Full Application | Access Dignity Care

Application Form

Role You Would Like To Apply For?

Full Name

Have you been know by any other name?

If yes, what please provide pervious name and date it was changed

Date of Birth

Place of Birth

National Insurance Number

Email Address

Contact Phone Number

Current Home Address

Date moved in to the property

Have you lived at this address for the more than 5 years

If no, please provide previous address

Date from and to for previous address

Additional previous address

Date from and to for previous address

What type of driving licence do you hold?

Do you have regular use of a car?

If yes, please provide vehicle, Make, Model & Year of registration

Is your vehicle insured for business use

Please provide details of any, Education, Professional Training or Qualifications completed and date received

Are you fluent in any foreign languages?

If yes, what language/s are you fluent in?

Do you have a criminal record?

If yes, please provide details and date of conviction/s

If the position you are applying for (whether paid or voluntary) is listed in Schedule 1, Part II of the Rehabilitation of Of-fenders Act (Exceptions) Order 1975, we are entitled to ask Exempted Questions as defined by Section 113(5) of the Po-lice Act 1997 about you. We are required to acquire a DBS Certificate in relation to any person who is a Care Manager or Care Worker. This means that if your application is successful, we will obtain an enhanced DBS. Having a criminal record will not necessarily bar you from working with us. This will depend upon the nature of the position and the circumstances and background of your offences. We observe the “Code of Practice for Registered Persons and Other Recipients of Disclosure Information” published by the DBS on behalf of the Home Office, and we will provide you with a copy of it upon request

By signing this statement, you agree to Access Dignity Care LTD applying for a DBS on your behalf with all the infor-mation you have provided on this application form

Previous Employer Company Name

Previous Employer Address

Previous Employer Contact Phone Number

Previous Employer Email Address

Dates From-To Previous Employer

Reason for leaving?

Please provide details of all other employment history since leaving FULL time education, starting with your present or most recent employment with relevant information as entered above

I am aware of The Working Time Regulations, 1998, and understand their implications with ref-erence to my Terms & Conditions of Employment. The Organisation’s Staff Time-keeping Records will confirm my hours worked on a weekly ba-sis. Where these records confirm that I have worked in excess of 48 hours per week I agree that this 48-hour week limit under The Working Time Regulations, 1998, shall not apply to me. I understand that I may agree to opt back into the 48-hour week limit at any time, giving the ap-propriate notice due.

Are you able to provide details of 2 referees who we may approach with regards to this Job Application. These referees must not be members of your family, and one must be your present or most re-cent employer

Reference One

Position held

Address

Contact Phone Number

Email Address

Reference Two

Position held

Address

Contact Phone Number

Email Address

ANY PERSON, UPON SUBSEQUENT EMPLOYMENT, THAT IS FOUND TO HAVE KNOWINGLY SUPPLIED FALSE OR MISLEADING INFORMATION, OR HAS DELIBERATELY WITHHELD RELEVANT INFORMATION, MAY BE SUBJECT TO DISCIPLINARY PROCEEDINGS WHICH MAY RESULT IN DISMISSAL I have read and understood the information supplied to me in relation to this Job Position, and the infor-mation requested in this Job Application Form. I confirm that all information supplied by me is true and cor-rect to the best of my beliefs. I give the prospective employer the right to follow up all references and to make any other job-related enquir-ies as may be deemed necessary. By ticking this box you confirm.

Access Dignity Care is an equal opportunities employer gThe sole criterion for selection of applicants will be suitability for the Job Position, regardless of gender, background, culture, ethnic denomination, religious affiliation, marital status or disability. Data Protection Act, 1998: Your signature on this document gives us the right, under the Data Protection Act, 1998 to process the information you have given, including data of a sensitive nature, relating to your application for employment. Any processing of the data by us will be in accordance with our Policy and the processing principles set out in the Act. Application forms of unsuccessful candidates will be destroyed after 6 months in accordance with our Record-keeping Policy.

Address

Thank you for your application, a member of our careers team will contact you shortly!

Contact us

Phone: 01255852882

Email: info@accessdignitycare.co.uk

Access Dignity Care Limited
34 Newgate Street
Walton-on-the-Naze
Essex
CO14 8AL

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