Join our team

As a growing care business, we are continuously looking for committed individuals to join our care team and help us forward to support the elderly within our community.


Application Form

Step 1 of 11

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Work Preference:







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





Day(s)















Time





Shift



Personal Details

Name(Required)





Extra Names







Address(Required)













Date Of Birth(Required)








Are you a driver?





Own Transport







Any Endorsements:







Section

*Are you a United Kingdom (UK) National?(Required)





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





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-actu00022010.

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?(Required)








Education

Examinations, Qualifications*(Required)

(All qualifications will be subject to a satisfactory check).
School / College / UniversityDate From:Date To:Examinations, Qualifications* 

Training Courses

(attended or completing (evidence of attending courses is required)SubjectLocationDateDetails 

Professional Memberships / Registrations

Name of OrganisationRegistration NumberRenewal DateDetails 


Drop files here or

Max. file size: 256 MB.


    Employment History

    Please record below the details of your full employment history beginning with your current or most recent first. Any
    gaps must be explained. Use a separate attached sheet if required; please sign the sheet(s)

    Current / Most recent employer

    Start Date







    End Date







    Duties:

    Address















    Employment History

    Start Date:







    End Date:







    Duties:

    Address














    Additional Employment History

    Start Date:End Date:Salary:Job Role:Employer Name:Reason for Leaving:Contact Name:Duties:Address:Postcode:Telephone:Email: 

    Explanation of Gaps

    (Use this section to detail any gaps in employment and why)

    References

    Please provide names, addresses and telephone numbers for referees below who we may approach for a
    reference. In line with CQC requirements, we require references (or other satisfactory evidence as the employer may
    determine) from all previous employers concerned with the provision of services relating to health or social care, or
    children or vulnerable adults which should include details of why their employment came to an end (note that this is not
    time limited).
    If your previous employment does not concern the provision of services relating to health or social care, or children or
    vulnerable adults, you must provide references from your two most recent employers.
    Please provide two-character references if you are unable to obtain two professional references, e.g. in the case of an
    applicant who has been raising children for ten years. All 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.

    Referee One

    Full Names(Required)





    Address(Required)















    Referee Two

    Full Names(Required)





    Address(Required)















    Additional References

    Contact Name:Address:Postcode:Telephone:Email:Professional / Character:Capacity in which known 

    Safeguarding / Ex-Offenders Declaration

    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 re-assignment, religion or belief, sexual
    orientation, pregnancy or maternity and marriage or civil partnership. Medicare Support and Housing 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?(Required)





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





    Privacy Statement

    We 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.
    We 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(Required)







    Consent(Required)

    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.

    Date(Required)







    Supporting Statement

    Please add here your reasons for applying. You should refer to the job description and person specification to guide you.
    It would also be of value to describe particular strengths and talents that set you apart from others as well as including
    skills gained from work, home and other activities.

    Optional Section

    Medicare Support and Housing LTD is committed to equality of opportunity and fair treatment in all aspects of
    employment. We aim to provide a working and learning environment which is free from unfair discrimination and will enable
    staff to fulfil their personal potential. The Equality Act 2010 protects people from discrimination and promotes equality on
    the basis of a number of ‘protected characteristics’. We ask for information on your ‘protected characteristics’ in order to
    help us monitor our performance on equality. In line with Government policy, and in accordance with the provisions of
    GDPR, the information you provide will be held confidentially and It will help us to comply with the law under the relevant
    Acts and to ensure that our employment policies and practices are fair and effective.
    IMPORTANT – Please Note: You do not have to complete this form. The information is given on a voluntary basis and the
    information provided will only be used for the monitoring purpose. Please do not enter any identifying marks on this form,
    so that your information remains confidential. This information will be stored on a computer.

    Ethnic Origin:

    Please indicate your Ethnic Origin

    Asian or Asian British










    Mixed










    Other Ethnic Background








    Black or Black British








    White








    None





    Gender:

    Gender:

    Please indicate your Gender













    Sexual Orientation:

    Please indicate your Sexual Orientation













    Religion or Belief:

    Please indicate your Religion or Belief



















    Marital Status:

    Please indicate your Marital Status













    As per Equality Act 2010:





    Do you consider yourself to have a disability

    Under the terms of the Act, a disability is defined as a “physical or mental impairment which has a substantial and long-term effect on a person’s ability to carry out day-to-day activities”



    Caring Responsibilities:





    Do you have any care responsibilities for anyone

    If yes







    Please answer the following questions

    Do you have or have you ever had any significant health problem, impairment / disability (physical or mental) or learning difficulties that may affect your ability to undertake the tasks set out in the job description of the post offered?





    Do you have or have you ever had any illness, impairment of disability that may have been caused or made worse by your work?





    Have you ever left or been denied employment in an organisation on the grounds of ill health or been medically retired on the grounds of ill health?





    Are you having, or waiting for any medical treatment or investigations at present?





    Will you need any special aids or adjustments or assistance to enable you to undertake the tasks set out in the job description of the post offered?






    Applicant's Declaration

    Kindly select ‘Yes’ / ‘No’ as appropriate if you read and understood

    I confirm that the information given above is complete and correct. I understand that any incomplete, untrue or misleading information given will entitle the employer to reject my application, withdraw any offer of employment, or, if I am employed, dismiss me without notice.(Required)





    By my signature, I give authority to the employer to contact my GP for further details regarding any of the potential health problems I have declared above.(Required)





    I agree that Medicare Support and Housing LTD reserves the right to require me to undergo a medical examination to assess my suitability for work.(Required)





    I do not wish to complete the questionnaire and I do not wish to have a free health assessment.(Required)





    Will you need any special aids or adjustments or assistance to enable you to undertake the tasks set out in the job description of the post offered?(Required)





    Name(Required)







    Date(Required)