Job Application | CQC Registered Care Provider

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Personal Information - Step 1 of 8

Please ensure you complete the application form in full. This form will be kept in confidence. Please note that no applicant will be unfairly discriminated against. This includes discrimination on account of age, cultural/religious/political belief, disability, ethnicity, gender, race, relationship status, sexual orientation, and/or Trade Union membership or stewardship.

Role you are applying for? *

Approx. no. of hours wanted *

Preferred employment type *

Part-Time
Full-Time

Full Name Name *

Previous Names

(Supply documentary evidence e.g., marriage certificate, deed of name change etc):

Nursing and Midwifery Council PIN number (Nurses only):

Email *

Date of Birth *

Phone *

National Insurance Number

Current Address *

This information will not be used in reaching a decision on whether to offer employment.

Moved to this address on (date): *

Previous Address *

This information will not be used in reaching a decision on whether to offer employment.

Moved to this address on (date): *

Do you have a drivers license? * *

Is your Drivers License clean? *

A 'Clean Driving Licence' means not having any penalty points on your license

How many years have you held your license for?

Do you have your own car? *

Do you have the right to work in the UK? *

If you are successful in the application, would you require a work permit prior to taking up employment? *

Are you related to a member of staff or service user at our company? *

Are you having, or waiting for any medical treatment or investigation of any kind at present? *

Have you ever left a previous employment through ill-health or a work related injury or condition? *

Do you have any back, neck or joint problems causing difficulty with standing, walking, bending, lifting or stair climbing? *

Under the Equality Act 2010 the definition of disability is if you have a physical or mental impairment that has a 'substantial' and 'long-term' adverse effect on your ability to carry out normal day-to-day activities. Do you consider yourself to have a disability? *

Do you require us to make any special arrangements in order for you to participate in the recruitment process? For example, large print forms? Or additional time to complete forms? *

If yes, please give details:

This information will not be used in reaching a decision on whether to offer employment.

This section is for detailing any training courses you have attended which are relevant to this role. Please note that evidence of attendance to the course will be required. If you haven't done any training relevant to this role then please skip to the next section.

Have you attended any training courses/ have any qualifications which are relevant to this role? *

If you haven't please answer 'No' and go to the next section

Training & Qualifications

Name of qualification

Date Completed

The CQC requires that carers disclose a full employment history, together with a satisfactory explanation of any gaps in employment. A “full employment history” means a career history from the age of first employment. In this section please outline all periods of employment or self-employment (whether or not related to health or social care), showing beginning and end dates, together with an explanation of periods of non-employment.

Employment History

Add History

Education
Employment
Unemployment

Reason for unemployment

Please provide further detail

Period of unemployment Start Month/Year (DD/MM/YYYY)

Period of unemployment End Date/Year (DD/MM/YYYY)

Name of School/College/University

Qualifications Obtained

School/College/University Start Month/Year (DD/MM/YYYY)

School/College/University End Month/Year (DD/MM/YYYY)

Position Held

Name of employer

Employer Address

Employment Start Month/Year (DD/MM/YYYY)

Employment End Month/Year (DD/MM/YYYY)

Nature of business/ Industry

Reason for leaving

Salary / Rate

You must provide references from your two most recent employers. Please provide a character reference if you are unable to obtain two professional references, e.g. in the case of an applicant who has been raising children for ten years. All will be contacted, therefore please inform the referees of the fact that you have used their name. If you are unable to provide the required references, please discuss the matter with us.

Employer Reference

Full Name

Job Title

Address

Phone

Character Reference

Full Name

Address

Phone

Relationship to you

What is your motivation for working for our company and working in the care industry? *

Ex-Offenders Declaration Please note this section will only be seen by those involved in the recruitment process and will be treated with the strictest of confidence. Rehabilitation of Offenders Act 1974 Best2 Care Ltd aims to promote equality of opportunity and is committed to treating all applicants fairly regardless of ethnicity, disability, age, gender or gender re-assignment, religion or belief, sexual orientation, pregnancy or maternity and marriage or civil partnership. Best2 Care Ltd undertakes not to discriminate unfairly against applicants on the basis of a criminal conviction or other information declared. Answering 'yes' to the question below will not necessarily prevent your employment. This will depend on the relevance of the information you provide in respect of the nature of the position and the particular circumstances.

Please declare all criminal convictions, whether spent or not, charges, whether proceeded with or not, and warnings and cautions in the space provided below. *

We are committed to promoting equal opportunities for all its employees and all prospective employees. To ensure that all applicants are dealt with equally, we wish to monitor your recruitment process and would ask for your help by completing the details below by placing tick in the appropriate box. This will allow the organization to monitor its policies.

What is your gender?

Male
Female
Other
Prefer not to say

Sexual Orientation

Heterosexual / straight
Bisexual
Gay woman / lesbian
Prefer not to say

Ethnic Group

White: • British - English Scottish or Welsh • Irish • Other White background
Mixed race: • White and Black Caribbean • White and Black African • White and Asian • Other Mixed background
Asian or Asian British: • Indian • Pakistani • Bangladeshi • Other Asian background
Black or Black British: • Caribbean • African • Other Black background
Chinese and other groups: • Chinese • Other ethnic group •
Peter not to say

Age

16–17
18–21
22–30
31–40
41-50
51-60
61-70
70+
Peter not to say

By signing this application, I acknowledge that the information in this application form is true and complete. I agree that any deliberate omission, falsification, or misrepresentation in the application form will be grounds for rejecting this application or subsequent dismissal if employed. Where applicable, I consent to allow the verification of professional registration details.

Signature (required)

Date / Time *

Data Protection Statement We will only collect data for specified, explicit, and legitimate use in relation to the recruitment process. By signing this application form, you consent to us holding the information contained within this application form. If successfully shortlisted, data will also include shortlisting scoring and interview records. We would like to keep this data until the vacancy is filled. (We cannot estimate the exact time period, but we will consider this period over when a candidate accepts our job offer for the position for which we are considering you). When that period is over, we will either delete your data or inform you that we would like to keep it in our database for future roles. We have privacy policies that you can request for further information. Please be assured that your data will be securely stored by the Registered Manager and only used for the purposes of recruiting for this vacant post. You have a right for your data to be forgotten, to rectify or access data, to restrict processing, to withdraw consent, and to be kept informed about the processing of your data. If you would like to discuss this further or withdraw your consent at any time, please contact management