birth

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Your Recruiters Name
Applicant Email
example@example.com
Applicant Telephone Number
Please enter a valid phone number.Format: 00000000000.
Job Role
Discussed and Confirmed
Agreed Availability
I {applicantName} confirm that the availability and in advance annual leave provided during the interview process is accurate and reflects my ongoing ability to work.

I understand that any offer of employment is made based on this stated availability. I {applicantName} acknowledge the importance of maintaining this availability once cleared for work, and that any changes may impact the offer or my continued employment.

I {applicantName} confirm that I'm unable to take annual leave from the 15th December - 2nd January

I {applicantName} agree to inform the company at the earliest opportunity should my availability change for any reason, providing at least four weeks notice.

In reference to Live in Care ONLY. {applicantName} Understands that the placement involves living in the client's home for several days at a time. Additionally, understands rest breaks and time-off arrangements for live-in work.

I {applicantName} confirm that I understand the requirements of the role and that my availability has been fully discussed and agreed. I {applicantName} acknowledge that the availability I have provided forms part of my terms of employment, if successful, and cannot be changed within the first three months. Any changes made within this period may constitute a breach of employment terms. After the initial three months, you must request a change in writing, providing a minimum of one month's notice. This notice period is required to allow the organisation sufficient time to make appropriate arrangements should any changes be approved. I {applicantName} further confirm that I will be available to work a minimum of three days per week between Monday and Friday, and that I am expected to be available to work every other Saturday and Sunday.
Applicant Signature
Getting To Know You
Tell Us About Yourself: Hobbies & Interests
How do you plan on travelling from one client’s home to another?

Other
Are you Happy to provide Personal Care to Males & Females

Other
Why do you want to work in care?
Live in Care - Why does live-in care suit you in particular?
Values and Attitude
What is your understanding of Home Care / Community Care, based on your experience?
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Live in Care - Have you lived away from home, or stayed in someone else's home, for long periods before? For example live-in work, lodging, or caring for a family member.
LC Scoring

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Do you have any experience or training providing care, either in a personal or professional capacity?
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Please provide some details of your experience or training:
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What is your understanding of Equal Opportunities and Diversity?
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Why is it important to follow your Training and Policies?
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Live-in care means living in the client's home for several days at a time. How would you keep a professional relationship while living so closely with someone?
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When living in a client's home, how would you respect their space, routines and privacy, while also looking after your own wellbeing and rest?
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Scenarios
Home Care & Live in Care - If a client told you they were being abused, what would you do?
What qualities are important when working with clients who show challenging behavior?
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What qualities and experience make you well suited for the position?
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What would you do if a client did not answer the door as expected?
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Live in Care - What do you think makes someone a good live-in carer?
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Live in Care - It is late at night, you are very tired, and the client still needs care. What would you do?
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Live in Care - You are alone with the client overnight and they have a fall and seem hurt. What would you do?
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Are there any aspects of care you find challenging or less comfortable with?
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If you see a client's medication running low, what would you do?
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If you used a key to enter a client’s home and found them on the floor, what would you do?
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A care plan says to prepare a meal, but the client refuses and says they will do it later. What would you do?
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Why are clear and accurate records important when visiting clients?
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Why is it important to follow your training and follow Policies & Procedures?
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Confirmation
Home Care & Live in Care - Do you confirm that you are happy to work in homes with the conditions outlined, where required by the needs of the clients we support?

Other
I {applicantName} confirm that the availability and in advance annual leave provided during the interview process is accurate and reflects my ongoing ability to work.

I understand that any offer of employment is made based on this stated availability. I {applicantName} acknowledge the importance of maintaining this availability once cleared for work, and that any changes may impact the offer or my continued employment.

I {applicantName} confirm that I'm unable to take annual leave from the 15th December - 2nd January

I {applicantName} agree to inform the company at the earliest opportunity should my availability change for any reason, providing at least four weeks notice.

In reference to Live in Care ONLY. {applicantName} Understands that the placement involves living in the client's home for several days at a time. Additionally, understands rest breaks and time-off arrangements for live-in work.
Applicant Signature
Total Scoring
HomeCare / 140 ................................. Live-In Care / 160
Interview Outcome
Interview Feedback
Restrictions, Experience, Availability or Additional Notes
Should be Empty:

Rows	7am-3pm	4pm-10pm	All Day	Nights
Every Monday
Every Tuesday
Every Wednesday
Every Thursday
Every Friday
Every Saturday
Every Sunday
Alternate Saturday & Sunday

Rows	Available
1-2 Weeks Only
3-4 Weeks
4-8 Weeks
8 Weeks Plus

Interview

Job Role

Agreed Availability

Getting To Know You

Values and Attitude

Scenarios

Confirmation