“ACME CARE LTD”
Application for Employment
Please Complete Using Black Ink
Job Title:
“Personal Assistant”
Please underline the type of employment in which you are interested:
“Full Time” “Bank” “Part Time” “Job Share”
PERSONAL DETAILS (please complete using BLOCK CAPITALS)Salutation: Mr / Mrs / Miss / Ms (delete as applicable)
Surname ……………………………………………………
Forenames…………………………………………………………………….………
Address………………………………………………………………………...………
…………………………………………………………...……..………………………
Postcode……………………………………………………….………………………
Telephone No………………………………………………………...……….………Mobile No………………………………………………………………..…………….
Work No………………………………………………………………..………………
National Insurance Number………./………./……..../……..../…..
MULTIPLE EMPLOYMENT
(We need this information for Income Tax and National Insurance purposes).
Please detail any current employment, the number of hours worked per week and whether or not you pay tax and insurance already. Also, do you intend to continue in this employment?Please complete this section if it is relevant to the job you are applying for,
Do you hold a fullcurrent driving licence?
Yes / No / Class of licence held? / Do you have the use of a car?
Yes / No
PRESENT EMPLOYMENT
Name of Employer:Address:
Telephone No:
Job Title:
Date of Appointment:
Period of notice required:
Present Salary and any other benefits:
(Your present employer will NOT be contacted without your permission)
PREVIOUS POSITIONS
Either “paid” or “voluntary” work (most recent first please).
Dates to and from / Employer / Position held / Salary / Reason for leaving
SECONDARY EDUCATION
Please include all secondary education and approx dates.
School or secondary education and address / Dates of attendingOTHER EDUCATION
Details of any qualifications and training.
Please include any overseas training that may be relevant to the post for which you are applying.
Level / Subject / Grade / Date / Where Awarded?Include all qualifications e.g. GCSE, O Levels, A Levels, NVQ’s, Professional Examinations or higher education.
RELEVANT TRAINING COURSES
Please list courses or training, which may be relevant to the post for which you are applying.
Date from / To / No. of days / College or Organisation / Course title
PERSONAL STATEMENT
Please tell us how you feel you meet the requirements of the position for which you are applying.
Explain how / where you acquired these skills, knowledge or abilities - whether through work experience, spare time activities, voluntary work etc. Please continue on a separate sheet if necessary.
REFERENCES
Please give the names of two people who can provide a reference to indicate your suitability for the post for which you are applying.
The first referee, if possible, should be your present or most recent employer.
Referee OneName:
Address:
Telephone no. / Referee Two
Name:
Address:
Telephone no.
Do you know each of these people – “Professionally” or “Personally”?
…………………………………… ………………………………….
Are you happy for us to take up the above references without first contacting you?
Yes / No
Please indicate below, any dates when you will not be available for interview:
…………………………………………………………………………………………………
Declaration
“I certify that, to the best of my knowledge, the information given on this form is current and accurate.”
“I understand that my application may be rejected, or that I may be dismissed, if it is found that I have withheld relevant information or supplied false information.”
Signature…………………………………………………………..Date……………
“ACME CARE LTD”
Equal Opportunities
Acme Care Ltd. is working towards equal opportunities in employment and service delivery. To help us to do this, please complete the section below.
Job Title………………………………………………………………………….……………………
Full Name……………………………………………………………………….…………………….
Gender: Male / Female (delete as applicable) Date of Birth……………….
Ethnic Origin: (please tick)
Bangladeshi / IndianBlack – African / Irish
Black – Caribbean / Pakistani
Black – other (please specify below) / White
Chinese / Other (please specify below)
………………………………………………….……………………...……………..…..
How did you hear about the vacancy?……………………………………………………….
Do you consider yourself disabled? (delete as applicable) Yes / No
Note for disabled candidates
We guarantee you an interview if you meet the minimum requirements for the post for which you are applying.
If you are unable to meet all the requirements because of your impairment but feel they are achievable with minimum adjustments, please explain below how you believe your disability might be accommodated?
We do not discriminate on the grounds of race, gender, nationality, national origin, marital status, disability, economic status, sexual orientation, age, trade union membership, political or religious beliefs or responsibility for dependants.
“ACME CARE LTD”
Personal Health Statement
This relates to any family medical or physical problems you may have or have experienced in the past that could affect your ability to carry out the duties outlined in your job description. This information is confidential and will only seen by your manager.
Please tick the appropriate boxes and comment on any areas relating to you.
MEDICAL.
Conditions / Y / N / CommentsHeart Problems
Skin Problems
Headaches / Migraines
Epilepsy / Convulsions
Allergies
PHYSICAL
MuscularMobility
Disability
MENTAL HEALTH PROBLEMS
Compulsive disordersDepression
Anxiety
Personal Health Statement (continued)
If you feel that a condition not listed in our questionnaire could affect your work in any way please use the box below to state what your condition is and if you are on medication to control it.
I declare I have not withheld any information which may influence my application for the position described in the supplied job description.
Signature…………………………………………..Date……………………………..
Print Name…………………………………………………….
“ACME CARE LTD”
Criminal Convictions Declaration
Declaration of Unspent and Relevant Spent Criminal Offences
Instructions· All Applicants must complete one section of the attached Criminal Convictions declaration.
· Applicants who require a Disclosure and Barring Service (DBS) Check must complete Box A or Box B
· Applicants who do not require a Disclosure and Barring Service (DBS) check must complete Box C
Guidance Notes
Box A or Box B of this declaration of disclosure must be completed by applicants who have applied for the post where, if successful, the candidate will be requires to obtain a certificate of disclosure from the Disclosure and Barring Service (DBS) previously the Criminal Records Bureau (CRB).
This does not mean that the possession of a criminal record will automatically prevent you from working for the company, rather, as part of the recruitment process such information will only be considered in the light of its relevance to the post for which you are applying. In many cases, a particular conviction will be of no relevance and so can be discounted for the purpose of your application. The assessment of your suitability for a post will be conducted in line with the Code of Practise recommended by the Disclosure and Barring Service.
Because of the nature of the work for which you are applying this post is exempt from the provisions of section 4(2) of the Rehabilitation of Offenders Act 1974 by virtue of the Rehabilitation of Offenders Act 1974 (exceptions) Order 1975. Therefore you must give details on this form of relevant convictions, cautions, reprimands and warnings that you have and any court case that you have pending.
Acme Care Ltd will use information provided by the Disclosure and Barring Service in conjunction with your application when considering your suitability for such jobs, and the final decision for recruitment will be made by management. In the event of employment, any failure to disclose such convictions could result in dismissal or disciplinary action by ourselves. Any information you give us about convictions will be kept confidential and will only be considered in relation to the job(s) for which you are applying.
DECLARATION OF CRIMINAL OFFENCES
WORKING WITH CHILDREN, YOUNG PEOPLE AND VULNERABLE ADULTS
Working any job(s) you are applying for involves working with Children, Young people and Vulnerable Adults you are required to disclose ALL spent and unspent convictions, cautions, reprimands, bind overs and final warnings.
OTHER POSTIONS
Where the job(s) you are applying for involve no work with Children, young people and vulnerable Adults please see below.
Using the guidelines below please list your unspent and relevant spent convictions, cautions, reprimands and final warnings, including and convictions and indicate that they are pending.
You must provide details of the following.
· Cautions relating to an offence from a list (see below) agreed by Parliament.
· Cautions given less than 6 years ago (where you were over 18 years old at the time of caution)
· Caution given less than 2 years ago (where you were under 18 years old at the time of the caution)
· Convictions relating to an offence from a prescribed list (see below)
· Convictions that resulted in a custodial sentence (regardless of whether served)
· Convictions given less than 11 years ago (where you were over 18 years of age at the time of the conviction).
· Convictions given less than 5.5 years ago (where you were under 18 years old at the time of the conviction)
Irrespective of the above list, if you have more than one conviction then all convictions must be declared.
The list referred to above includes a range of offences which are serious and which relate to sexual offending, violent offending and/or safeguarding. It would never be appropriate to withhold details of offences on this list. A list of offences which should always be declared has been derived from the legislation and can be accessed using the following link.
https://www.gov.uk/goverment/publications/dbs-list-of-offences-that-will-nevver-be-filtered-from-a-criminal-record-check
False Information
Please note that providing false information could result in your application being rejected or your dismissal from employment if you are appointed.
Applicants must complete either Box A, Box B or Box C depending on the role applied for.
Box A should be completed by workers who require a DBS check if the applicant has no convictions (spent or unspent) cautions, reprimands or final warnings.
Box B should be completed by workers who require a DBS check if the applicant has unspebt convictions or (where relevant) spent convictions, cautions, reprimands or final warnings.
Box C should be completed by all staff who do not require a DBS check.
Box A(For roles that require a DBS check, please complete only if no convictions, cautions, reprimands or final warnings, either spent or unspent. You should note that this post is exempt from the provisions of the Rehabilitation of Offenders Act 1974, consequently no convictions is considered spent and must be declared)
I HAVE NO CONVICTIONS, CAUTIONS, REPRIMANDS OR FINAL WARNINGS.
As the applicant for the position I confirm that the details shown above are an accurate record of the details contained within my disclosure certificate received from the Disclosure and Barring Service and that this information can be shared amongst all parties involved within the applicable recruitment process.
Signature...... (Applicant) Date ...... /...... /......
Box B
(For the roles that require a DBS check, please record below details of any and all unspent convictions, relevant spent convictions (where Necessary) cautions, reprimands and/or final warnings that you may have to declare)
I HAVE THE FOLLOWING CONVICTIONS, CAUTIONS, REPRIMANDS AND/ FINAL WARNINGS.
......
......
......
......
As the applicant for the position I confirm that the details shown above are an accurate record of any criminal offences that may appear on my Disclosure and Barring certificate, as of the date listed below and that this information can be shared amongst all parties involved within thew applicable recruitment process.
Signature...... (Applicant) Date ...... /...... /......
Box C
(To be completed by workers who do not require a DBS check)
Have you ever been convicted of a criminal offence which has not been spent under the Rehabilitation of Offenders Act 1974?
If yes, please give details below, or state N/A if not:
......
......
......
......
As the applicant for the position I confirm that the details shown are an accurate record of any unspent criminal convictions as of the date listed below and that this information can be shared amongst all parties involved within that applicable recruitment process.
Signature...... (Applicant) Date...... / ...... /......
“ACME CARE LTD”
Registered Company Number 4150091
“ACME CARE LTD”
Job Description
Post: Personal Assistant
Job Description:To provide care and assistance for clients with either physical / mental disabilities elderly and infirm throughout the Coventry area to live independently. To promote, establish and maintain an independent lifestyle whilst enjoying a mutual, equal relationship. To maintain an appropriate level of professional care while in the contracted hours.
Description of responsibilities and duties.
A. Each carer will be responsible and for carrying out the duties that have been agreed between the agency and our client.
B. A record of all visits and duties is to be documented on time sheets and report sheets.
C. To be aware of all policies and procedures.
D. To assist where necessary in all aspects of care e.g. dressing, washing, toileting, drinks and snacks during the day, preparing / cooking meals and clearing away, laundry, shopping and home help.
E. To work as part of a rota system which includes the need to work on bank holidays and statutory holidays, also to increase hours worked above normal to cover for other staff holidays and sickness.
F. To have the ability to create stimulating activities outside the home environment and where necessary incorporating outside agencies.
G. Applicants must be able to demonstrate an understanding of the rights of people to lead quality lifestyles.
H. The applicant must be able to respond to a client’s personal care and support needs with regard to their privacy, dignity and respect.
I. To demonstrate a positive attitude towards clients choices.
J. To undertake any duties which may be reasonably requested from time to time.
K. To have an understanding and be able to support clients preferences and to respect their opinions.
L. Numeracy skills are required for cash handling i.e. collecting a client’s pension, shopping, bill paying etc.
ALL EMPLOYEES OF ACME CARE LTD ARE REQUIRED TO COMPLY WITH THE COMPANY’S EQUAL OPPORTUNITIES POLICY WHEN UNDERTAKING THEIR DUTIES.
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