Referral Line:
0800 7833 779
info@thedrivecarehomesltd.org.uk
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Support Worker - Application Form
Support Worker - Employment Application
Step
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7
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Title
Select a title
Miss
Ms
Mrs
Mr
Other
Name
First
Last
Position Applied For:
*
Support Worker
Location Applied For
*
Long House, Bexleyheath
Swanley House, Swanley
Glover House, Ashford
The Drive, Sidcup
Dartford House, Dartford
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
National Insurance Number
Please enter your NI number e.g. QQ123456C *without spaces
Home Number
Please enter your home number, including area code e.g. 01202 455661 *space optional
Mobile Number
Please enter your number, including area code e.g. 441122334455.
Email
Do you hold a valid driving license?
Yes
No
Is your license clean?
Yes
No
Please answer yes if you have no points on your license
Please give details on why your license isn't clean
Give details on points, convictions and dates
Section 2: ASYLUM AND IMMIGRATION
The Immigration, Asylum and Nationality Act 2006 makes it illegal to employ a person aged 16 or over who is subject to immigration control unless:
That person has current and valid permission to be in the United Kingdom and that permission does not prevent him or her from taking the job in question; or
The person comes into a category specified by the Home Secretary where such employment is allowed
Any employment offered will be subject to the successful applicant producing appropriate evidence that the above Act is not being contravened.
Are you eligible to work in the UK?
*
Yes
No
I confirm that I am entitled to work in the UK on the following basis:
*
UK Citizen
EU Citizen
Right of abode in UK
Permit free visa / Student Visa
Spouse of EU Citizen
Other
Please enter the expiry date of your visa
*
DD slash MM slash YYYY
Does your visa have any restricting conditions in the UK?
Yes
No
Please detail your visa restrictions
*
Section 3: EDUCATION & PROFESSIONAL QUALIFICATIONS
SECONDARY EDUCATION
Name of School
From (Month / Year)
To (Month / Year)
QUALIFICATIONS
Subject
Grade (GCSEs, "A" Levels)
Add more qualifications
I attended more than one school
Hide
Select if you attained your GCSEs and/or A levels from more than one school
SECONDARY EDUCATION
Name of School
From (Month / Year)
To (Month / Year)
Study / Qualification
Grade
FURTHER EDUCATION
Name of College/University
From (Month / Year)
To (Month / Year)
Study / Qualification
Grade
OTHER STUDIES / QUALIFICATION(S)
Name of Examining Body
From (Month / Year)
To (Month / Year)
Study / Qualification
Grade
Section 4: TRAINING & DEVELOPMENT
Please give details of any training and development courses or non-qualification courses which support your application. Include any on the job training as well as formal courses.
Training and Development
Title of Training Programme or Course
Duration of Course
Section 5: PRESENT EMPLOYER DETAILS
Company Name:
Position:
Brief description of duties:
Date of employment:
From:
DD slash MM slash YYYY
Still employed here
Yes
No
To:
DD slash MM slash YYYY
Notice Period:
Current Salary £
Reason(s) for leaving
Section 6: EMPLOYMENT HISTORY
Please enter all previous employment starting with the most recent first. Please do not leave any unexplained gaps in employment.
Employment History
Name of Employer and Location
From
To
Position held and brief summary of duties and responsibilities
Reason for leaving and last salary or wage
Section 7: EMPLOYMENT GAPS
Please use the section below to explain any unexplained gaps in your employment in
Section 6
.
Employment Gaps
Section 8: REFERENCES
Please give the names and addresses of your two most recent employers, including in what capacity you know them. Any job offer will be subject to two satisfactory references. Please note that references from friends and relatives will not be accepted. A third reference may be contacted at the Company discretion from your list of employers.
PRESENT / MOST RECENT EMPLOYER
Title
Select a title
Miss
Ms
Mrs
Mr
Other
Name
First
Last
Position
Company Name
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Telephone
Email
Can we contact this person at this stage?
Yes
No
PREVIOUS EMPLOYER
Title
Select Title
Miss
Ms
Mrs
Mr
Other
Name
First
Last
Position
Company Name
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Telephone
Email
Add another reference
Yes
No
ADDITIONAL REFERENCE
Title
Select Title
Miss
Ms
Mrs
Mr
Other
Name
First
Last
Position
Company Name
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Telephone
Email
Can we contact this person at this stage?
Yes
No
Section 9: QUESTIONNAIRE
1. What is one of your main achievements in your past employment?
2. What key skills can you bring to the role of support worker?
3. What areas do you feel that you require training?
4. Why do you think it is important to modify your approach to different service-users?
5. How do you think you can maintain good teamwork and communication within a shift pattern?
6. Please state what you would do to support a service user to carry out their daily tasks?
7. Please state what information a care plan should hold?
8. In your own words, please explain why you consider yourself suited to this position outlining what you would contribute to the post if appointed, by reference to the job description & person specification.
Section 10: PROFESSIONAL MISCONDUCT / SAFEGUARDING
Have you ever been involved in any disciplinary proceedings, suspension or subject to a disciplinary investigation?
Yes
No
In addition, please confirm whether there have been any allegations raised against you or any investigations previously in respect of childcare issues or other matters which may be of relevance if working with vulnerable groups in residential care?
Yes
No
Please state the nature of the allegation/investigation/proceeding and outcome:
SAFEGUARDING
Safeguarding Statement
“The Drive Care Homes Ltd is committed to safeguarding and promoting the welfare of children, young people and adults in its care. We believe that our service users deserve a safe, happy and healthy life, we expect all staff to share this commitment. In accordance with our safeguarding practise, we will endeavour to;
promote and prioritise the safety and wellbeing of children, young people and our service users
ensure everyone understands their roles and responsibilities in respect of safeguarding and is provided with appropriate learning opportunities to recognise, identify and respond to signs of abuse, neglect and other safeguarding concerns relating to children, young people and service users
ensure appropriate action is taken in the event of incidents/concerns of abuse and support provided to the individual/s who raise or disclose the concern
ensure that confidential, detailed and accurate records of all safeguarding concerns are maintained and securely stored
prevent the employment/deployment of unsuitable individuals
ensure robust safeguarding arrangements and procedures are in operation
The Company has a full Safeguarding Children and Adult Policies and Procedures which members of staff are required to familiarise themselves with at the beginning and during their employment”.
Outside of employment, have you been the subject of any safeguarding allegation and or investigation against a child or vulnerable adult?
Yes
No
Please state the nature of the allegation/investigation and outcome:
*
SECTION 11: OTHER INFORMATION
Where did you learn of this vacancy?
Please give any dates in the near future when you are not available for interview:
Do we need to make any specific arrangements in order for you to attend the interview?
Yes
No
The purpose of this question is to comply with our duties under the Disability Act 1995. Do you have any condition or other circumstances that will prevent you from carrying out the duties of the post?
Yes
No
Section 12: DECLARATION
A. Relatives/Other Interests
Any candidate who directly or indirectly canvasses an employee of the Company will be disqualified from consideration for the job. The Company does not bind itself to appoint any applicant.
Are you related to or do you have a close personal relationship with an employee(s) of The Drive Care Homes Ltd?
Yes
No
Specify name(s), position(s) and relationship(s)
B. I declare that to the best of my knowledge the above information, and that submitted in any accompanying documents, is correct, and
I give permission for any enquiries that need to be made to confirm such matters as qualifications experience and dates of employment, and for the release by other people or organisations of such information as may be necessary for that purpose.
I give permission for the processing of the personal data contained in this form for employment purposes
I confirm that the information I have provided on this application form is, to the best of my knowledge, true and accurate. I understand that any job offer may be immediately withdrawn or my employment summarily terminated if any of the information on this form is found to be false or misleading.
Consent
I agree to the above statement