Application Form for Employment s3

Application Form for Employment

If you have a covering letter, please send this with the application form. If you need to use a separate sheet of paper to complete the answers to any of the questions, then please do so

Personal & Contact Details Miss Mrs Ms Mr Title (please circle) Dr Other

First name

Last name

Email address

Address Line 1

Address Line 2

City / Town

County

Postcode

You need to provide at least one contact number:

Mobile

Business

How did you hear about this vacancy? (please circle) Care4u WE Ltd Staff Care4u WE Ltd BS Social Care EasyWeb Recruitment Member Website Job Centre / Universal Facebook Indeed Job Board / On-Line Job Match / direct.gov Local Poster / Postcard Job Fair JobsIn Kent LinkedIn / Leaflet Newspaper Advert Ourtlc Pathways S1 Jobs Social Care SmartList The Daily Jobs Post Totaljobs Recruitment Twitter Word of Mouth WorkingMums.net Other

If “Other” please state

Please answer these questions which are related to essential requirements for the role Are you willing and able to work the shifts stated in the advert Yes No

If you have any questions or need assistance with the application please email [email protected] Were you over 18 when you started this application? Yes No

Questions (Please circle appropriate answer) Do you have the legal right to work in the UK? Yes No

Have you previously applied for a position with Care4u WE Ltd? Yes No At anytime in the past, have you previously held either a permanent or temporary position, or have you worked for Care4u WE Ltd through an agency in the past Yes No 12 months? Are you related to, or do you know any person who works for us, is a trustee of, Yes No or is supported by Care4u WE Ltd? If you are applying for a part time role, please indicate the number of hours you would be available for work each week?

Education Please provide details of your education, including schools and colleges and any qualifications you obtained From To Subject/ (MM/YYYY School/College Qualification Level (MM/YYYY) Grade )

Personal & Professional Development

If you have any questions or need assistance with the application please email [email protected] Please give details of short courses and/or in-service training you have attended in last 5 years From To Title & nature of course Organised by (MM/YYYY) (MM/YYYY)

Are there any other commitments you have, which might have an effect Yes No on your working hours (e.g. magistrate's or local government duties)?

Employment Record

If you have any questions or need assistance with the application please email [email protected] Please start with your present or most recent employment and work backwards through your career. Include voluntary work if relevant.

Are you currently employed? Yes No

Previous Employment Please give details of ALL posts held, including part time and unpaid work, from the age of your first employment. This should include any work you did whilst at school or college. Please start with the most recent. If you have any gaps in your employment history, due to raising a family, unemployment, travelling etc. please give full details on the next page. This is a requirement of the Care Quality Commission From To Employer (Name and Post, salary & main (MM/YYYY Reason for Leaving (MM/YYYY) Full Address) Responsibilities )

Additional Questions Please give us examples of how you can demonstrate your skills and values in relation to this role

If you have any questions or need assistance with the application please email [email protected] Please tell us about a time when you have made a positive difference to someone else's life

With reference to the information provided, please tell us why you are applying for this role and what you would enjoy most

Are you willing and able to do Sleep In shifts (for which an additional Yes No payment is made)?

Do you hold a full driving licence? Yes No

Diversity Monitoring

If you have any questions or need assistance with the application please email [email protected] Care4u WE Ltd is committed to equality of opportunity in employment and to the selection of the right person for the job. The information you are providing on this page is used for monitoring purposes only. It is not used in the selection process. You do not need to fill out this section Gender Male Female Rather Not Say

Date Of Birth (DD/MM/YYYY) / / Care4u WE Ltd wishes to encourage suitably qualified disabled people to apply for jobs. All information provided will be treated in confidence. The Disability Equality Act 2010 defines disability as a 'physical or mental impairment which has a substantial and long term adverse effect on the ability to carry out normal day-to-day activities'. Do you consider yourself to have a disability? Yes No Sexual Asexual Bisexual Heterosexual Homosexual Orientation Nationality

Agnostic/Atheist Buddhist Christian Hindu Religion Islamic Jewish Sikh Other Asian or Asian Asian or Asian Asian or Asian Black or Black British - British - Indian British - Pakistani British - African Bangladeshi Black or Black Mixed – Asian Mixed – Black British - Chinese and white African and White Caribbean Ethnic Origin Mixed – Black Other Asian Other Black Other Ethnic Caribbean and Background Background Background White

Other Mixed Other White White – British White – Irish Background Background

Diversity Monitoring I declare to the best of my knowledge and belief, that all particulars I have given in all parts of this application form are complete and true. I understand that any false declaration, misleading statement or significant omission may disqualify me from employment and render me liable to dismissal. I understand that any job offer is subject to references, checks on relevant qualifications, employment eligibility and criminal convictions, a probationary period and (if the organisation believes it appropriate) a medical report, all of which must be deemed satisfactory by Care4u WE Ltd. When a DBS check is required for the role I am applying for, I give my permission for my DBS certificate, when it is received, to be copied and held in a secured file in accordance with the DBS Code of Conduct by Care4u WE Ltd and U-Check, I understand that Care4u WE Ltd will be able to directly access the certificate provided the DBS check is clear. If it is not then the certificate will be sent directly to me and I must forward this to Care4u WE Ltd Head Office upon receipt. I understand it will be returned to me as soon as possible.

Signature

Print Name Date

If you have any questions or need assistance with the application please email [email protected] If you have any questions or need assistance with the application please email [email protected]