Simple Care 4 U

Safe and fair recruitment commitment

Our organisation is committed to safeguarding and promoting the welfare of adults at risk and expects all our staff to share these values. We are also committed to treating all applicants equally and fairly based on their skills, experience, and ability to fulfil the duties required of the role applied for. This is regardless of any protected characteristics (ethnicity, gender or gender re- assignment, religion or belief, sexual orientation, physical/mental disability, age, pregnancy or maternity, marriage, or civil partnership).

Applicants must share with us all the relevant information that we have requested in this application form, but we would like to reassure applicants that they will not be refused employment because of offences or conduct which are no longer relevant, and do not place them at, or make them a risk in – the role for which they are applying.

Post details

Post applied for		Full or Part time
Date of application

Where did you hear about us? *

Google		Find a job.gov
Simple Care 4 U Website		Facebook
Job Centre		Referred by a friend
Other (Please Specify)

Personal details

First name(s) *		Last name *
Address *		Home number
		Mobile number *
		National insurance number *
Date of birth *		Email *
Postcode *		Preferred contact method

Education

Please include all periods of any post-secondary education or training.

School/college/university	Dates	Qualifications	Subject and grade	Full/part time study

Professional registration

Professional body	Registration/membership level	Date awarded

Other relevant training or qualifications ( please give details and dates )

Current employment

Are you currently in employment? (if no go straight to the next section)	Yes No
Name and address of employer
Current job title
Start date		End date (if applicable)
Contract type (permanent, temporary etc)		Notice period
Salary (including allowances)		Reason for leaving
Key duties

Employment history

Please provide full employment history in chronological order since leaving secondary education, including periods of any post-secondary education/training, and part-time and voluntary work as well as full time employment, with start and end dates. IMPORTANT NOTE: When providing reason for leaving, for each role, please confirm that you were not under investigation for or subject to any disciplinary sanctions in relation to your conduct at the time of leaving/dismissal. If you were, please provide details.

Employer's name and address	Dates	Post held and duties	Reason for leaving

Gaps in employment, education or training history

Please detail each period (of more than four weeks) when you were not in employment or education training.

From	To	Reason for gap in employment, education and training history

Further information

Period of notice required		Are you legally eligible for employment in the UK or have settled status?	Yes No
Date available for work		Do you hold a current driving licence?	Yes No
Do you require a work permit?	Yes No	Do you own a car?	Yes No N/A
Type of visa and expiry date of visa		Are you confident to drive other clients' cars?	Yes No N/A

Knowledge, Skills and Experience

(Please tick the relevant boxes) I have worked with the following clients:

Area	Yes	No	N/A
People with learning disabilities (e.g. Autism, Down syndrome etc)
People with mental health problems (e.g. Schizophrenia, bi-polar)
People with dementia
People with physical disabilities (e.g. Multiple sclerosis, Spina Bifida)
Older people
People with sensory disabilities (e.g. Blind/Deaf)

Supporting statement

(please give details of your skills, abilities, experience and personal qualities to demonstrate how you meet the criteria in the person specification, using examples wherever possible)

Referees

Please provide contact details for at least two referees who are able to comment on your suitability for the job applied for.

You are responsible for providing accurate contact details so that referees can be contacted.

The first referee MUST be your current or most recent employer (or your course tutor if you are currently in, or have just left, full-time education).

Professional references will not be accepted from work colleagues who are not authorised to provide professional references in an official capacity on behalf of the organisation, or from people writing solely in the capacity of friends, or from relatives.

	Referee 1	Referee 2
Full name
Position
Address
Telephone
Email

Our organisation will seek references on successful candidates, and will approach previous employers for information to verify particular experience or qualifications. If you are currently working with adults at risk and/children, your current employer will be asked about disciplinary offences relating to adults at risk and/children (including any conduct related to safeguarding concerns which the penalty is ‘time expired’), and whether you have been the subject of any safeguarding related investigations or concerns, and if so, the outcome of any enquiry or disciplinary procedure including any referrals to Disclosure and Barring Service (DBS), other professional bodies or the police.

If you are successful at interview, any offer of employment will be subject to receipt of two satisfactory references and additional pre-employment checks.

Declarations

Relationships

Are you a relative or a partner of, or do you have a close personal relationship with any employee of [insert organisation name]?	Yes No
If yes, please state their full name, post title and place of work
Have you previously been employed or sought employment with [insert organisation name]?	Yes No
If yes, please provide details

Right to Work

Do you require permission to work in the UK?
(you will be required to provide evidence of eligibility to work in the UK)

Yes No

Criminal record checks

We will only ask those candidates who have been selected for interview to complete a criminal record selfdeclaration form or provide a written disclosure statement to give them the opportunity to provide sufficient information. At interview, or in a separate confidential discussion, we will ensure that an open and measured discussion takes place on the subject of any offences that might be relevant to the position. We will only carry out criminal record checks with DBS on successful candidates at the appropriate level for the role applied for.

Failure to provide accurate and truthful information is considered a serious matter. If it becomes apparent that inaccurate or incomplete information has been provided, we will need to establish why. Any finding of serious misdirection or intent to deceive will result in an application being disqualified or, if appointed, disciplinary action being taken and/or dismissal.

DBS barred lists

This post involves working in Regulated Activity under the Safeguarding Vulnerable Groups Act 2006 and is subject to an enhanced DBS with barred list check (i.e. adults, children or both).

It is a criminal offence to apply for or accept a position working with adults at risk and/or children if you have been barred from engaging in regulated activity with the relevant group (i.e. adults, children or both).

Are you included in the list of people barred from working with adults maintained by the Disclosure and Barring Service (DBS) under the Safeguarding Vulnerable Groups Act 2006?	Yes No N/A
Are you included in the list of people barred from working with children maintained by the Disclosure and Barring Service (DBS) under the Safeguarding Vulnerable Groups Act 2006?	Yes No N/A
If you are not currently barred from working with adults at risk and/or children under the Safeguarding Vulnerable Groups Act 2006, have you been referred to the Disclosure and Barring Service (DBS) for consideration to be added to one of the barred lists?	Yes No N/A
If yes, please provide details
If you are on the DBS Update Service, please provide your certificate number

Conduct declaration

Have you ever been subject to any sanctions being placed on your professional registration, by a regulatory or licensing body in any country?	Yes No N/A
If yes, please provide details and details of any sanctions and, the name and address of the regulatory or licensing body concerned.
Have you ever been dismissed for misconduct from any employment, volunteering, office, or other position previously held by you?	Yes No N/A
If yes, please provide details
Have you ever been under investigation for or subject to any disciplinary sanctions in relation to your conduct at the time of your dismissal/leaving any employment, volunteering, office, or other position previously held by you?	Yes No N/A
If yes, please provide details

I declare that the information I have given in this application is correct and complete. I understand that any false statements or failure to disclose information requested on this form may result in my application being disqualified or may lead to my dismissal or disciplinary action if appointed.

I understand that if I am appointed, personal information about me may be stored for personnel/employee administrative purposes in accordance with relevant Data Protection legislation, including UKGDPR/DPA 2018 and any other UK legislation which supports it. .

Our organisation will process the data you give us to determine your suitability for the role you have applied for as part of the recruitment process and the ongoing employment relationship if appointed.

In submitting this form, I give my authority for use of my personal data for the purposes outlined above.

Signature

Date

Application for Employment