Application for Employment as a Care Worker




When starting a new home care business you will need an application for employment as a care worker.

APPLICATION FOR EMPLOYMENT AS A CARE WORKER : SPECIMEN

You MUST provide the following at interview. Applicants without this documentation may have their application rejected.

1) Two forms of identification (preferably passport and driving licence)
2) An ‘official’ letter with YOUR name and address on it (e.g. Phone Bill / Bank Statement etc)
3) Proof of ‘Right to Work in the UK’ (if you do not hold an EU passport)

Part 1. Personal details.

Availability.
Please read this before you complete the Availability Form: Standard working requirements are five days each week plus alternate weekends. It is not a requirement that Care Workers should work more than one period per day but you are free to commit to as many as you would like to. Hours are not guaranteed and shift periods are for illustration only. Payment is made for ‘contact time’ only.

IMPORTANT: This availability will form the basis of any employment offer and, if you are accepted, forms a commitment on your part.
AVAILABILITY FORM Weekdays Weekends
Tick the boxes corresponding to the
times you are available Minimum of alternate weekends
Morning
0700-1200
Tick if available Tick if available
Lunch & Afternoon
1200- 1700 Tick if available

Tick if available
Evening
1700-2200

Tick if available
Tick if available

• Total number of hours per week you are seeking…………………………………
Please note that the amount of work is variable and that
staff may not be working throughout periods marked above
as ‘available’.





Employment History

Are you currently employed? Yes / No
IMPORTANT NOTE: You must include ALL your previous jobs. Any gaps in employment must be explained.

Employer’s name & address Your job title From (month & year) To (month & year) Reason for leaving
Current or last employer
Previous 1
Previous 2
Previous 3
Previous 4
Previous 5
Previous 6
Previous 7
All other previous employment

Continue overleaf if necessary

Education, Qualifications & Training

Training/Qualification
Where Completed Date Completed

Experience

Do you have experience of: Moving & Handling people? Tasks you have performed (e.g. Hoisting, Moving from wheelchair to bed etc.)
Do you have experience of: Personal care including bathing and toileting? Tasks you have performed (e.g. washing, shaving etc.)
Do you have experience of: Cooking housekeeping and feeding? Tasks you have performed (e.g. your cooking abilities, housekeeping, have you fed anyone? etc.)
Do you have experience of:
Handling medication?

Tasks you have performed (e.g. oral medication, medication prompting etc.)
Have you carried out general care (this may be on a personal or professional basis)
Tasks you have performed
Have you managed the running of a house?
Give details here of your experience at cooking / food preparation and the types of food you can cook

Rehabilitation of Offenders Act

The provisions of the above Act and its subsequent amendments state that convictions which are normally deemed as ‘spent’ do not apply in cases where employment involves vulnerable people. Therefore your answer to this question should include ANY ‘spent’ convictions.

Have you ever been cautioned or convicted of any criminal offence? YES / NO Delete as appropriate
If ‘Yes’ give details here:

Independent Safeguarding Authority (‘ISA’), Protection of Vulnerable Groups & Criminal Record checking

This post requires all applicants to receive an ISA First/PVG check (where applicable) and enhanced criminal record check (and from 26 July 2010 onwards to complete an application for registration with the ISA). From 1 November 2011 all employees will be required to be registered with the ISA/PVG. The company will register an interest (or subscribe) with the ISA for updates regarding any employee’s ongoing ISA registration status. Please sign the declaration below which provides your acknowledgement of this and confirms your consent for the company to check your ISA/PVG status.

DECLARATION
I give my consent for Quality Home Care to check my registration status with the Independent Safeguarding Authority/Protection of Vulnerable Groups and to register their interest to receive updates regarding my ongoing registration status during the period of my employment with them.
Signed …………………………………………………………………………………………………….……Date ………………………………………
References
We need to have details of two people who can give you a reference. One should be your present or previous employer and one should be someone who knows you in a professional capacity (not a relative);
Please note: We do not request references until after the interview (an offer of employment is subject to satisfactory references)
Reference 1
(Your current employer. If you are unemployed you may enter your most recent past employer and write ‘Currently Unemployed’. No other is acceptable)
Name address and post code
Referee’s job title………………………………

Telephone number ……………………….

By providing this referee you are giving your permission for us to contact them about your suitability for the role.
Reference 2
Name address and post code
How do you know this person? ………………………………..

…………………………………………………………………………….

Referee’s job title (if applicable)……………………….….
Telephone number ……………………….……………….

By providing this referee you are giving your permission for us to contact them about your suitability for the role.
STATEMENT
I hereby declare that the information given throughout this form and in any verbal statement is accurate and complete and that no material facts have been withheld. I confirm that this is a genuine application for work and that if I am selected I am available for work at the times stated within this form and that I will abide by the regulations and contractual requirements of Quality Home Care

Signature ………………………………………………………………………………..………………. Date ……………………………..

When you have completed this form please return it in the stamped addressed envelope to
Quality Home Care, Centre4, 17A Wootton Road, Grimsby DN33 1HE

Please note that Quality Home Care is an equal opportunities employer