Application Form - Carers

PREVIOUS EMPLOYMENT

A full employment history must be detailed beginning with your current employment and covering all reasons for gaps in any given year.

Employment Details 1

Employment Details 2

Employment Details 3

Employment Details 4

Employment Details 5

PREVIOUS EDUCATION

(Original documents as proof of qualification will be required at interview)

REHABILITATION OF OFFENDERS ACT 1974 – NOTICE TO OFFENDERS

Because of the nature of the work involved, the post for which you are applying is exempt from Section 4(2) of the Rehabilitation of Offenders Act 1974 by virtue of the Rehabilitation Offenders Act (Exemption Order 1975). This means that you are not entitled to withhold information relating to any convictions you may have had.

Any information should be given on a separate sheet and sent with this application form. This information will be treated as confidential and will not necessarily preclude you from employment.

Failure to declare or the falsification of any of the above details will result in the withdrawal of any job offer.

ADDITIONAL PERSONAL DETAILS

REFERENCES

Please give the name and address of at least two referees, one of whom must be your present employer or your most recent employer.

This organization seeks to work in a flexible and family-friendly manner with its staff, however, unsocial hours are part and parcel of a quality care service. Weekend working is a requirement for all staff, the frequency of which will be determined at the interview.

Thank you for completing this application form.

I declare that to the best of my knowledge, all of the information contained and documented herein is complete and truthful.

FOR OFFICE USE ONLY

Additional Notes from Application

Equal Opportunities Monitoring

This section of the application will be detached and used for monitoring purposes only. Our organisation recognise and actively promote the benefits of a diverse workforce and are committed to treating all employees with dignity and respect regardless of race, gender, disability, age, sexual orientation religion or belief. We welcome applications from all sections of the community.

Race Relations (Amendment) 2000

I would describe my ethnic origin as (please indicate with a tick

Employment Equality Regulations 2003

Please select the option which best indicates your religion or describes your sexuality.

Health Questionnaire

(To be used for those applicants that have been deemed appointable).

In order to comply with the Health and Social Care Act 2008 and the Equality Act 2010, please complete this questionnaire as fully as possible. Failure to do so could impede or delay your appointment. All information is confidential.

Have you ever had or suffered from:

Please List Below any Periods spent Outside of the United Kingdom as a Resident (do not include holidays)

Please List below any vaccinations or immunisations

I declare that the information given is correct to the best of my knowledge. In my view, I am fit physically and mentally to undertake this post. I understand that omissions or false statements may disqualify me from employment or lead to dismissal. I give the employer the right to investigate all references.

Divine Healthcare Solutions Limited, 47 Field Road, Bloxwich, Walsall, West Midlands, United Kingdom, WS3 3JD,

Phone: 03335770655

Email: info@divinehealthcaresolutions.co.uk | Website: www.divinehealthcaresolutions.co.uk