Care World Agency Application

Stage 1

Homecare Worker- Stage 1

Thank you for taking the time to apply.

Please provide all mandatory (marked as required) fields and submit when ready.

Please ensure, all data is provided in English language and does not include any non-English characters.

Title

First Name

Middle Name

Last Name

Birth Surname

Have you used other name in the past (i.e. name before marriage etc.)?

Yes

If you answered 'Yes' to the above, please provide other name used

Marital status

Gender

Mother's maiden name

NI Number

Date of Birth

Town of Birth

Country of Birth

Nationality

Passport number (if available)

Passport Issue Date

Passport Expiry Date

Are you a Driver?

Own Transport?

How long have you had a licence?

Driving Licence number

Driving Licence Type

Driving Licence valid from

Driving Licence country of issue

Any endorsements

Mobile Number

Landline Number

Are you a United Kingdom (UK) National?

If No, please detail your current immigration status and the relevant visa currently held

Visa Number

Are you related to any of our current members of staff or Service Users?

Do you have a DBS registered on update service?

If Yes, please upload a copy in the documents page of this application.

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Equality Act 2010

Under the Equality Act 2010, the definition of disability is if you have a physical or mental impairment that has a “substantial” and “long-term adverse effect” on your ability to carry out normal day-to-day activities. Further information regarding the definition of disability can be found at: www.gov.uk/definition-of-disability-under-equality-act 2010.

For the purposes of this application and interview stage only, is there anything you would like us to be aware of so that we can make reasonable adjustments during the process?

Position Applied For

Please ensure that you complete the application form in full. 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.

Position Applied For

Preferred working hours

What is your normal mode of transport

I understand this role may include: Shift work, Unsociable Hours, and Lone working.

Please tell us your reasons for applying for this role. You should refer to the job description and person specification to guide you. It would also be of value to describe your strengths and weakness that set you apart from others as well as including skills gained from previous work or education.

Qualifications

Do you hold any certificates for qualifications or Trainings for health and social care?

If Yes, please attach below. Please upload any certification that you declared

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Medical Details

Do you have any medical conditions?

Yes

If yes, please explain in the space provided below?

How many days sick have you had in the past year?

GP Surgery

GP's Name

Address

City

Post Code

Country

Safeguarding / Ex-Offenders Declaration:

Please note this section will only be seen by those involved in the recruitment process and will be treated with the strictest confidence.

The Rehabilitation of Offenders Act 1974 aims to promote equality of opportunity and is committed to treating all applicants fairly regardless of ethnicity, disability, age, gender or gender reassignment, religion or belief, sexual orientation, pregnancy or maternity, and marriage or civil partnership. Care World Agency Ltd undertakes not to discriminate unfairly against applicants on the basis of a criminal conviction or other information declared.

Answering 'Yes' to the question below will not necessarily prevent your employment. This will depend on the relevance of the information you provide in respect of the nature of the position and the particular circumstances.

Are you currently bound over or do you have any current UNSPENT convictions that have been issued by a Court or Court-Martial in the United Kingdom or in any other country?

Do you have any current UNSPENT police cautions, reprimands or final warnings in the United Kingdom or in any other country?

Privacy Statement

Care World Agency Ltd will only collect data for specified, explicit and legitimate use in relation to the recruitment process. By signing this application form, you consent to us holding the information contained within this application form. If successfully shortlisted, data will also include shortlisting scoring and interview records. We would like to keep this data until the vacancy is filled. (We cannot estimate the exact time period, but we will consider this period over when a candidate accepts our job offer for the position for which we are considering you). When that period is over, we will either delete your data or inform you that we would like to keep it in our database for future roles.

Care World Agency Ltd have privacy policies that you can request for further information. Please be assured that your data will be securely stored by the Registered Manager and only used for the purposes of recruiting for this vacant post.

You have a right for your data to be forgotten, to rectify or access data, to restrict processing, to withdraw consent and to be kept informed about the processing of your data. If you would like to discuss this further or withdraw your consent at any time, please contact the Registered Manager to discuss.

Declaration

The information in this application form is true and complete. I agree that any deliberate omission, falsification, or misrepresentation in the application form will be grounds for rejecting this application or subsequent dismissal if employed. Where applicable, I consent that can seek clarification regarding professional registration details.

Full Name

Signature

Sign Here

Date

Personal Referees

Please provide contact details for two persons who can provide us a gap reference.

Referee will be contacted by the authorities to verify the information provided. Please provide accurate and true information.

You and the referee need to know each other for the period of 2 years minimum and must stay in regular contact.

The following must not provide personal references on your behalf:
- blood relatives,
- current or ex-relatives by marriage,
- relatives by adoption - including cousins,
- current or ex-partners and their relatives,
- persons living at your current address,
- current Care World Agency Ltd employees, or
- individuals under the age of 16 years.

Referee name (1)

Referee address (1)

Referee contact number (1)

Referee email (1)

Referee name (2)

Referee address (2)

Referee contact number (2)

Referee email (2)

Documents

Proof of ID: This can be your passport, Biometric residence card Please ensure: - photocopy is clear and readable - photocopy is in colour - all four corners of the document are visible - there's no glare - just document is visible (no other objects or content) - there's plain background (no other objects or content)

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Proof of ID 2: This can be your passport, Biometric residence card Please ensure: - photocopy is clear and readable - photocopy is in colour - all four corners of the document are visible - there's no glare - just document is visible (no other objects or content) - there's plain background (no other objects or content)

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Proof of Address (can be Full/Provisional UK Driving Licence if not already in use as Proof of ID) Please ensure: - document was issued within the last 3 months - photocopy is clear and readable - all four corners of the document are visible - there's no glare - just document is visible (no other objects or content) - there's plain background (no other objects or content)

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Latest CV

Choose File

Enhanced DBS Certificate

(if you have this, please upload a copy to speed up your application process)

Proof of NI Number (optional)

Choose File

Other supporting document (optional)

Choose File

DBS and Checks consent form

In accordance with our data privacy policy, we required to obtain your consent to use your data. This is strictly for the purpose of employment background checks by Care World Agency Ltd, who may request references and apply for specified pre-employment checks. Which could include DBS Standard Disclosure, DBS Enhanced Disclosure, Disclosure Scotland, Access NI, UK Right to Work Check.

I have read the Care World Privacy Policy and understand how my personal data will be processed.

I give my consent to Care World Agency Ltd to:

Submit an application to Disclosure and Barring Service on my behalf for an Enhanced Disclosure Certificate if legally required.
Submit an application to the Disclosure and Barring Service for an Enhanced DBS using third-party supplier Mencap, who’s acting as DBS Registered Organisation.
Being advised from Disclosure and Barring Service about whether or not my Basic Disclosure Certificate will contain information about unspent convictions and conditional cautions.
Being advised from Disclosure and Barring Service about whether or not my Standard/Enhanced

Disclosure Certificate will contain information about spent and unspent convictions, cautions, warnings, reprimands and also result of the optional search of children’s and/or adult’s barred list.

I confirm Care World Agency Ltd has confirmed that if Disclosure and Barring Service indicates that my DBS Disclosure Certificate will contain information, a recruitment decision about me will not be made until the content of that certificate is considered by Care World Agency Ltd.

I consent to the DBS providing an electronic result directly to the responsible organisation, or body, that has submitted my application. I understand that an electronic result contains a message that indicates either the certificate does not contain criminal record information or to await certificate which will indicate that my certificate contains criminal record information. In some cases the responsible organisation, or body, may provide this information directly to my employer prior to me receiving my certificate.

I understand that to withdraw my consent whilst my application is in progress I must contact the DBS helpline 03000 200 190. My application will then be withdrawn.

Current address

Please provide your current address details.

PLEASE NOTE: Type in UK postcode in "CR11 2ED" format

Address

Address Line 1

Address Line 2

Town

County

Post Code

Country

Resident From

Previous address

Please provide your previous address details for the last 5 years including dates you moved in and out for each address.

Please ensure there's no gaps in history. If you've been living at current address for the last five years, you can skip this step.

PLEASE NOTE: Type in UK postcode in "CR11 2ED" format

Address

Address Line 1

Address Line 2

Town

County

Post Code

Country

Work/Education History

PLEASE READ BEFORE YOU START

Please provide your complete work history for the last 10 years.

This must include all periods of employment, education, volunteering, unemployment, self-employment or gap periods and will require the exact dates (day/month/year) and full referee contact details including person name, address, email and contact number.

Last Company / School / College / University

Job Role / Qualification Gained

Phone/Mobile

Address

City

Post Code

Country

Date From

Date To

Do you was to add another institution / school?

Yes

Company / School / College / University

Job Role / Qualification Gained

Phone/Mobile

Address

City

Post Code

Country

Date From

Date To

Do you was to add another school?

Yes

Company / School / College / University

Job Role / Qualification Gained

Phone/Mobile

Address

City

Post Code

Country

Date From

Date To

Do you was to add another school?

Yes

Company / School / College / University

Job Role / Qualification Gained

Phone/Mobile

Address

City

Post Code

Country

Date From

Date To

Do you was to add another school?

Yes

Company / School / College / University

Job Role / Qualification Gained

Phone/Mobile

Address

City

Post Code

Country

Date From

Date To

Do you was to add another school?

Yes

Company / School / College / University

Job Role / Qualification Gained

Phone/Mobile

Address

City

Post Code

Country

Date From

Date To

Do you was to add another school?

Yes

Company / School / College / University

Job Role / Qualification Gained

Phone/Mobile

Address

City

Post Code

Country

Date From

Date To

Declaration by Applicant

I have provided complete and true information in support of the application, and I understand that knowingly making a false statement for this purpose is a criminal offence.

Full Name

Signature

Sign Here

Date