Global Care Centre | Careers

Careers

Name of the position applied for:

Branch / Location:

Where did you see this post advertised:

Title

First Name

Last Name

Date of Birth

NI Number

Email Address

Street Address

City

Postcode

Mobile Number

Home Number

Do you possess a valid driving licence For the UK?

Yes No

Do you have use of a car for work?

Yes No

Do you have the legal right to work in the UK?
Please note we are unable to recruit anyone who does not have the legal right to work in the UK

Yes No

If ‘Yes’ but there are conditions attached, please specify (e.g. start/finish dates/WRS etc.):

Are you related to or do you know anyone who works for Fields Care?

Yes No

If ‘Yes’ please give the name of the employee and the relationship to them

Would you class yourself as disabled?

Yes No

If you selected yes please describe in detail :

Do you have any other work commitments, either paid or unpaid, which you would wish to continue with if offered employment by Fields Care? (if yes, please advise details at interview)

Yes No

If you are applying for a post involving access to persons in receipt of care services, your offer of employment will be subject to a satisfactory enhanced disclosure and barring scheme. It is, therefore, a requirement that all previous convictions are declared, even those which would otherwise be regarded as ‘spent’. (Any such information will be treated confidentially). Please read the above carefully and then answer the following questions:

Have you ever been convicted of a criminal offence?

Yes No

Have you ever received any official cautions, reprimands or warning?

Yes No

To your knowledge, are you currently the subject of any criminal proceedings or any police investigation?

Yes No

Secondary Education with grades and qualifications gained:

Further / Higher Education with grades and qualifications gained:

Other relevant training, professional qualifications or work related skills (including dates)

Current / Most recent employment

Job Title

Start Date

End Date

Street Address

Address Line 2

City

Postcode

Country

Phone Number

Brief description of duties and responsibilities:

Full Employment History (most recent first with any gaps explained)

Employers Name

Job Title

Start Date

End Date

Street Address

Address Line 2

City

Postcode

Country

Phone Number

Reason for Leaving

Employers Name

Job Title

Start Date

End Date

Street Address

Address Line 2

City

Postcode

Country

Phone Number

Reason for Leaving

Please use this section to state how your skills, experience and training would enable you to meet the Requirements of the role for which you are applying. Please make reference to the person specification. Please use a continuation sheet if necessary.

Availability Time (only complete this section if you are applying for a Care Worker position):

Availability Days (only complete this section if you are applying for a Care Worker position):

Weekdays Saturdat Sunday

Ideal number of hours you would like to work per week:

Please provide the names and contact details of at least four referees, the first two must be your present or most recent employer, if there is less than two years between both of these then please provide two further references. We will not contact any referee without your permission or until an offer of employment has been accepted. If you do not have four employment references, one may be from a professional body, a lecturer or teacher or similar. Also, if you have previously been employed in a position which involved working with vulnerable adults or children for more than three months then one of the references you provide must be from this agency/employer. (In accordance with the Health and Social Care Act 2008). Personal referees such (as relatives, friends, neighbours etc.) ARE NOT acceptable as referees.

Reference 1 - Present or Last Employer

Full Name

Street Address

Address Line 2

City

Postcode

Country

Daytime Phone Number:

Email Address:

Occupation / Relationship of referee:

Contact prior to the interview:

Yes No

Reference 1 - Previous Employer

Full Name

Street Address

Address Line 2

City

Postcode

Country

Daytime Phone Number:

Email Address:

Occupation / Relationship of referee:

Contact prior to the interview:

Yes No

Reference 3

Full Name

Street Address

Address Line 2

City

Postcode

Country

Daytime Phone Number:

Email Address:

Occupation / Relationship of referee:

Contact prior to the interview:

Yes No

Reference 4

Full Name

Street Address

Address Line 2

City

Postcode

Country

Daytime Phone Number:

Email Address:

Occupation / Relationship of referee:

Contact prior to the interview:

Yes No

The information in this form is true and complete. I agree that any deliberate omissions, falsification or misrepresentation on this form will be grounds for rejecting this application or subsequent dismissal if employed by the organisation. This equally applies to any medical questionnaires I may complete.

I confirm that I have not been subject to any cautions or convictions (other than those given above), investigation, disciplinary action, or enquiry into adult/child protection matters or inappropriate behaviour, and that the information I have given in the Criminal Record declaration section is to the best of my knowledge correct.

I agree to the Global Care Centre Privacy Policy

Name

Date

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