Online Form Complete the application form and submit Post Apply for:*Please SelectHealth AssistantSupport WorkerDomestic WorkerRGNRMNHow did you hear about this job?*Please SelectInternet SearchJob CentreFriendNewspaperOtherDate available to start:* Date Format: MM slash DD slash YYYY Upload ID Photo*Personal InformationName* Mr.Mrs.MissMs.Dr.Prof.Rev. Title First Last Email* Phone Number*Date of Birth* Date Format: MM slash DD slash YYYY National Insurnce No:*NMC Pin No: (Nurses Only)Address* Street Address Town/City Postcode Personal DetailsNationality*Please SelectAfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweGender*Please SelectMaleFemaleReligion*Please SelectChristianMuslimHinduBhudistJewishSikhOtherRace/Ethnicity*Please SelectWhite BritishWhite IrishWhite (Other)Mixed RaceIndianPakistaniBangladeshiOther Asian (Non-Chinese)Black CaribbeanBlack AfricanBlack OtherChineseOtherSexual Orientation*Please SelectStraight/HeterosexualBisexualGay Woman/LesbianGay ManPrefer not to answerEmployment EligibilityAre you permitted to work in the United Kingdom?*YesNoCan you provide evidence to prove eligibility?*YesNoWhat visa/permit/status do you currently hold?*Working HolidayWork PermitLeave to RemainI don't need a VisaOtherState Other*Please state what visa/permit you hold (If applicable):Permit/Document No (If applicable):Visa/Permit Expiry Date (If applicable): Date Format: MM slash DD slash YYYY Driving DetailsDo you have full Driving License that allows you to drive in the UK?*YesNoIf yes, please enter your Driving License No:LanguagesEnglish – Spoken*FluentGoodFairEnglish – Written*FluentGoodFairOther Languages Spoken:*Next of kin detailsName* First Last Relationship*Email NOK Phone Number*NOK Address*NOK Town/City*NOK Postcode*Work HistoryWe need up to 10yrs work history please with no gaps.Previous Job Title / Position Held*Date Previous Job Started* Date Format: MM slash DD slash YYYY Date Previous Job Ended* Date Format: MM slash DD slash YYYY Previous Job Title / Position Held*Previous Job Description (Please list all other work history below, including start and end dates)Education/Qualification HistoryInstitution*Course*Year*Grade*Education (Please list all other education history below, including Courses, Years and Grades)Upload CV if you have one.*ReferencesRef Name 1*Relationship*Ref 1 Email* Ref 1 Phone Number*Ref 1 Address* Address Town/City ZIP / Postal Code Ref Name 2*Relationship*Ref 2 Email* Ref 2 Address* Address Town/City ZIP / Postal Code Skills Experience & TrainingPlease click on which training you have completed and the date on the notes (certificates must be provided). Manual Handling Basic life support Health and Safety Infection Control Other Health DeclarationDo you or have ever suffered from long term illness?* Yes No Have you ever required sick leave for a back or neck injury?* Yes No Do you suffer with any back or neck injuries?* Yes No Have you been in contact with anyone who is suffering from a contagious illness within the last six weeks?* Yes No Do you suffer with a communicable disease?* Yes No If you have answered ‘yes’ to any of the above, please give details:Are you currently receiving active medical attention?:* Yes No Are you registered disabled?* Yes No How many days have you been absent from work due to illness in the last 12 months?State reason(s) for absence:GP Name:*GP Surgery Name:*GP Address:*Town / City*GP’s Postcode:*GP’s Phone Number:*May we contact your Doctor for health check?YesNoPlease Note The above information will be held in strict confidence. If you are aware of any health issue that you feel may affect your ability to undertake responsibilities of the post, it is your responsibility to inform the Care Manager immediately. Again any details discussed in the meeting will be held in strict confidence.DBS DeclarationDo you have a current DBS (Disclosure Barring Service) certificate?:*YesNoPlease enter disclosure numberDate of issue Date Format: MM slash DD slash YYYY Reference Number (if applicable):DBS Check* I agree to the privacy policy.I understand that a DBS check will be sort in the event of a successful application.Terms of employmentIf any provision of this Agreement should be held to be invalid it shall to that extent be severed and the remaining provisions shall continue to have full force and effect. You may be required to use personal vehicle to and from work. No fuel reimbursement will be given. You are responsible for meeting the cost of DBS Disclosure. The employer, in some circumstances, may agree to advance the cost only if you agree it to be deducted from your pay. Carers will achieve NVQ Level 2 within 2 years of the start of employment. All care staff and trainees, including all staff under 18, will register on and successfully complete Skills for care certified training programme. The Company has written and published a formal policy/procedure document covering employee grievances which relate to your employment. The document is entitled “Employee Discipline” and is available for review at any reasonable time. Please contact your Manager for further information, or to request to review a copy. If you are dissatisfied with any disciplinary or dismissal decision relating to you then you should, in the first instance, apply in writing, to the Care Manager stating the grounds for your appeal. The person who will consider the appeal may vary according to individual circumstances. The Company has written and published a formal policy/procedure document covering employee grievances which relate to your employment. The document is entitled “Employee Grievances” and is available for review at any reasonable time. Please contact your Care Manager for further information, or to request to review a copy. If a grievance cannot be resolved informally then you must put your grievance, in writing to your Care Manager. A simple form has been designed for this purpose. Employees with reading or language difficulties should seek assistance, for example, from a work colleague. Subsequent steps, including the right of appeal, are explained in the formal document. The following documents form part of this statement: Employee handbook Policy and procedure manual NoticesTerms of employment* I have read and agree to the terms.Choose a Username*Create Password* Strength indicator
