ApproCare"Your LOCAL home care provider" Toggle NavigationHomeAbout UsTestimonialsContact UsCareers at ApproCareChevronApply TodayHomeAbout UsTestimonialsContact UsCareers at ApproCareChevronApply Today Community Carer Application Form PERSONAL DETAILSTitleSurname*Forename(s)*YOUR FULL ADDRESS including postcode*Email Address*Landline NumberMobile Phone Number*National Insurance Number*Do you have the right to take up employment in the UK?*YES I DONO I DONTUNSUREAre You Currently Employed?*YESNOEMPLOYMENT DETAILS*Current Employer (Company Name & Address) If not currently employed please put N/A.Start Date At Current EmploymentREFEREES*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.2. CHARACTER REFERENCE (Must not be family)*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? Yes, I ConsentNo, I Do Not ConsentDRIVING LICENCE - Do you hold a driving licence?*Yes - full licence, I am a driverYes - provisional licence only and learning to driveYes - I have a provisional licence but NOT currently learning to driveNo - I do not driveDo you have any endorsements?*YesNoN/A (Non Driver)If yes, please give details:Do you have your own vehicle?YesNoDECLARATION OF HEALTH - Has your employment ever been terminated on the grounds of ill health?*YesNoAre you currently taking any prescribed medication?YesNoAre you currently under the care of a doctor or other medical professional?YesNoHave you had your vaccination against COVID-19?*YES, I HAVE HAD BOTHYES, I HAVE HAD ONE SO FARNO I HAVE NOT HADI DO NOT WISH TO DISCLOSEApproximately, how many days/weeks sickness absence did you have in the last 12 months?*Are you currently suffering from or have you ever suffered from any of the below? (tick if yes)*Heart troubleStomach/Bowel troubleJaundice/HepatitisJoint problemsHeadaches/MigrainesDiabetesBack/Neck problemsDepression/AnxietySkin problemsMobility problemsAllergiesStressSerious AccidentHigh Blood PressureAsthmaHernia/RuptureKidney/Bladder DisorderFits/Blackouts/EpilepsyHearing/Sight problemsSurgical operationsNONE OF THE ABOVEIf you have answered YES to any questions in the declaration of health section please give details and approximate dates where relevant. This is particularly important if you have a qualifying disability under the Disability Discrimination Act, as it will enable us to identify what, if any, reasonable adjustments can be made.For use in case of emergency please provide details of your Next of Kin / Emergency Contact with their full address and telephone numbers.*Your GP detailsI 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.YesNoEXPERIENCE & QUALIFICATION - PLEASE ACCOUNT FOR YOUR MOVEMENTS SINCE LEAVING FULL TIME EDUCATION WITHOUT ANY UNEXPLAINED BREAKS. IF YOU DID NOT WORK FOR A PERIOD OF TIME, PLEASE STATE WHAT YOU WERE DOING EG: HOUSEWIFE/MOTHER/FATHER/JOBSEEKING ETC:* Current / Most Recent Employer (Employment 1): Employment 1 Start DateEmployment 1 Leave Date: (If applicable)Employment 1 Job Title/Position Held:Reason For Employment 1 Ending?Previous Employer (Employment 2):Employment 2 Start Date:Employment 2 Leave Date:Employment 2 Job Title/Position HeldReason For Employment 2 Ending?Previous Employer (Employment 3):Employment 3 Start Date:Employment 3 Leave Date:Employment 3 Job Title/Position HeldReason For Employment 3 Ending?Any Other Previous Employments:(please include start date, leave date, position held and reason for leaving)Date Of Leaving Full Time Education:*When are you free to start work?*Do you have any prebooked holidays or dates of unavailability? *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:*Bath/Shower/Strip WashBed BathUse of Bath AidsShavingOral Hygiene (Inc. Dentures)Hair CareFoot CareCare of FingernailsDressing/Undressing Service UsersCare of EyesCare of Bladder/BowelsEmptying/Connecting Catheter BagUse of Bedpan/Commodes etcColostomy BagChanging Incontinence PadsMoving & Transferring Service UsersUse of HoistsUse of Walking AidsUse of Sara StedyUse of Rota Stand/Patient TurnerRepositioning/Rolling a Bedbound Service UserReport Writing / Recording InformationContacting Emergency/Non Emergency Services (999/111 etc)Observing Changes in Service User Needs or Condition & Reporting Back To OfficePreparation of Meals / CookingFeeding (Orally)Completing Nutrition Monitoring FormsPEG FeedingEmailSMS TextMicrosoft WordMicrosoft ExcelUse of a Smart Phone (Mobile Phone)Pressure Area CareEnsuring Medication Has Been TakenLight HouseworkWashing of Personal LaundryShoppingIroningSitting With a Terminal Service UserDealt With Relatives of ill or Terminally illMaintaining ConfidentialityUsing a KeysafeChanging Bedding/Making a BedBedmaking (with a Bedbound Service User on it)TRAINING COURSES - have you completed any of the following?*Care CertificateNVQ/QCF in CareI have not completed either of thesePlease list any other training completed and date of completion:(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'. YesNoIf yes, please give details and dates:Declaration*"I DECLARE THAT, TO THE BEST OF MY KNOWLEDGE, THE INFORMATION PROVIDED HEREWITH, IS TRUE AND ACCURATE"PRINT FULL NAME*DATE OF COMPLETION*This site uses Google reCAPTCHA technology to fight spam. Your use of reCAPTCHA is subject to Google's Privacy Policy and Terms of Service.SUBMITThank you! Your message was sent successfully. / PreviousNextPausePlayClose