APPLICATION FORM

APPLICATION FORM

The recruitment process within this organization has a minimum of two stages.

 

The completion of this application form is part of stage one. This application will be reviewed, and a decision made as to whether to proceed to stage two, the interview, based on this information.

 

PLEASE COMPLETE FULLY

Full time / part time

(please circle which you want to work, or delete as appropriate)

DaysNightsMorningsAfternoonsEveningsWeekends Only
Full Time
Part Time

Address: Full addresses covering the five years up to the application date must be

supplied. If necessary, use another sheet of paper.

EDUCATION

TRAINING HISTORY/PROFESSIONAL STATUS

FULL EMPLOYMENT HISTORY

State the reasons for any breaks in employment. Use a separate sheet if required, please sign that sheet and attach.

 

HEALTH DETAILS

NEXT OF KIN

CAPACITY TO WORK IN THE UK

Note: Minimum age; legislation dictates that care workers in general must be 18 years old or older, and Carers working with people with learning disabilities must be 21 or older. Please inform your interviewer immediately if you do not meet these specifications.

REFEREES

You must provide references from your two most recent employers. All will be contacted, therefore please inform the referees of the fact that you have used their name. If you are unable to provide the required references, please discuss the matter with us.

Current or most recent employer

Previous employer to the one above

 

CRIMINAL RECORD

Workers in this establishment are subject to the Health and Social Care Act 2008, and will be subject to a Police Record Check through the DBS. Please declare all criminal convictions, whether spent or not, charges, whether proceeded with or not, and warning and cautions.

You will not be eligible for work in a care setting if you are on the ISA Register(s).

 

SIGNATURE and DECLARATION

 

IMPORTANT – READ BEFORE SIGNING

I declare that to the best of my knowledge and belief the information given by me in this application is true, and I understand that the above information forms the basis of my contract of employment. I understand that if any of the information supplied by me is found to be falsely declared, my contract may have been fundamentally breached and my employment may be terminated immediately.

 

I understand that I cannot be offered a post until a satisfactory response has been received with respect to my DBS Register status, and that should I subsequently be offered a post, that offer will be subject to receipt of two satisfactory references, one of which must be from my previous employer, and that confirmation of the employment will be subject to a satisfactory criminal record check from the DBS. I understand that until a satisfactory response is received from the DBS, and my employment is confirmed, I will be supervised at all times at work, and will not seek or have unsupervised access to vulnerable people. If the post I have applied for is as a Registered Nurse, my confirmation of employment will also be subject to a satisfactory search of the Nursing and Midwifery Council records and registers. By my signature, I authorise the organisation to request a DBS Register check and a criminal records check from the DBS, on initial employment and at any time during my employment thereafter. I undertake to inform my employer immediately if my DBS Register status or criminal status changes at any time during my employment, such as by being charged with an offence (other than motoring offences), the administering of a warning, criminal conviction, referral to any register of barred Care workers, or withdrawal of any registration required by my employment status.

EQUAL OPPORTUNITIES

 

Alas HealthCare is an equal opportunities employer. Selection of applicants will be based on suitability for the job regardless of ethnic background, sexual orientation, age, disability, gender, culture, marital status, religion, or belief.

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