Apply to work for HomecareThis page contains 2 separate forms. Please take care to press ‘send’ on BOTH forms, halfway down the page and at the bottom of the page. Post Applied For * Carer Live-In Care Worker Where did you see the job advert? * Title * Name * First Name Last Name Home Address (including postcode) * Email Mobile Number * (###) ### #### Period of notice required in present job * National Insurance Number * Do you have an active work permit? * Yes No Do you have any health conditions (including hearing or vision problems) that may impact your work as a carer? * Have you had all of your doses of the Covid-19 vaccine? * Yes No Have you ever been convicted of a criminal offence? * Yes No If you answered "Yes", please provide details of the offence and dates (This information will be disclosed by the disclosure and Barring Service (DBS) which will be required if successful. Please note a criminal record will not necessarily be a bar to employment. Criminal Records Bureau (CRB) checks are now called Disclosure and Barring Service (DBS) checks). Please provide your education and qualifications, listing the name of the University/College/School, the Subject, the date and year of when you went to that University/College/School, and the grades you got * Please provide your employment history, listing the name and address of all previous employers, the position you held, the dates of when you worked there, and the reason for leaving * Reference 1- Name, Job Title, Telephone Number, Email Address and Relationship to you * Reference 2- Name, Job Title, Telephone Number, Email Address and Relationship to you * If you are short listed, references may be taken up before your interview. Please indicate if you do not wish us to contact your current employer prior to interview. * Do you have a Level 2 NVQ in Health and Social Care? * Yes No If you don't have this qualification, are you willing to attend training and complete an NVQ Level 2 within 2 years of starting your employment? (Hopscotch will pay for the training) * Yes No Are you willing to attend further training as part of the role? * What evidence or examples can you give us to show that you are able to undertake personal care? * What evidence or examples can you give us to show that you are organised and reliable with good timekeeping skills? * What evidence or examples can you give us to show that you have a caring and patient nature and that you are sensitive to the needs of others? * What evidence or examples can you give us to show you that you are a team player? * Do you have a good level of written and spoken English? * Yes No Do you speak any other languages? Please give details below: * Please tick your availability to work. Please remember you will be asked to work at 2 evenings a week and alternate weekends. For Care Workers Early mornings-7am-10am Late mornings-10am-12pm Early afternoon-12pm-3pm Late afternoon-3pm-6pm Evenings-6pm-11pm Weekends Bank Holidays For Live In Care Workers Monday Tuesday Wednesday Thursday Friday Saturday Sunday Bank Holidays Sleeping Nights Waking Nights Do you have the legal right to work in the UK? * Yes No I declare that the information given on this form is, to my knowledge, true. I understand that if it is subsequently discovered that any statement is false, I will be disqualified from the selection process, an offer of employment may be withdrawn, or I may be dismissed from employment without notice. Thank you! Diversity Monitoring Form Diversity Monitoring - Hopscotch Women’s Centre is striving to be an equal opportunities employer. To ensure that we follow our equal opportunities policy, we need to capture information on the diversity of our applicants and employees. The information provided will be confidential and will be used for monitoring purposes only. Age * 16-24 25-34 35-44 45-54 55-64 65-74 75+ Sex * Male Female Prefer not to say Do you have a disability? * Yes No What is your religion or belief? * Christian Buddhist Hindu Muslim Jewish Sikh Atheist Prefer not to say Other What is your sexual orientation? * Straight Gay Lesbian Bisexual Rather not say Other What is your ethnic group? * White British White Irish White Other Mixed White and Black Mixed White and Asian Mixed Other Indian Bangladeshi Afghan Pakistani Other Asian Caribbean Somali Other African Chinese Other Ethnic Group Thank you!
