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Allhands Care — Application Form

Allhands Care Ltd, Suite 7, 74 George Street, Luton, Bedfordshire, LU1 2BD · T: 01582 380775 · info@allhandscare.com

The recruitment process has a minimum of two stages.

The completion of this application form is stage one. This application will be reviewed and a decision made as to whether to proceed to stage two, the interview. PLEASE COMPLETE FULLY.

Once completed, please email to info@allhandscare.com — only typed applications will be accepted.

1. Personal Details

Position Applied For*		How did you hear about this vacancy?
Title*		Surname*
Forenames (in full)*		Former Names (if applicable)
Date of Birth (DD/MM/YYYY)*		National Insurance Number*
Address*
Postcode*		Telephone No.
Mobile*		Email Address*

Next of Kin

First Name*		Last Name*
Relationship to you (e.g. Sister)*		Their Contact Number*

2. Work Requirements / Right to Work in the UK

What type of work do you require?	[ ] Flexible agency work [ ] Full time hours [ ] Part time hours [ ] Long term contract (1yr+) [ ] Ad hoc shifts
When are you able to start work? (DD/MM/YYYY)*
Where would you prefer to work? (Town/City)

Right to Work in the UK

Do you hold a British or EU Passport?	( ) Yes( ) No
If no, do you hold any of the following visas?	[ ] Spousal Visa [ ] Residency Visa [ ] Student Visa (Tier 4) [ ] Ancestry Visa [ ] Working Holiday/Youth Mobility [ ] Work Permit/Sponsor (Tier 2) [ ] Other
Other (please specify)		Any restrictions on your right to work?

Please note: All passports and visas will be verified as part of the Allhands Care recruitment process.

3. Professional Registration

Professional Body Registration

Full/Provisional Registration?	( ) Yes( ) No
Specialist Register?	( ) Yes( ) No

Professional Body Details

Professional Body
Registration Number		Expiry Date (DD/MM/YYYY)

Specialist Register Details

Specialist Register Body
Registration Number		Expiry Date (DD/MM/YYYY)

4. Employment History

Current Employment (or last employer)

Employer Name*		Post Title
Employer's Address
Start Date (DD/MM/YYYY)		End Date (or 'Currently')
Notice Period		Current Salary / Hourly Rate
Brief description of current duties, responsibilities and achievements
Reason for leaving / considering leaving

Previous Employment History (most recent first)

Please list all previous employment. Explain any gaps in employment of over 3 months.

#	Employer Name & Location	Job Title	Dates (From–To)	Reason for Leaving
1
2
3
4

5. Education, Training & Qualifications

Secondary and Further Education

Institution Name	Level / Qualification	Year Obtained

Other Training & Development

Title	Date (DD/MM/YYYY)

Professional Qualifications and Training

Include Post Graduate Diploma, training courses, etc. All certificates will be verified.

Please note: To work in Children Supported Living, applicants must hold NVQ Level 3 in Children's Residential Care or equivalent, or be actively working towards it.

Qualification, Place obtained, From (month/year) To (month/year)
Date of last Basic Life Support Training		Date of last Moving and Handling Training
Date of last Health and Safety Training

Memberships of Professional Associations or Statutory Body

Organisation Name	Level & Registration No.	Registration Date

6. Supporting Statement

Reasons for Applying

Please give reasons for applying for this post (50 words maximum)*

7. Professional Referees

Please provide details of 2 referees who can comment on your suitability for this post. The referee must be a line manager or supervisor. Allhands Care cannot offer you work until satisfactory references have been obtained.

Referee 1 (current or most recent employer)

Name		Relationship to Applicant
Position / Title		Employer Name
Capacity in which known		Dates Employed (DD/MM/YYYY)
Professional Work Address
Telephone No.		Email
Can we contact them prior to interview?	( ) Yes( ) No

Referee 2

Name		Relationship to Applicant
Position / Title		Employer Name
Capacity in which known		Dates Employed (DD/MM/YYYY)
Professional Work Address
Telephone No.		Email
Can we contact them prior to interview?	( ) Yes( ) No

8. Additional Information

Do you hold a current full UK driving licence?	( ) Yes( ) No
Are there any restrictions on your availability to work evenings, weekends, and nights?	( ) Yes( ) No
If yes, please give details
Will this be your only employment?	( ) Yes( ) No
If no, please give details of days, hours worked and whether full or part time
Have you been the subject of a formal disciplinary sanction or are you in the process of any ongoing disciplinary proceedings in your current employment?	( ) Yes( ) No
If yes, please provide details
Have you been dismissed from any previous employment?	( ) Yes( ) No
If yes, please indicate which employment and specify the reasons
Are you related to anyone that currently works here?	( ) Yes( ) No
If yes, please provide details
Have you ever worked for Allhands Care?	( ) Yes( ) No

Disability

The Disability Discrimination Act 1995 defines disability as a physical or mental impairment which has a substantial and long-term adverse effect on his/her ability to carry out normal day-to-day activities.

Do you consider yourself to be disabled?	( ) Yes( ) No
If yes, please detail the nature of your disability
Are there any arrangements we can make for you at interview? (e.g. ground floor venue, hearing loop, sign language interpreter)

9. DBS & Criminal Records

Enhanced DBS Check
All posts defined as "regulated activity" are subject to an Enhanced DBS check so that any criminal background (including "spent" convictions or cautions) is disclosed to the organisation. We cannot employ someone to this post without this check. If you are successful for this post, we will ask DBS for a Disclosure.

The position for which you are applying involves contact with vulnerable groups. It is exempt from the Rehabilitation of Offenders Act 1974 and all subsequent amendments (England and Wales). For this position you are not entitled to withhold information about police cautions or any criminal convictions that would otherwise be considered "spent" under the act.

CRB/DBS Number		DBS Issue Date (DD/MM/YYYY)
Is it on the Update Service?	( ) Yes( ) No
Update Service Number (starts with C)
Have you ever been convicted by the courts, cautioned, reprimanded or given a warning by the police?	( ) Yes( ) No
Have you ever had a Police check in another country?	( ) Yes( ) No
Are you currently subject to any police investigations following allegations made against you?	( ) Yes( ) No
If you answered YES to any of the above, please give details (treated as confidential)

10. Bank Details

If you wish to be paid via a Ltd Company Bank Account, please provide that information here.

Bank / Building Society Name		Bank Address
Town / City		Postcode
Account Name (exactly as on bank statement)		Account Number
Sort Code (6 digits)		Roll No. (if applicable)

11. Equal Opportunities

This information will be kept strictly confidential and used exclusively to track our performance as an equal opportunity employer. It will not be used as part of the selection process.

Gender		Marital Status
Religion or Belief		Ethnic Origin
Sexual Orientation	[ ] Straight or Heterosexual [ ] Homosexual [ ] Bisexual [ ] Other [ ] Prefer not to say

12. CV Upload

Attach CV (optional)

If completing electronically, email your CV to info@allhandscare.com alongside this form.

13. Declaration & Submit

DATA PROTECTION ACT: Information provided by you on this application form may be copied for use during the recruitment procedure. Once the recruitment procedure is completed, the data will be stored for 12 months and then destroyed. If you are a successful candidate, relevant information may be taken from this form and used as part of your personnel record.

I declare that the information given in this application is correct and understand that to knowingly give or to leave out any relevant information could result in: the withdrawal of any offer of employment, or my dismissal at any time in the future, and possible criminal prosecution.

I acknowledge that Allhands Care is authorised to apply for and obtain a Criminal Records Check and references from any previous employers and educational establishments. My personal details will be stored and handled correctly in accordance with the Data Protection Act.

I have read and agree to the above declaration	[ ] Yes, I confirm all information is accurate and complete
Full Name (as signature)*		Date

Official Use Only – Safer Recruitment

This application form has been reviewed, validated and identified as complete by :

Name :		Title :
Signature :		Date :