Domiciliary Care Givers

About the Role

Domiciliary Care Givers Application Form. Please ensure that you complete the application form in full as we cannot accept CVs. Please complete with black ink and block capitals. This form will be kept in confidence. Please note that no applicant will be unfairly discriminated against. This includes discrimination on account of age, cultural, religious, political beliefs, disability, ethnicity, gender, race, relationship status, sexual orientation, and / or Trade Union membership or stewardship.

If you have any special requirements to support you to complete this form (e.g., the need for large print or additional time), please contact the Registered Manager

Personal Details

• First Names
• Surname
• Marital Status
• Gender
• Address
• Date of Birth
• Postcode
• Place of Birth
• Nationality
• DBS Number
• DBS date of issue
• NI Number
• Mobile Number
• Email Address
• Are you a Driver? (Yes/No)
• Own Transport (Yes/No)
• How long have you had a licence?
• Any Endorsements (Yes/No)
• Are you a United Kingdom (UK), National (Yes/No)
• If no, please detail your current immigration status and the relevant visa currently held (including Visa number)
• Are you related to any of our current members of staff or Service Users? (Yes/No)
• Equality Act 2010 - Disability definition and reasonable adjustments
• Addresses resided at within the last 5 years

Employment History

• Current / Most recent employer details (Start Date, End Date, Salary, Job Role, Employer Name, Contact Name, Reason for Leaving, Duties, Address, Postcode, Telephone, Email)
• Previous Employment History details
• Explanation of Gaps in employment

References

• Referee One details (Contact Name, Business Name, Address, Postcode, Telephone, Email, Capacity in which known)
• Referee Two details
• Referee Three details
• Referee Four details
• Additional Referee details

Safeguarding / Ex-Offenders Declaration

• Rehabilitation of Offenders Act 1974 information
• Declaration on current UNSPENT convictions
• Declaration on current UNSPENT police cautions, reprimands or final warnings

COVID-19 Vaccinations

• Are you fully vaccinated against COVID-19 or exempt from vaccination? (Yes/No)
• Are you able to evidence your vaccination or exemption status using the NHS COVID pass? (Yes/No)

Privacy Statement

Data collection for recruitment process, consent for holding information, data retention policy, rights regarding data (forget, rectify, access, restrict, withdraw consent).

Monitoring Information

• Travel to the UK (Dates, Visa type, Length of Stay, Date of travel, Date of Departure)
• Denied VISA to the UK (Details)
• Denied VISA to any European or Western Country (Details)
• Deported from any European or Western Countries (Details)

Supporting Statement

Reasons for applying, reference to job description and person specification, description of strengths, talents, and skills.

Values Based Screening Questions

Questions related to service user care, family relations, team support, relationships, learning, and team dynamics.

Position Applied For

Location

Work Preference

• Full Time
• Part Time
• Bank
• Hours Requested
• Understanding of Shift work, Unsociable Hours, Lone working (Yes/No)
• Availability (Monday-Sunday)

Company Information

[Employer hidden] Services

CQC overall rating: Insufficient evidence to rate (2 December 2022)

homecare.co.uk Review Score: 9.3 (5 reviews)

Contact Details

Unit 205 Lansbury Business Estate, 102 Lower Guildford Road, Woking, GU21 2EP.

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Out of hours contact: [contact hidden]

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