ApproCare



"Your LOCAL home care provider"

Community Carer Application Form

Title
Are You Currently Employed?*
Current Employer (Company Name & Address) If not currently employed please put N/A.
1. EMPLOYMENT REFERENCE (Must be your current employer). If you are not currently employed, please give your last employer. If this is your first employment or for more support please contact us for guidance.
AN OFFER OF EMPLOYMENT IS MADE ON THE UNDERSTANDING THAT TWO ACCEPTABLE REFERENCES ARE RECEIVED (ONE BEING FROM YOUR CURRENT/MOST RECENT PLACE OF EMPLOYMENT), TOGETHER WITH A DISCLOSURE & BARRING SERVICES CHECK THAT IS SATISFACTORY TO THE AGENCY AND SHOWS THE STAFF MEMBER IS NOT BARRED FROM WORKING WITH VULNERABLE ADULTS. WE RESERVE THE RIGHT NOT TO OFFER YOU WORK OR TO IMMEDIATELY TERMINATE ANY ASSIGNMENT IF ANY INFORMATION ON THIS APPLICATION IS FOUND TO BE FALSE......................................................................................................................................................................................................*
At this stage, do you give consent for us to contact your referee's to support your application?
DRIVING LICENCE - Do you hold a driving licence?*
Do you have any endorsements?*
Do you have your own vehicle?
DECLARATION OF HEALTH - Has your employment ever been terminated on the grounds of ill health?*
Are you currently taking any prescribed medication?
Are you currently under the care of a doctor or other medical professional?
Are you currently suffering from or have you ever suffered from any of the below? (tick if yes)*
I give full permission to ApproCare to contact my GP in the case of emergency or should they deem it necessary and in my best interests.
Current / Most Recent Employer (Employment 1):
(please include start date, leave date, position held and reason for leaving)
If so, please give full dates below. If none, please just write none:
EXPERIENCE CHECKLIST - To correctly enable us to assess any experience or training needs you may or may not have, could you please TICK the appropriate boxes you have any personal or professional experience in:*
TRAINING COURSES - have you completed any of the following?*
(Please note, you may be asked to show your certificates in the above and the below courses)
DECLARATION - Have you been convicted of any criminal offence at any time?*
- The provision relating to the non-disclosure of criminal convictions does not apply to certain occupations and activities. The position for which you are applying is one which is exempt under the above Order. Therefore, it is necessary for you to disclose any criminal convictions, even if, under the Rehabilitation of Offenders Act, they would otherwise be regarded as 'spent'.
Declaration*
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