Employee Application - The Responsive Care

Employee Application Form

We are glad that you are interested to work with us.

Before you begin, please keep these information with you:

Position you are applying for and possible start date.
Your personal details – address, email, contact details etc.
Passport, Driving Licence, NINO, permit to work documents.
School / University degree details, training details.
Employment history.
Next of Kin and details of two references.
Any information related to your health.
Your passport sized photo.
CV, covering letter etc.

We will get back to you very soon after accessing your application by our HR department.

Application Form

Personal Info
Equality and Diversity
Confidentiality Agreement
Letter of Commitment

EMPLOYEE APPLICATION FORM

Responsive Care

Pentax House, South Hill Avenue

Harrow HA2 0DU

Personal Information

Position Applied For

When can you start with us?

Available start date

First Name

Middle Name

Last Name

Phone/Mobile

Address

Address Line 1

City

Postal Code

Country

Date of Birth

Place of Birth

City

Country

Your Nationality

Do you hold a current / valid Passport?

Passport Number

Passport Issue Date

Country

Do you require a Work Permit/ settlement status for the UK?

Upload a copy of work permit / settlement status

Choose File

Do you hold a current valid driving licence?

Upload copy of Driving Licence

Choose File

Do you hold a current endorsements?

Endorsement details

Have you ever been fined, cautioned, sentenced to imprisonment, placed on probation, discharged on payment of costs, or had any order made against you by a criminal, civil or military court or public authority?

More details

Have you had any time off work through illness/injury in the past 2 years?

More details

Does your health prevent you from performing certain types of work?

More details

In the next 12 months, are there periods when you will be unavailable for work?(i.e. Holidays, Medical appointments etc.?

More details

Education

Begin from Secondary school and include any current courses you are attending.

Education and Trainings

Name of School /College / University	Qualifications Attained	Year

Employment History

Start with the most recent and working backwards. Please state the details below with all periods of Employment, Unemployment & Military Service to cover the last 5 years. It is important that you give exact dates, full name, address, email/contact numbers to enable us to complete the necessary checks required. An incomplete background check may result in employment and/ or completion of probationary period being denied.

Employment History

Job Title	Employer's Name	From	To	Reason for Leaving

Supporting Statement

Briefly describe why you would like to work with us and why we should consider you

DBS Check

Are you happy to undergo the full enhanced DBS check with this application for work?

National Insurance Number

Provide Address history for the past 5 years

Address	From	To

Next of Kin

Please provide details of next of kin below.

First Name

Last Name

Phone/Mobile

Address

Address Line 1

City

Postal Code

References

Please provide the names and details of two referees one of which must be a previous/recent employer.

Referee 1

How does the referee know you as

First Name

Last Name

Occupation

Address

Address Line 1

City

Postal Code

Country

Phone/Mobile

Known to you (in years)

Referee 2

How does the referee know you as

First Name

Last Name

Occupation

Address

Address Line 1

City

Postal Code

Country

Phone/Mobile

Known to you (in years)

Photograph, CV and Other Supporting Documents

Please provide these below

Photograph

Choose Photo

CV, Cover Letter, Statement

Choose File

Declaration

I declare that the information given on this form is completed and accurate and to the best of my knowledge Any false statement may lead to refusal of employment or disciplinary proceedings or summary dismissal. I understand that any engagement entered is subject to a probationary period, satisfactory references, and documentary evidence of a National Insurance Number/other proof of the right to work in the UK and a satisfactory medical examination (if required). I have no criminal convictions other than those disclosed on the form. I authorise you to approach my former employers, education establishments, Government agencies, personal credit references agencies and personal referees for verification of information. I accept final offer of employment is conditional on satisfactory Criminal Record Check / Counter Terrorist Check.

I have read and agree to the above declaration.

Equality and Diversity

Responsive Care is committed to Equal Opportunities in employment and welcome applications from all sections of the community. In order to ensure the effectiveness of this policy and for no other purpose you are requested to place a tick in the appropriate boxes below and complete the details as required. The information is exclusively for monitoring purposes and will be kept strictly confidential.

FAILURE TO COMPLETE THIS SECTION WILL NOT AFFECT YOUR APPLICATION

If you believe that there has been unfair discrimination in making the appointment, there is a process of investigation available, subject to reasonable grounds for suspicion being identified. If you wish to pursue an unfair discrimination complaint, please contact the Director of Responsive Care

Sex

Marital Status

Religious Background

Sexual Orientation

Please tick the appropriate box that indicates your cultural background

A. White

B. Mixed

C. Asian or Asian British

D. Black or Black British

E. Chinese or other Ethnic Group

The Disability Discrimination Act 1995 defines a disabled person as anyone who has had a physical or mental impairment which has a substantial and long-term effect on their ability to carry out normal day-to-day activities.

Taking this definition into consideration do you consider you have a disability?

If yes, please give more details

Confidentiality Agreement

I confirm that during every assignment and afterwards:

To hold information relating to the client in the strictest confidence, ensure it is kept safely and securely when not in use. I acknowledge that no information is to be removed from the client’s premises without the permission of the client.

To use such information only for the purpose of the work for which it was given.

Not to disclose to any third party or copy the information except as is required in the course of my duties

Any breach, either by me or a third party, may result in legal proceedings being brought by the Client against me to recover any losses that have occurred as a result of a breach.

I understand any conversations that compromise the patient relating to the above statement may jeopardise my position with Responsive Care.

Letter of Commitment

I understand that my role as a Care / Support Worker is a significant responsibility and will make it a priority. I look forward to working with this team and, like the others:

Support the Mission, Vision, Values and Goals of Responsive care.

Will offer my expertise to help ensure the growth and success of Responsive Care.

Will work with the rest of the team to communicate the organisation’s role to our most important audiences.

Will attend in person or by phone, at least ¾ or the meetings held each year I serve and, whether I attend or not, will continually communicate with the team and the main coordinator to ensure I understand all current affairs.

Will actively participate in all requests for my assistance and response.

I will keep up to date with the organisation policies and procedures as well as relevant care documents of the client such as care plan, risk asses, to ensure safety and wellbeing of the clients.

It is my responsibility to report any identified hazards to ensure a safe working environment.

I fully understand the importance of maintaining privacy and conf of the client while following organisation GDPR policy

I will be committed to promote independence of the client and bearing in mind their personal choices and preferences. Person centred care will be maintained while keeping the client engaged and allowing them to take charge of their life.

Any task supported or delivered will be done with the consent of the client only.

I have read and fully agree to this Letter of Commitment and look forward to assisting the organisation in this role.

Signature

Please write your name in capital

Date of Signature