Beverley Martins Agency

Beverley Martins Limited Social Care Agency

Application Form

PLEASE COMPLETE IN CAPITAL WRITING.

SURNAME…………………………………………………FIRST NAME…………………………………..

(MR/MRS/MISS/MS)…………………………………….OTHER NAMES: …………………………………

HOME ADDRESS……………………………………………………………………………………………….

...... …….…………………………… POST CODE: ……………………

HOME TELEPHONE NO……………………………. WORK TELEPHONE………………………………..

MOBILE NO………………………………

NATIONAL INSURANCE NO:

DATE OF ENTRY INTO U.K (IF APPLICABLE):

Further Education Experience:

Original certificate of qualification will be required for record purposes at interview.

College Date From - To Course Qualification

259 Bromley Road, Catford, London SE6 2RA. Telephone: 020 8695 2470 Fax: 020 8695 2476 Registered Office: 259 Bromley Road, Catford, London SE6 2RA. Registered Number: 03411394 [email protected]. www.beverleymartins.com

ISO9001:2008 Accredited Work Record A full 5-year continuous occupational history is required, including periods of unemployment, with start and end dates

Name and Address Post Dates (From – To) Reason for leaving of Employer

Relevant Experience: (include any Voluntary work.)

……………………………………………………………………………………………………. ……………………………………………………………………………………………………. ……………………………………………………………………………………………………. ……………………………………………………………………………………………………. …………………………………………………………………………………………………….

To promote the welfare of customers in the very best way possible 2 by providing a first class set of quality service. Which Areas of work are you experienced in: - Please circle and state duration of time worked with Client group and whether paid or voluntary work.

A. CHILDREN B. YOUNG PEOPLE C. ELDERLY D. MENTAL ILLNESS

E. PHYSICAL DISIBILITY

F. LEARNING DISABILITLY

What are Your Leisure Activities? …………………………………………………………………………………………………….. …………………………………………………………………………………………………….. ……………………………………………………………………………………………………. ……………………………………………………………………………………………………. …………………………………………………………………………………………………….

DO YOU HAVE TRANSPORT OF YOUR OWN? (YES/NO) (Please circle)

Have you any objections to working with Clients who smoke? YES / NO

Your preferred working area:

Two Work References: (These must be your present or immediate past Employers or one employer and a character reference, but not from friend or member of family).

Full Name and Title Telephone No. and Fax Address & E-mail address

To promote the welfare of customers in the very best way possible 3 by providing a first class set of quality service.

Medical

Do you consider yourself a fit and healthy person physically and mentally? (YES/NO)

Have you had an x-ray in the last 3 years (YES/NO?)?

If YES please state reason:……………………………………………………………………….

Are there any concerns about your state of health that may affect your work practice? ……….

If so please specify:

Have you had a D.B.S check completed? ______

If yes, specify DBS date______

Next Of Kin

Name: Relationship:

Telephone No:

Address:

Availability to work

06:00 07:00 08:00 09:00 10:00 11:00 12:00 13:00 14:00 15:00 16:00 17:00 18:00 19:00 20:00 21:00 22:00 23:00 Mon Tue Wed Thurs Fri Sat Sun

I agree I am willing to work at these times indicated, and it is not my intention to change the time with-in my probationary period of six months.

Applicant signature______Date______

Print Name______

Confirmed By ______Postition______

To promote the welfare of customers in the very best way possible 4 by providing a first class set of quality service. Other Work Commitments Name of Employer Address:

Job description/Title

Hours/days employed:

How did you hear of Beverley Martins Limited? ______

______

To promote the welfare of customers in the very best way possible 5 by providing a first class set of quality service. Rehabilitation of Offenders Act 1974

Law requires that the nature of work you are applying for is covered by the exemption order 1975 No. 1023. Applicants are required to declare and detail below any previous cautions, arrests and convictions for criminal offences, including those that would otherwise be considered as “spent”. If there are no convictions then enter so as “none”………………………………………………………………………………………………….

Has a Local Authority concerning a child/children or young person/people less than 18 years of age taken any action against you? (YES/NO)

Have you at any time been the subject of an abuse investigation or enquiry? (YES/NO) please circle. If yes please give dates and results of enquiry or investigation.

An Enhanced Disclosure check with the Criminal Records Bureau will be undertaken prior to an offer of employment; this will be specific to this employment, as any current DBS disclosure cannot be carried over from another employment. DBS will be updated at least every three years. You must notify the Agency of any Convictions or Cautions, which are received after your appointment to the Agency.

Where appropriate we encourage all applicants called for interview to provide details of any criminal record at an early stage in the application process. We request that this information is sent under separate, confidential cover, to the HR Manager, Anthony Badresingh. We guarantee that this information will only be seen by those who need to see it as part of the recruitment process.

Offence………………………….. Date of Conviction…………………… Sentence………………….

I understand that the police will check the above information.

SIGNED: DATE:

Declaration. That all the information I have provided in this application is correct to the best of my knowledge. I have read and understood the terms of engagement and agree to abide by them at all times. Should any false information become evident after an offer of employment by the Agency then my employment may be terminated without reason or notice.

SIGNED: DATE:

To promote the welfare of customers in the very best way possible 6 by providing a first class set of quality service. PLEASE NOTE ONLY SUCCESSFUL APPLICANTS WILL BE CONTACTED

FOR OFFICE USE ONLY

Application form received……………………………

Date References requested: ………………………….

Date DBS received ………………………………Date of issue………………………………….

DBS Disclosure No:

Tax document P46 P45 P60

Two proofs of Address: Utility bills, Rent book, Bank statement. (These documents must not be less than 3 months old).

Proof of Identity: Passport/ID Card (EU only) /Driving Licence/Birth Certificate/ Marriage certificate /N.I. Card (please circle)

Applicant Name…………………………………………………………………………………………………… (Please print)

Only Job…………………….YES…………………NO

NVQ 2 or Equivalent… YES………………..NO

Allocated Day off…………………………………….

P46 to be completed unless candidate has produced a P45 from most recent job

Pay Scale……………….Level ….1…... 2……3 or Domestic

Start Date…………………………………………………………………..

End Date…………………………………………………………………..

Applicant Signature…………………………………………………………………………..

JOB DESCRIPTION CARE WORKER To promote the welfare of customers in the very best way possible 7 by providing a first class set of quality service. 1. PURPOSE OF THE JOB 1.1 To provide a specialist weekday or 24 hour Care Service to meet the assessed needs of a wide range of Service Users to maintain them within the community. Service Users include elderly people, people with disabilities, the terminally ill and other vulnerable adults. The duration of the visits will be either, 30 minutes, 45 minutes or one hour, then the Care Worker will move on to their next client. On occasions clients may require a sitting service, which may be for two or three hours. 2. Range of Duties 2.1 To clean the Service User’s homes concentrating on those tasks which the Service User is unable to perform themselves, including vacuuming, washing floors, toilet, bathrooms, kitchens, dusting, washing up, tidying etc. 2.2 To launder Service User’s clothes using the Service User machine, the local launderette or washing small personal items by hand to prepare incontinent laundry for collection.

2.3 To mend and darn clothes as necessary and undertake ironing. 2.4 To make beds, change linen where appropriate, if there are difficulties in moving furniture Care Worker is expected to report problems to the office. 2.5 To shop for food and personal items, as directed, to collect prescriptions and pay bills – keeping a record of money spent and ensuring correct change and receipt is given and recorded on the expenditure sheet. 2.6 To prepare, cook and serve meals and beverages and ensure availability of refreshments during the day if required. 2.7 To assist the Service User in responding to any enquiries via the telephone, letters or in person. 2.8 To identify and report to the Manager changes in a Service User’s abilities, behaviour, needs of personal circumstances. 2.9 To identify and respond to the needs of individual Service User which may require a change in emphasis or adjustment to the work schedule and timetable identified by management. To work with others involved in the provision of care to the Service User. To be aware of individual circumstances relating to the Service User which may affect the need for practical support in the home and to attend Case Reviews as required. 2.10 To carry out duties with an awareness of health and safety, e.g. not moving and lifting heavy furniture, as well as reporting household equipment or conditions, which are observed to be unsafe. 2.11 To keep up to date with developments in the provision of Care, attending training courses, group supervision etc., as required. 2.12 To take appropriate action if no answer is received from a Service User or there are circumstances, which require the assistance of the emergency services. To promote the welfare of customers in the very best way possible 8 by providing a first class set of quality service. 2.13 To assist the Service User to undertake physical care tasks within Agency guidelines including: - Washing and assisting the Service User to bathe, - Shaving the Service User (using an electric razor), - Hair care, - Dressing, i.e. clothing, - Dealing with incontinence problems - Assisting the Service User from bed to commode/bathroom using transfer aids, which include the use of a hoist to transfer Service User to and from bed - CARE WORKER MUST NOT PERFORM TRANSFER ACTIVITY THAT REQUIRES A TRANSFER AID SINGLE HANDED. 2.14 To attend sick and bed-bound Service Users, providing close physical and emotional care as required and to administer medication in accordance with Agency policy. 2.15 To escort the Service User in a wheelchair or help with wheelchair mobility. 2.16 To develop a supportive working relationship with the service User which encourages maximum independence, giving confidence to a Service User in receipt of rehabilitation aids and people returning to community living. To promote well-being by allowing individuals to reminisce express anxieties, and respond to situations such as bereavement, stress etc. 2.17 To arrange appointments and act as an escort to GPs, Opticians, (etc.), making transport arrangements appropriate for the user. 2.18 To be responsible for security while at, and on leaving the user’s premises and to respond to any emergency problems with regard to maintenance. 2.19 To keep basic records in Service User`s home file and provide reports which may be used as a basis of assessment. To report any incidents concerning Service Users emotional and physical health & well being including suspicions or allegation of abuse or neglect, or inappropriate contact or unacceptable behaviour. 2.20 To work within the Agency`s Equal Opportunities Policy. 2.21 Any other duties appropriate to the post and grade.

JOB SPECIFICATION FOR THE POSITION OF CARE WORKER

1) Must have N.I. Number and be a resident of the U.K.

2) Experience with client group desirable

3) A full C V will be required with application form To promote the welfare of customers in the very best way possible 9 by providing a first class set of quality service. 4) NVQ level 2 qualifications essential for the job. Beverley Martins can provide training

5) Minimum of two references- one must be from previous employer and not more than 3 years old

6) Must have Proof of Identity (e.g. Passport)

7) Must have Proof of address (e.g. Council tax bill, Full Driving Licence, Bank statement) not mobile telephone bill. Bills must be within three months.

8) Understanding of Community Care

9) Understanding of equal opportunities (e.g. non-discriminatory practice)

10) Car desirable

11) Able to work unsociable hours

12) Ability to work without direct supervision

13) Responsible caring attitude

14) Will be required to write reports for the Agency and other external Agencies

15) Ability to cook basic dishes

16) Commitment and reliability

17) Positive attitude to Training and updating skills

18) Attend Staff meetings and Team Meetings

Equal opportunities monitoring form Date: Beverley Martins Limited believes in equal opportunities. We want to make sure that we are an equal opportunities employer in practice, which is why we want to monitor our recruitment procedures. We will separate this part of the form from the application form. It will not form part of the selection process. Please note completion of this form is not compulsory

To promote the welfare of customers in the very best way possible 10 by providing a first class set of quality service. Please tick the appropriate boxes Gender  Male Female  If you are undergoing the process of gender reassignment, please tick the box that applies to your future gender.

What age group do you belong to? 18-25  25-35  35-45 45-55 over 55

Do you consider that you have a disability?  Yes  No

Do you have a disability as defined by the Disability Discrimination Act?  Yes  No

Do you consider that you have a long-term health problem?  Yes  No

How would you describe your religion? My faith is ______I am not religious______

How would you describe your nationality?  British  English  Scottish Welsh  Irish Other (please describe) ______

How would you describe your ethnic origin? White/Mixed  White  White and Black Caribbean  White and Black African  White and Asian Any other mixed background (please describe) ______Asian  Indian  Pakistani  Bangladeshi Any other Asian background (please describe) ______Black  Caribbean  African Any other black background (please describe) ______Chinese Any other ethnic group/background, please describe ______

What languages do you speak (including 1st language) ------

To promote the welfare of customers in the very best way possible 11 by providing a first class set of quality service.