Application Form

Please do not for get to attach THREE
identical passport size photographs
of yourself
(approx 45 millimetres high by 35 millimetres wide)

Please complete the form on computer or by hand, sign, attach the photographs and then post all to:

B Carers Ltd

19 IBSTOCK CLOSE, READING RG30 2NU

Tel: (0118) 957 1723

Email: info@bcarers.co.uk

Web: www.bcarers.co.uk

  • yes no
  • yes no
  • type of employment sought:



  • emergency contact details

  • Non-British and Non-EU Nationals only


  • general information

  • please state specialised areas in which you feel competent to work in

additional information:

language:

     

written:

     

spoken:

education

  • institute
  • name & address
  • from
  • to
  • school
  • college/University
  • vocational qualifcations;(NVQ/QCF/Diploma/First aid)

training courses attended (internal and external training)

  • course title
  • course provider
  • Certificate Date
  • course duration
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You will be asked to bring original certificates for all courses to your interview for verification.

Employment History

Please enter below FULL and complete employment history

For all periods when you were not employed please give dates and state what you were doing

  • dates from
  • to
  • company and contact details
  • brief description of job/role/tasks/responsibilities
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Referees:

Please provide the names and addresses of three referees we can contact for references. At least one referee should be your present or most recent employer (school/college if student). Relatives or partners cannot be accepted as referees.

Please note that no offer of employment will be made prior to receipt of references. We usually apply for references before interview.

  • 1. Name & job title
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  • full address
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  • contact details:
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  • date:
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  • Capacity in which Referee knows you
  • yes no
  • 1. Name & job title
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  • full address
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  • contact details:
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  • date:
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  • Capacity in which Referee knows you
  • yes no
  • 1. Name & job title
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  • full address
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  • contact details:
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  • date:
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  • Capacity in which Referee knows you
  • yes no

To progress your Registration with B Carers, there follows a number of declarations, each to be completed, signed and dated

Disclosure of Employment History Declaration

Have you at any time

  • yes no
  • yes no
  • yes no
  • yes no
  • yes no

If Yes to any of the above,please supply details

I will inform B Carers promptly of any incident of the type listed above,at any place of work, occurring at any time from the date of this form,until my employment with B Carers ceases.

Availability

Willing to work:

State your Minimum and Maximum number of hours you are willing to work per week.

  •  
  • start time
  • end time
  • total hours
  • sunday
  • monday
  • tuesday
  • wednesday
  • thursday
  • friday
  • saturday
  • Working Time Directive:

  • I (name):

  • Agree that I may work for more than an average of 48 hours per week.

  • Do not wish to work more than 48 hours per week.

  • Signature:

  • Date:

  • Student Declaration:

  • Name:

  • Address:

  • CourseName:

  • College:

  • CourseTutor:

  • College Address:

  • Course Dates:

  • From:

  • To

  • I declare that I am currently enrolled at the above college and studying the above course, and I consent to B Carers contacting the college to confirm this.

  • Signature:

  • Date:

  • Other Information: Please enter here any experience not mentioned earlier, which may support your application; e.g. short term voluntary work, personal experience of particular client groups, overseas experience, any other spoken languages and relevant experience, etc.

  • Please give reasons for applying for this post describing how you consider your skills and experience are relevant to this post:

Please bring as many as you can of the following documents to your interview.

Documents marked* are necessary for your registration.
  • Passport*
  • Passports are the base of our identity check. If you do not have a passport, please call before your interview date.
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  • Visa If required*
  • Or other proof of eligibility to work in the UK
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  • Driving licence
  • Paper, AND photo-card if you have one.
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  • Two proofs of address*
  • Recent, e.g. bank statement, utility bills under 3 months old. Driving licence does not count unless under 3 months old.
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  • Birth Certificate
  • Original copies only.
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  • Marriage Certificate
  • We must see documents to prove changes of name.
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  • Three photos*
  • Standard passport - type colour photos of yourself.
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  • Cash
  • To pay for your DBS checks.'
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  • Certificates
  • Original certificates for Qualifications or training.
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  • Gap evidence
  • Documentation verifying any gaps in your employment history
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  • NI number
  • Proof of your National Insurance number, an original P45 or P60
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  • Referees
  • e will need references from 3 recent employers. References must be from the HR department, or can be from your line Manager if they are still working there. We need a minimum of 2 references. If you only had one employer in the last 3 years, please think of someone suitable to be a personal referee, e.g. a Social Care professional who knows you well.
    Please bring the contact details for your referees, including email and postal address.
    A mobile phone number is not sufficient.
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Health Questionnaire

Care Work can be stressful and demanding, and it is part of our registration process to ensure that all candidates are fit to work in such circumstances.

 

Do you suffer, or have you ever suffered, from any of the following health conditions?

Please tick YES or NO for each statement below.

1. Have you ever been admitted to hospital (apart from childbirth)?

yes

no

2. Have you ever had an accident at work?

yes

no

3. Are you at present under medical supervision or taking any medicines?

yes

no

4. Are you under psychiatric supervision?

yes

no

5. Have you any disabilities or are you registered disabled?

yes

no

6. Have you had any absence from work due to sickness in the last 2 years?

yes

no

7. Do you have or have you ever had diabetes?

yes

no

8. Have you or, to the best of your knowledge, any of your relatives, ever had TB?

yes

no

9. Persistent or recurrent back trouble?

yes

no

10. Mental illness or nervous breakdown (including time off work related to stress and/or depression)?

yes

no

11. Migraines, blackouts, epilepsy, fainting?

yes

no

12. Chronic chest complaint, persistent cough, asthma, coughing up blood or similar disorder?

yes

no

13. Stomach or intestinal disorders, e.g. ulcer, bowel disorder, dysentery, typhoid, cholera,other chronic diarrhoea?

yes

no

14. Hepatitis, jaundice or other liver disease?

yes

no

15. Heart or circulatory disorders including angina or raised blood pressure?

yes

no

16. Skin complaint or allergy? (Please specify)

yes

no

17. Any condition which causes difficulties sleeping?

yes

no

18. Have you ever had, or been vaccinated against, Hepatitis B?

yes

no

19. Any other health factors that might affect your fitness to work in Social Care?

yes

no

If you have answered 'YES' to any of the above Questions, please give details here. Use a continuation sheet if necessary.

I, the undersigned, confirm that the above information is correct to the best of my knowledge.

EQUAL OPPORTUNITIES:

B Carers Ltd operates an equal opportunity policy. To help us monitor the effectiveness of this policy please complete this form and return it with your application form. A statement of our equal opportunity policy is included in the recruitment pack. This monitoring form will be detached from your application form and will be kept separately from the information to be used in the selection process.

[Note: Certain details are necessary for the monitoring process to be effective but it is not necessary to add your name to this form.]

1) ETHNIC CATEGORY:

The following categories are based on those used in the 2001 census as recommended by the Equality and Human Rights Commission. Please note the ethnic questions are not about nationality, place of birth or citizenship. UK citizens can belong to any of the ethnic categories indicated.

Please tick the box which best describes the ethnic category to which you belong:

2) GENDER:

3) DISABILITY:

Please state if you have any long-term physical or mental condition that affects your ability to carry out day-to-day activities.

(Advice can be obtained from the Disability Rights Commission 08457 622 633)

yes

no

4) AGE:

Please state your age and date of birth:

5) RELIGION:

Please state your religion, if applicable:

  • Data Protection Act

  • I understand that B Carers may hold data about me, whether obtained directly from me or from other sources, and that some of this data may be sensitive.This data may be held indefinitely, and I give my permission for this data to be disclosed to third parties in the course of seeking employment or training for me.

  • In particular I understand that all data held about me by B Carers may be subject to inspection as required by the Care Standards Act 2000.

  • Signature:
  • Date:
  • Rehabilitation of Offenders Act

  • Because of the nature of the work placements offered by B Carers, the terms of Section 4 part 2 of the Rehabilitation of Offenders act (1974) (exceptions) Order 1975, apply. You must declare here any convictions or cautions you have ever received, even those which would normally be considered spent.

  • B Carers follows the Disclosure and Barring Service (DBS) Code of Practice (previously CRB).
    A criminal record is not necessarily a bar to employment.

  • Have you ever been convicted of or cautioned for, or are you under investigation for any offence?

  •    Yes

  •    No

  • If Yes, please supply details:

  • Please sign the following statement: I understand that my DBS Disclosure may be verified, copied and shared with any client considering employing
    me on a temporary or permanent basis.

  • Signature:
  • Date:
  • Declaration

  • I declare that all information given on this form is true and accurate to the best of my knowledge. I understand that B Carers may make enquiries as they see fit to verify any of the information given, and that if I have knowingly made false statements I may be subject to prosecution.

  • I understand that my registration is subject to satisfactory references and DBS disclosure being obtained by B Carers.

  • I will Inform B Carers promptly of any incident which may affect my employability, includlng, but not limited to, my conviction of any offence, or receipt of any formal or written warning at any place of work.

  • Signature:
  • Date: