Join Our Team

You MUST provide the following at the interview. Applicants without this documentation may have their application rejected.

1. Two forms of identification (preferably passport and driving license)

2. An 'official letter with YOUR name and address on it (e.g. Phone Bill / Bank Statement etc)

3. Proof of 'Right to Work in the UK'

Personal Details

Title*

Forename*

Surname*

Previous surnames (if any)

Phone number*

Email address*

House number & street name*

Locality

Town*

Postcode*

National insurance number*

Nationality*

Are you currently entitled to work in the UK?*
YesNo

Passport number*

Passport issue date*

Are you a car owner?*
YesNo

Do you intend to use your car for work?*
YesNoNot applicable

Do you hold a current full license to drive in the UK?*
YesNo

Driving license number

Driving license valid from

Driving license country of issue

Availability

Please read this before you complete the Availability Form: Please tick all available times below. It is not a requirement that Care Workers should work more than one period per day but you are free to commit to as many as you would like to. Hours are not guaranteed and shift periods are for illustration only. Payment is made for 'contact time' only.

Total number of hours per week you are seeking*

I acknowledge the availability marked above will form the basis of any employment offer and, if you are accepted, forms a commitment on your part.

Please note that the amount of work is variable and that staff may not be working throughout periods marked above as 'available'

Employment History

IMPORTANT NOTE: You must include ALL your previous jobs. Any gaps in employment must be explained.

Are you currently employed?*
YesNo

Further details (if any)

Education, Qualifications & Training

Further details (if any)

Experience

Do you have experience of: Moving & handling people?

Do you have experience of: Personal care including bathing and toileting?

Do you have experience of: Cooking housekeeping and feeding?

Do you have experience of: Handling medication?

Have you carried out general care (this may be on a personal or professional basis)

Have you managed the running of a house?

Rehabilitation of Offenders Act

IMPORTANT: The provisions of the above Act and its subsequent amendments state that convictions which are normally deemed as 'spent' do not apply in cases where employment involves vulnerable people. Therefore your answer to this question should include ANY 'spent' convictions

Have you ever been cautioned or convicted of any criminal offence?*
YesNo

Further details (if any)

DBS Check with Enhanced Disclosure for Adults and Children

This post requires all applicants to be in receipts of an enhanced DBS certificate for adults and children, dated within the last 3 months. If applicants do not already hold a DBS certificate dated within the last 3 months at a comparable level of disclosure, The Care Worker Agency will arrange for a DBS check on their behalf. Portable DBS Certificates are most welcome as evidence of DBS status; but the applicant must be able to provide their reference number to enable The Care Worker Agency to verify the DBS status online.

Please sign the declaration below which provides your acknowledgment of this and confirms your consent for the company to check your DBS status.

DECLARATION

I give my consent for The Care Worker Agency to check my DBS status and agree to inform them if anything changes in regards to my DBS status during my employment with them.

Further details (if any)

References

We need to have details of two people who can give you a reference. One should be your present or previous employer and one should be someone who knows you in a professional capacity (not a relative);

Please note: We do not request references until after the interview (an offer of employment is subject to satisfactory references)

First Reference

(Your current employer. if you are unemployed you may enter your most recent past employer and write 'Currently Unemployed'. No other is acceptable)

Name

Referee's job title

Phone Number

Email

Relation to you

By providing this reference you are giving your permission for us to contact them about your suitability for the role.

Second Reference

Name

Referee's job title

Phone Number

Email

Relation to you

By providing this reference you are giving your permission for us to contact them about your suitability for the role.

Declaration of Health

The Care Worker Agency have a responsibility to protect your health and wellbeing, to aid us with this please provide the following information. Please indicate as necessary providing details where necessary.

Statement

I hereby declare that the information given throughout this form and in any verbal statement is accurate and complete and that no material facts have been withheld. I confirm that this is a genuine application for work and that if I am selected I am available for work at the times stated within this form and that I will abide by the regulations and contractual requirements of The Care Worker Agency."