B - Recruitment - Job Application

Job Application

Please enter your National Insurance Number

Position applied for

How did you hear about this job?

Please clarify

Please select the area you wish to work in

Bristol Cardiff Central Support Office Neath Newport Torfaen Vale of Glamorgan

Personal details

Name

If you have a preferred Name please state it here

Address

Contact telephone number

Email address

Please state your date of birth

CV Upload (Optional)

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Are you over 18?

Yes No

Please note, if you are unable to answer "Yes" to this question your application will not be accepted as it is a regulatory requirement that you must be 18 or over to apply.

Do you speak or read any other language than English?

Do you hold a full UK driving licence?

Yes No

Do you have access to your own vehicle, are you a:

Driver Walker

Are there any restrictions to your residence in the UK that might affect your right to take up employment in the UK?

Yes No

UK employment law requires all applicants to demonstrate they are legally entitled to work in the UK. Any restrictions should be declared during the Recruitment Process.

Education and Professional Qualifications

Do you have an NVQ/QCF level 2 (or above) in Health & Social Care?

Yes No

Availability

Date available to commence employment

Please input the total weekly hours you require below

Please use the format NN.NN for example for 40 hours use 40.00

Please indicate below the days and hours you are available to work. Should your application be successful we endeavour to develop your rota around your selected availability.

Monday

Able to work‎ Not able to work‎

Tuesday

Able to work‎ Not able to work‎

Shifts Available to Work on Monday

06.00 - 08.00‎ 16.00 - 20.00‎ 19.30 - 23.00‎

Shifts Available to Work on Tuesday

06.00 - 08.00‎ 16.00 - 20.00‎ 19.30 - 23.00‎

Wednesday

Able to work‎ Not able to work‎

Thursday

Able to work‎ Not able to work‎

Shifts Available to Work on Wednesday

06.00 - 08.00‎ 16.00 - 20.00‎ 19.30 - 23.00‎

Shifts Available to Work on Thursday

06.00 - 08.00‎ 16.00 - 20.00‎ 19.30 - 23.00‎

Friday

Able to work‎ Not able to work‎

Shifts Available to Work on Friday

06.00 - 08.00‎ 16.00 - 20.00‎ 19.30 - 23.00‎

Please detail the Start and End times you are able to work on the days you have selected.

2

Please select at least one of the following weekend shifts, although if you can work all weekend just tick both days.

Saturday‎ Sunday‎

Available to Work on Saturday

06.00 - 12.30‎ 12.00 - 218.30‎ 18.00 - 23.00‎

Available to Work on Sunday

06.00 - 12.30‎ 12.00 - 218.30‎ 18.00 - 23.00‎

Saturday

07:00 to 14:30‎ 16:00 to 22:30‎

Sunday

07:00 to 14:30‎ 16:00 to 22:30‎

If the above shifts are not suitable to you please detail the days, start and end times you are available:

Please confirm that upon submitting this availability you confirm you will not seek to change your stated availability within any three month period.

Yes‎

Do you have any holidays already booked?

Yes No

Please provide holiday dates:

Are you registered with the Social Care Wales?

Yes No

Current Employment

Are you currently employed?

Yes No

Please indicate your contracted notice period in weeks

Criminal Record

This post is exempt from the Rehabilitation of Offenders Act 1974 as it involves contact with
patients. This means that you must declare on your application form whether or not you have any
convictions, cautions, reprimands or bindovers even if these would be considered as spent under the Act. All criminal histories, including cautions, regardless of how long ago they occurred or any
assurances made by the Police at the time that it would not count as a Police record, will be revealed on a CRB check.

If you have answered yes on the application form, but due to the sensitive nature of
the offence(s) you have not recorded the detail, this information must be provided separately to us.

If a CRB is undertaken and offences are recorded that have not been declared on your application
form, or disclosed separately to us, this will result in any offer of employment being withdrawn and you may be liable for the cost of the CRB check.

Care workers work with vulnerable people and we take our responsibility to protect them very seriously. Your appointment will depend on the satisfactory completion of a criminal records disclosure, but at this stage, we need you to answer the following questions truthfully and honestly.

Have you received any convictions, cautions, reprimands or final warnings that are not ‘protected’ as defined by the Rehabilitation of Offenders Act 1974

Yes No

Please provide details:

To your knowledge, are you currently the subject of any criminal proceedings (for example, charged or summoned but not yet dealt with) or any police investigation?

Yes No

Please provide details:

Do you hold an enhanced DBS?

Yes No

Please provide the issue date of your DBS

Are you registered with the DBS update service

Yes No

Please provide the Disclosure Number

Are you currently under investigation by any authority?

Yes No

Please provide details

Equality and Diversity

1st Grade Care wants to meet the aims and commitments set out in its equality policy. This includes not discriminating under the Equality Act 2010, and building an accurate picture of the make-up of the workforce in encouraging equality and diversity. We require your help and co-operation to enable us to do this, but filling in this section is voluntary.

The information you provide in this section is for monitoring purposes only. It will stay confidential, and be stored securely and limited to only some staff in the organisation’s Human Resources section.

Gender

Marital status

What is your religion or belief?

What is your sexual orientation?

What is your ethnicity?

White Mixed multiple ethnicity Asian/Asian British Black/African/Caribbean/Black British Other

White

Mixed/multiple ethnic groups

Asian/Asian British

Black/ African/ Caribbean/ Black British

Other ethnic group

Disability Definition

Individuals who were registered under the Disabled Person (Employment) Act 1944 on both 12th January 1995 and 2nd December 1996 are treated as being disabled under the Disability Discrimination Act 1995 (DDA). The DDA states: 'a person has a disability... if he has a physical or mental impairment which has a substantial and long-term adverse effect on his ability to carry out normal day-to-day activities.' The person must satisfy the four criteria in the above statement to fall under and, therefore, to be protected under DDA. This definition is subject to amendments made by DDA 2005.

Do you consider yourself to have a disability within the meaning of the Disability Discrimination Act 1995? (Please see above for definition)

Yes No Prefer not to say

What is the effect or impact of your disability or health condition on your ability to give your best at work? Please detail below:

Reference Name - 1

Company Name (if applicable)

Please select if this referee is an employer or a character referee:

Character Referee Employer Referee

Address

Contact telephone number

Email

Reference Name - 2

Company Name (if applicable)

Please select if this referee is an employer or a character referee:

Character Referee Employer Referee

Address

Contact telephone number

Email

Declaration

I declare that, to the best of my knowledge, all parts of this form have been completed and are accurate and apply for the position conditionally upon this declaration.

By ticking this box I confirm I have read, understood and make the above declaration‎

Electronic signature

Clear

Name of form

Date

To verify your application please select the current month

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