Application – Conscience Care

Application Form For Carers and Support Workers

Personal Details

Position Applied For: *

Location *

Work PreferenceFull TimePart TimeBank

Hours Requested: *

I understand this role may include: Shift work, Unsociable Hours, Lone working involved. (Please indicate your availability below) *

First Name *

Middle Name

Last Name *

Job Title *

Date of Birth *

Gender *

Sexual Orientation *

Religion *

Nationality *

Place of Birth *

Email Address *

Phone *

House Number *

Street Name

Town / City

County

Post Code

Country

Do you drive in the UK? *

Provide National Insurance Number *

Do you have DBS? *

Are you related to any of our current care staff / members of staff / Service Users? *YesNo

Next of Kin Full Name *

Address of Next of Kin *

Country of Residence of Next of Kin *

Relationship with Next of Kin *

Phone number of Next of Kin *

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? *

Academic Qualifications

contact us if you have no educational background

1. Institute/Location of Study *

1. Qualification Obtained *

1. From (Start Date) *

1. To (End Date) *

2. Institute/Location of Study *

2. Qualification Obtained *

2. From (Start Date) *

2. To (End Date) *

3. Institute/Location of Study

3. Qualification Obtained

3. From (Start Date)

3. To (End Date)

Employment History

Work Experience

1. Company Name *

1. Position / Job Title *

1. Duties *

1. Job Start Date *

1. Job End Date *

Reason For Leaving Job 1 *

2. Company Name *

2. Position / Job Title *

2. Duties *

2. Job Start Date *

2. Job End Date *

Reason For Leaving Job 2 *

3. Company Name

3. Position / Job Title

3. Duties

3. Job Start Date

3. Job End Date

Reason For Leaving Job 3

Professional Reference

Reference 1 Full Name *

Reference 1 Company Name *

Reference 1 Job Title *

Reference 1 Address *

Reference 1 Country of Residence *

Reference 1 Phone Number *

Reference 1 Email Address *

Capacity in which known *

Reference 2 Full Name *

Reference 2 Company Name *

Reference 2 Job Title *

Reference 2 Address *

Reference 2 Country of Residence *

Reference 2 Phone Number *

Reference 2 Email Address *

Capacity in which known *

Declarations

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.

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? *

Are there any restrictions on your right to work in the UK that may prevent your employment opportunity with Conscience Care? *

If your application is successful, you will be required to provide evidence that you have the right to work in the UK. Do you have a British birth certificate? Evidence to be provided and a copy taken: *

Do you have a DBS Certificate? *

Are you on the DBS Update Service? *

Medical Questionnaire

CONFIDENTIAL The purpose of the questionnaire is to see whether you have any health problems that could affect your ability to undertake the duties of the post you have been offered or place you at any risk in the workplace. Our aim is to promote and maintain the health of all staff at work. Kindly complete this section.

Do you have any illness/impairment/disability (physical or psychological) which may affect your work? *

Have you ever had any illness/impairment/disability which may have been caused or made worse by your work? *

Do you think you may need any adjustments or assistance to help you do the job? *

Are you undergoing, or waiting for treatment (including medication) or investigations at present? *

If your answer is "Yes" for any of the above medical questions, please provide further details of the condition, treatment and dates:

Have you had COVID 19 Vaccination? *

Do you have reason to believe you may have been exposed to hepatitis C infection? *

If yes, please provide further details:

Documents / Certificates Upload

Upload your Curriculum vitae (CV) *

Upload your BRP *

Upload your DBS Certificate *

Provide your passport if no DBS yet

Upload your Sharecode *

Upload your Passport *

Upload your 3 months Bank Statement *

Upload Passport Picture (Please make sure image is clear enough) *

Upload Driver's License *

Upload all your educational certificates and other credentials *

Upload all your care courses certificates *

Requirement: You will take additional courses as and when necessary

Upload your P60 Form

skip if not available

Upload your P45 Form

Skip if not available

Recommendation

I understand that if any recommendations from my current/previous employer(s) are necessary as a result of this assessment:

I give consent for their recommendations without me having seen a copy of the recommendation(s) first. *YesNo

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.

I declare that the answers to the above questions are true and complete to the best of my knowledge and belief. *YesNo

Type your full name to indicate signature *

Date of Submission *

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