Application Form

    PERSONAL DETAILS

    Miss/ Mrs/ Mr/ Other: (required)

    Date of Birth: (required)

    Forenames(s): (required)

    Surname: (required)

    Address: (required)

    Postcode: (required)

    Tel Home:

    Tel Mob: (required)

    Email Address: (required)

    N.I. Number:

    EDUCATION

    From

    To

    School / College - Name & location

    Examinations Taken / Level

    Grades

    PROFESSIONAL QUALIFICATIONS/TRAINING COURSES – original certificates required

    Date

    Qualifications / Other

    Grade

    WHY ARE YOU INTERESTED IN THIS POSITION WITH STARCARE?
    Please add any relevant experience you may have to the position applied for?

    Tick the shifts you are available to work

    Are there any days you cannot work? Please specify below with reasons

    7am - 2pm

    Yes

    7am - 6:30pm

    Yes

    3:30pm - 6:30pm

    Yes

    3:30pm - 11:15pm

    Yes

    6:30pm - 11:15pm

    Yes

    Other:

    Yes

    Please note: It is compulsory that all support workers are able to commit to working alternate weekends. As a minimum requirement, hours will be same as during the weekdays. Staff can select to work extra on their working weekend or planned weekend off

    Are there any times that you are not available?

    What date are you available to start work?

    Do you require any assistance due to disabilities?

    Please give details:

    EMPLOYMENT HISTORY

    Due to the nature of employment, it is required that you state ALL employment history from leaving school, you must include ALL periods of employment and explain fully any breaks in employment. This is statutory for all support staff.
    Please start with your most recent employment

    From Month/year

    To Month/year

    Company name and address

    Job title and responsibilities

    Reason for Leaving

    Are you currently in Employment
    If yes, please give details of notice required

    YES

    NO

    REFERENCES (references will only be requested following your acceptance of position with the company)

    Please provide a minimum of two referees, one of which must be your most recent employer. For employment references, they should be your most recent employers (no relatives). If you cannot provide two employment references, you must provide one employment reference and two character references. If you have not worked in the last 5 years you should provide 3 character references
    Character references - work colleagues, neighbours, friends of the family, business acquaintances, and clients.
    References will be applied for once you have accepted a formal offer

     

    Reference 1

    Employment or character:

    Referee name:

    Job title/relationship:

    Company name if applicable:

    Address:

    Email address:

    Contact phone number:

    Reference 2

    Employment or character:

    Referee name:

    Job title/relationship:

    Company name if applicable:

    Address:

    Email address:

    Contact phone number:

    Reference 3

    Employment or character:

    Referee name:

    Job title/relationship:

    Company name if applicable:

    Address:

    Email address:

    Contact phone number:

    Reference 4

    Employment or character:

    Referee name:

    Job title/relationship:

    Company name if applicable:

    Address:

    Email address:

    Contact phone number:

    PLEASE SPECIFY AND TICK IN THE ( ) BELOW THE AREAS YOU ARE ABLE TO WORK IN?

    CHESTER
    Covers the below areas

    (YES?)

    Chester

    Malpas

    Tarporley

    Ellesmere Port

    Neston

    WINSFORD
    Covers the below areas

    (YES?)

    Winsford

    Middlewich

    Northwich

    Frodsham

    Helsby

    KNOWSLEY
    Covers the below areas

    (YES?)

    Netheton

    Maghull

    Lydiate

    Waterloo

    Bootle

    Knowsley

    EXTRA CARE HOUSING
    Covers the below areas

    (YES?)

    Abbotswood

    Devapoint

    Kingswood

    Hollymere

    Hallwood

    Hartley Place

    If you are applying for a specific role that has been advertised, please indicate the shifts, days & area that were stated in the advert:

    DO YOU HAVE A FULL DRIVING LICENCE

    YESNO

    DO YOU HAVE ACCESS TO YOUR OWN TRANSPORT

    Do you currently have/have held a full enhanced DBS

    YESNO

    If you have a transitional DBS we will need the barcode and photocopy – Please provide below

    REHABILITATION OF OFFENDERS (EXCEPTIONS) ACT 1979

    Have you ever been convicted of a criminal offence?

    YES   NO

    In accordance with the rehabilitation of Offenders (Exceptions) Act 1979 all convictions including those deemed spent must be disclosed (not including traffic offences). This includes convictions, cautions, reprimands, or final warnings

    All successful applicants must undergo and DBS Disclosure. On sending this form you are agreeing to a DBS being carried out on offer of employment.

    DECLARATION

    In signing this form, you are giving your permission for the following:

    • You personal data to be stored and processed for the purpose of arriving at a selection decision and, for the successful candidate, future personnel administration.

    • Permission for your data to be shared with our training provider Richmond Training to enable them to prepare documents and assessments for your induction and any subsequent training and relevant funding.

    • You give the employer the right to apply for references (following acceptance of job offer) and to secure all additional information about you, if position related. You hereby release from your liability the employer and the representatives for seeking such information and all other persons, corporations and organisations for furnishing such information.

    I understand that the position applied for/offered will be subject to the satisfactory outcome of references, proof of my right to work in the UK, a completed DBS and proof of qualifications. I declare that all information provided is accurate at the time of signing and understand that if I have enetred any false or misleading information, this may lead to termination of any emplyment offered.

    By submitting this form, you are agreeing to Starcare Ltd's Privacy Policy.

    Agree? (required)YES

    Date

    By using this form you agree with the storage and handling of your data by this website.

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