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Job Form Dev

Your Information

Contact Details

Previous Surname(s)

Current Address

Previous Addresses

For Disclosure & Barring Service purposes, addresses covering the five years up to the application date must be supplied. Enter your previous addresses below. You can add more by clicking the + icon.

Driving Licences

Identity Details

Photo

Please upload a recent photo of yourself.

Carer Standards

In order to guide the interview process, we would like you to indicate your personal philosophy of care by completing the following statement:

Education & Training

For any examinations passed or qualifications gained, please provide evidence below. You can do this by uploading a document or photo of your certificate(s).

Add more training or education history using the + icon.

Employment History

Applicants must complete full employment history and unemployment from leaving school to present, there must be no gaps.

Example:

If there is a time throughout your working life you have been unemployed or had time unemployed to raise children or care for a family member you need to record this on the employment history section provided below. We require this information to comply with Care Quality Commission our regulator.

Most recent/last employer

Previous employer(s)

Health Details


GP Contact Details

Your GP will not be contacted without your permission

Next of Kin

Your GP will not be contacted without your permission

Capacity to work in the UK

Note: Minimum age; legislation dictates that care workers in general must be 18 years old or older and care staff 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 who 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.

You can skip this section as you have stated that you have not worked before or are applying as an apprentice.

Current/Most Recent Employer

Previous Employer

Medical Questionnaire

This questionnaire is intended to assess your fitness for Night work. It is not mandatory; if you complete this questionnaire, and it indicates a potential medical problem you will be offered a free full health assessment.

Complete only if you wish to.

All applicants who complete this section MUST sign the declaration. We operate a 24 hour shift system over 7 days and all nurses and care workers are required to work their share of night duty, unless agreed otherwise at interview by the Manager and documented on this form to this effect
.

YesNo
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 the timing of meals of particular importance?
A medical condition affecting sleep?
A chronic chest condition?
Any medical condition requiring medication to a strict timetable?
Any other medical condition in which the symptoms get worse at night?

Catering Workers Medical Questionnaire

This questionnaire is intended to identify if you may have any medical conditions which affect your suitability to work in catering. It is not mandatory; if you complete this questionnaire and it indicates a potential medical problem in working in a catering setting, you will be offered a free full health assessment.

YesNo
Food Poisoning
Dysentry
Typhoid or Paratyphoid
Tuberculosis
Parasitic infections
Has any close family contact suffered from any of the above?

YesNo
Diarrhea or vomiting
Skin rash
Recurring boils
Discharge from ear, eye or nose
Do you suffer from any other medical problems which may affect your employment as a food handler?
Have you been abroad within the last two years?
Should it be necessary will you agree to provide such specimens as may be required by the Doctor to ensure you are not a carrier of any organism which may infect food?

Declaration - Important

Please read the following statements and check to confirm you understand and agree.

Criminal Record

Workers in this establishment are subject to the Care Standards Act, and will be subject to a Police Record Check through the Disclosure & Barring Service. Please declare all criminal convictions, whether spent or not, charges, whether proceeded with or not, and warning and cautions.

Declaration

Important. Please read and confirm before submitting your application.


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 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 Disclosure & Barring Service. 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 authorize Sycamore Care Centre to request a criminal records check from the DBS application process and online services when registered, on initial employment and at any time during my employment thereafter. I undertake to inform my employer immediately if my 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.

GDPR Statement

The information that you provide on this form will be used to process your application for employment in line with SLW- Sycamore Care Centre Privacy Policy.

If you succeed in your application for employment, the information will be used in the administration of your employment with us. Further details on the processing of your data at this stage will be provided to you on offer of employment.

If you would like further information, please read our employee privacy notice available to download from Sycamore Care Centre’s website: www.sycamorecarecentre.co.uk/gdpr

By signing this application form we you agree to the processing of your personal data in accordance with SLW Sycamore Care Centre Data Protection and Privacy Policy.