Apply

Application Form

General Information
Position applied for:*
Full time / Part time / Bank hours:
Title:*
First name:*
Middle name(s):
Surname:*
Date of birth*
National insurance number:
Previous surnames:

including used to- from dates
Current address:*
Moved to this address:
Post code:*
If less than 5 years please state all previous addresses and to- from dates:
Mobile Telephone number:
Home telephone number:*
Email address:
Own transport:
Driving licence number:
If you do not hold a driving licence how will you get to and from work?
Please specify the hours you are able to work (including weekend availability, all staff are required to work alternate weekends):
Please state the notice period required for current employment:
Earliest start date:
Employment History
Please provide current/ most recent first. This must cover the whole of your working life. State reasons for any career breaks. Add as many fields as required.
Job title:
Dates employed (to-from):
Reason for leaving:
Salary:
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Please give details of relevant experience. This may be taken from the work situation, voluntary work, charity or your own home:
Referees

You must provide references from your two most recent employers. Please provide an additional character referee. All will be contacted, therefore please inform the referees of the fact you have used their name. if you are unable to provide the required references, please discuss the matter with us
References
Name:
Address:
Postcode:
Telephone number:
Email address:
Their job title:
Relationship to you:
Do you give permission to contact prior to interview:
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Education
Please complete below, add more fields as required.
School/ university name:
Qualifications gained:
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Training History/ Short Courses Attended
Please complete below, add more fields as required.
Subject:
Qualifications gained:
Untitled
Carer Standards

In order to guide the interview process, we would like you to indicate your personal philosophy of care by completing the following statements:
I believe the purpose of care from a care service is:
If I were a Service User I would like:
I believe that Service Users family and relatives would like from Cambridge Care Company:
I believe that I can support a Service User in Cambridge Care Company because:
As a member of the Cambridge Care Company care team I feel valued when:
I believe a good relationship between me and the Service User depends on:
I believe I learn best when:
I believe a good working team is made by:
I believe my role in relation to the Service User is:
My other beliefs and values of relevance to my job are:
Capacity to Work in the UK
Are there any restrictions to your residence that might affect your right to take up employment in the UK?
If yes, please provide details:
If you are successful in the application, would you require a work permit prior to taking up employment?
Criminal Records Disclosure

Workers in this establishment are subject to the Care Act, and will be subject to a Disclosure and Barring Service Criminal Records Check. You will not be eligible for work in the care setting if you are on the ISA Register.
Please declare all criminal convictions, whether spent or not, charges, whether proceeded with or not, and warnings and cautions:
Health Details
Do you have any mental or physical disability or illness (currently or recurring) which is relevant to the post for which you are applying?
If yes, please give details:
What adjustments (if any) need to be made to the working environment to accommodate your disability?
Please give details of all absences from work in the past 12 months, except holidays:
Please give details of any illnesses/ accidents/ injuries in the last 2 years:
GP’s name:
Telephone number:
GP's Address:

(your GP will not be contacted without your permission). )
Do you suffer from any of the following conditions?
Diabetes, requiring insulin injections to a strict timetable?
A heart or circulatory disorder which affects your physical stamina?
Stomach or intestinal disorder, such as ulcers?
Any other condition which makes timings of meals of particular importance?
A medical condition affecting sleep?
A chronic chest infection?
A chronic chest condition?
Any medical condition requiring medication to a strict timetable?
Please give details of any question you have answered yes to:
DECLARATION

Applicant’s declaration – read and understand as you will be required to sign official declaration at interview.
1. I confirm that the information I have supplied is complete and correct, and I understand that any incomplete, untrue or misleading information given to the employer will entitle the employer to reject my application, withdraw any employment offer made, or, if I am employed, dismiss me without notice.

2. I understand that if any of the information supplied by me is found to be falsely declared my contract may be fundamentally breached and my employment may be terminated immediately.

3. I understand that I cannot be offered a post until a satisfactory response has been received with respect to my ISA Register status, and I understand 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 will be subject to a satisfactory criminal records check from the DBS. I understand that until a satisfactory response is received from the DBS I will be supervised at all times at work and will not seek to have unsupervised access to vulnerable people.

4. By signature on this application I authorise the organisation to request and ISA 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 ISA Register status criminal status changes at any time during my employment, such as 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.

5. By my signature, I give authority to the employer to contact my GP for further details regarding any of the potential health problems I have declared above.

6. I agree that the employer reserves the right to require me to undergo a medical examination to assess my suitability for night work.
Equal Opportunities Monitoring Form
This form will be detached and filed separately from your application.

This reply is anonymous and confidential.

The organisation is committed to promoting equal opportunities for all its employees and all prospective employees.

To ensure that all applicants are dealt with equally, we wish to monitor your recruitment process and would ask for your help by completing the details below by placing a ‘tick’ in the appropriate box. This will allow our organisation to monitor its policies.

Please note: you do not have to complete this form. The information is given on a voluntary basis and the information will only be used for monitoring purpose. Please do not enter any identifying marks on this form, so that your information remains confidential. This information will be stored on a computer.
Gender:
Registered disabled:
Marital status:
Children:
Please indicate your ethnic background:
Age:

Apply

Application Form

General Information

Employment History

Referees

Education

Training History/ Short Courses Attended

Carer Standards

Capacity to Work in the UK

Criminal Records Disclosure

Health Details

DECLARATION

Equal Opportunities Monitoring Form