Job Application Form Job Application Step 1 of 3 - Step 1 33% How did you hear about us?*Advertisement Social MediaOur websiteReferral/FriendUniversityJob boardOtherName* First Last Job title you are applying for:*Head of CareCare Assistant (days)Care Assistant (nights)Senior Carer (days)Senior Carer (nights)Bank staff Activities Co-ordinatorHouse Keeper/CleanerMaintenance PersonCookKitchen Assistant Deputy Care Home Manager Care Home Manager DriverHome you are applying to:*The Old VicarageOld Rectory Ladydale Hollybank HeathersideBeechy Knoll The Clough SandfordGillingreaneGedling VillageBrantley ManorGlenfield WoodlandsSpratslade HouseThe KnightsWellfieldThe LaurelsPearlcare HQThe DalesAddress* Street Address Address Line 2 City Post Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Mobile Phone Number*Home Phone NumberEmail* NI Number* Education:*(Please list any qualifications from school, college, university &/or vocational and include the years obtained & your grade)Employment history:*(Include; your employer, job role, duration of time within that role & reason for leaving, as well as your principal duties & learnt experience & knowledge within that role. Start with most recent & explain any gaps in employment)Describe in detail what values you could bring to help us provide good quality care to older people*Describe what you understand by the term Safeguarding Vulnerable Adults?*What do you think ‘person centred care’ means and how would you provide this?*Please tell us why you want to work with older people?*Tell us what you would want from working at this home?*Describe your general health and include any healthy problems you currently have or have had that may affect you within this role (optional) We are required to obtain TWO references on your behalf, one must be your current/most recent employer.*(Please include: employers name, contact telephone number, address and whether you want us to contact them before your interview. Also include your position within the company)* I declare that I have no criminal convictions (including spent convictions as defined by the Rehabilitation of Offenders Act 1974), cautions, warnings, reprimands and orders. * I confirm that should I receive any of the aforementioned convictions during my employment I will advise my employer immediately. * I understand that should an enhanced DBS check be returned that is unsatisfactory in that criminal convictions have not been declared my employment will be summarily terminated. I UNDERSTAND THAT IF I AM SUCCESSFUL IN MY APPLICATION IT WILL BE SUBJECT TO CERTAIN CONDITIONS INCLUDING THE BELOW*- Satisfactory written references - An independent safeguarding authority check (ISA) - A satisfactory enhanced disclosure and barring check (DBS) Yes * I confirm the information i have given in this application is true and i understand that i am required to produce all certificates to verify my qualifications.