Confidential Application for Employment

Currently we are not accepting any application from abroad.

Section 1 – Personal Details

(Please complete as shown on passport)

Forename(s): *

Surname *

Address: *

Mobile Number: (Pls provide country prefix) *

UK National Insurance No:

Post Code/Pin Code *

Country *

Email Address *

Date of Birth *

COVID-19 Vaccination Information

As per UK government regulations, anyone wants to work or working in residential care home must be vaccinated against COVID-19. Unless the proof is provided, we won’t be able to take this application any further. You must provide either vaccine certificate or clinical exemption certificate with the application.

Have you taken COVID-19 vaccination? *

If yes, then state name of vaccine

Date of 1st Dose *

Date of 2nd Dose:

Second dose not applicable (please tick)

Place vaccine is taken: *

Vaccine certificate attached - If no, sorry we can’t take this further, start the application when you can attach the certificate and terminate the application *

If exempted, then proof of exemption attached *

Upload vaccine certificate

Click or drag files to this area to upload. You can upload up to 5 files.

Upload proof of exemption

Click or drag files to this area to upload. You can upload up to 5 files.

Section 2 – Employment Details

Position applied for *

Name of Care home where you would like to apply *

NMC Pin Number (If applying for nurse role)

Please provide details of any referral made to the NMC or any allegations investigated or currently under investigation? (If this is not applicable, please write N/A in the box provided)

Please provide details of any restrictions placed on your practice (past or current) Please provide the details such as date, reason and exact wording of the restriction shown on your NMC status. (If this is not applicable, please write N/A in the box provided)

Expiry Date

Re-Validation Date

What date will you be available to start work?

Holidays Booked

SSSC registration

If you are currently not registered with SSSC please note you must apply for the registration within first 3 months of employment with Abbey Healthcare and must keep it up to date during the entire employment period.

SSSC Registration number

Expiry Date

Have you ever been referred to SSSC regarding your practice? If “yes”, pls provide details such as date, reason, and outcome. If not, please write “no” in the box below.

Disclosures & Rehabilitation of Offenders Act 1974

Because of the nature of the work for which you are applying this post is exempt from the provisions of the Rehabilitation of Offenders Act 1974, by virtue of the Rehabilitation of Offenders Act (Exemptions) Order 1975.

Applicants are therefore not entitled to withhold information about convictions which for other purposes are “spent” under the Provisions Act and in the event of employment any failure to disclose such convictions could result in dismissal or disciplinary action by the organisation.

Any information given will be completely confidential and will be considered only in relation to the application for the positions to which the order applies.

As the job you are applying for involves specific responsibilities, it is required by law for us to conduct Disclosures and Criminal Record Checks.

Do you have any previous convictions/cautions/reprimands?

If yes, please provide further details.

Are you currently subject to any police investigation or court cases?

If yes, please provide further details.

Please provide details of any disciplinary action you have faced in the past or any pending disciplinary action against you. If this is not application, pls write N/A in the box given.

Section 4 – Work History (please provide in chronological order with current/most recent first)

Any employment gaps must be explained, use additional information box if necessary.

Name of Employer

Address of Employer

Work Telephone

Work Email

Starting Date

Leaving Date

Job Title

Salary

Duties/Responsibilities

Reason for Leaving

Name of Employer

Address of Employer

Work Telephone

Work Email

Starting Date

Leaving Date

Job Title

Salary

Duties/Responsibilities

Reason for Leaving

Name of Employer

Address of Employer

Work Telephone

Work Email

Starting Date

Leaving Date

Job Title

Salary

Duties/Responsibilities

Reason for Leaving

Name of Employer

Address of Employer

Work Telephone

Work Email

Starting Date

Leaving Date

Job Title

Salary

Duties/Responsibilities

Reason for Leaving

Name of Employer

Address of Employer

Work Telephone

Work Email

Starting Date

Leaving Date

Job Title

Salary

Duties/Responsibilities

Reason for Leaving

If required, you may add additional information in the additional information box provided before the declaration.

Have you ever worked for our Company before?

If yes, please give details.

Start Date

End Date

Job title, duties/responsibilities, and reason for leaving

Section 5 – Education

School/College/University

Qualifications (Subjects and Results)

Date Qualification awarded

School/College/University

Qualifications (Subjects and Results)

Date Qualification awarded

School/College/University

Qualifications (Subjects and Results)

Date Qualification awarded

Please state any other training you have attended relevant to the position you have applied for

List your current membership of the professional body/institute to which you may belong/subscribe

Do you speak or read a foreign language? If yes, please give details

Health & Medical Fitness

Please give details on any absence from work which has occurred within the last 2 years.

Number of Ocassions

Total Number of Days

The position for which you are applying may require:

Physical effort (including but not limited to - sitting, standing, carrying, walking, moving, and handling people/heavy objects),

Mental effort (including but not limited to - dealing with emergencies and short-notice changes to work in a fast-paced environment) and possible.

Emotional/Psychological effort (including but not limited to - dealing with bereavement and challenging behaviour in a potentially stressful environment)

Do you have any health conditions that would prevent you from meeting these intrinsic requirements for which the organisation might need to make reasonable adjustments? (If yes, please be aware that we may need to arrange a meeting to discuss further)

If you wish to clarify the reason for sickness absence or any relevant health conditions, please state in the box given:

Section 6 – Supporting Information (copy)

Please include any skills and experience you have acquired that can support this application whether within the working environment or outside.

Section 7 – References

We only accept work phone number and email address for referees.

Please give the details of three people to whom we may contact for references (One of which must be your most recent or current employer. If you do not want us to contact them unless we offer you the position, please tick the box.

Name of referee 1 *

Position *

Name of Company *

Work Phone Number *

Address *

Work Email Address *

Length of Time Known *

Name of referee 2 *

Position *

Name of Company *

Work Phone Number *

Address *

Work Email Address *

Length of Time Known *

Section 8 – How did you hear about this job?

Through our website (https://www.abbeyhealthcare.org.uk/)
Carehome.co.uk (https://www.carehome.co.uk/)
Find a job (https://findajob.dwp.gov.uk/)
Indeed (https://www.indeed.co.uk/)
Banner outside the care home (If yes, please provide the name of care home below)
Facebook Page (If yes, please provide the name of care home below))
From our employee (Please provide full name and care home name they work at below)
From our ex-employee (Please provide full name and care home name they used to work at below)
Others (Please specify below)

File Upload

Click or drag files to this area to upload. You can upload up to 10 files.

Additional Information: (Use this box for additional employment. Do not repeat any information already given.)

Declaration

Please read the following statements carefully. If there is anything you do not understand, please ask before you sign this document.

I, the job applicant named on the front of this form, confirm that the information I have given in this application is accurate and true to the best of my knowledge.

I also understand and agree that: The company may make checks to verify the information I have provided; Providing misleading or false information in this form or at any other time during the application process may disqualify me from appointment or, if I have already been appointed, may result in my dismissal;

The personal information I have provided in this form (and any other personal information that I or my referees may provide) is confidential and will be handled in line with the Data Protection Act 1998; The company will use the personal information I have provided to decide if I am suitable for the job I have applied for;

Until I am employed, the company will not use my personal information for any purpose other than monitoring its own recruitment processes and that if the company does use my personal information for statistical analysis, it will be anonymised;

If my application is unsuccessful, the organisation will keep only basic information about me and destroy the rest;

If my application is successful, my personal information will be used for legitimate purposes in relation to my work (my contract of employment, which I will sign before I start work, will include further detail on how my information may be used);

The company may process my personal information for the purposes described above or as otherwise permitted or required by law in line with its registration with the Information Commissioner;

Any formal offer of employment will depend on the receipt of satisfactory employment references and the satisfactory completion of a criminal records disclosure;

Note that if, once a criminal records disclosure has been completed, it is discovered that you have failed to accurately disclose the information requested above, the company reserves the right to terminate your employment without notice.

Please be aware, however, that you’re having a criminal record will not necessarily mean you cannot be employed by the company – if you would like to know more about our policy on the recruitment of ex-offenders, please get in touch.

I DECLARE THAT THE INFORMATION GIVEN ON THE APPLICATION IS TO THE BEST OF MY KNOWLEDGE TRUE AND COMPLETE. *

Date *

Message

Application Forms – Guidance Notes

Please read the following notes to help you fill in the form correctly. The following headings correspond to some of the appropriate sections of the application form:

Employment Details:
The full job title should be completed, and indicate the earliest date on which you could start work for us if the job is offered to you.

General Information:

Let us know if you hold a current driving licence and also if there are any current penalty points.
Employers are required to check the criminal background of those employees whose jobs give them access to children or other vulnerable members of society. Decisions to appoint will be subject to consideration of a disclosure from the Criminal Records Bureau.
If the post for which you are applying requires a Criminal Records Bureau check, you must provide information about ALL convictions, as the post is automatically exempt from the Rehabilitation of Offenders Act 1974 and rules relating to ‘spent’ convictions do not apply.
If the post for which you are applying does not require a Criminal Records Bureau check, you are still required to answer this question but you do NOT need to disclose convictions which under the Rehabilitation of Offenders Act 1974 are considered as ‘spent’.

Work History:

Starting with your last employer, list all employers you have worked for, providing the job title, starting / leaving dates, salary and the reason you left. If relevant include any voluntary work.
Give only a brief concise outline of your duties and responsibilities, perhaps using bullet points.
This information may be used to assess whether you meet the experience requirement for the vacancy.
List your formal qualifications, including grades where appropriate, where they were obtained and when awarded.
Please detail the organising body and the details of any training you have attended.
List your current membership of the professional body/ institute/s to which you may belong/subscribe.
This information may be necessary for us to assess whether you are fully qualified for the vacancy. Please make sure nothing has been omitted.

Supporting Information:

This section is probably the most important part of your application, as you have to make your case here for selection. Make sure you complete this in a concise, well organised and positive way. Do not repeat your career history; refer only to the relevant parts.
In considering your experience, reflect on all your previous work. Consider other relevant experience outside work, such as any community, voluntary or leisure activity you have been involved in. Remember that unpaid work or work at home is often just as valuable as being in a paid job.
Express any relevant views on the requirements specified in the job description and person specification in support of your application.

References:

Please give details of two referees including your current or most recent employer. Note references will be taken up prior to interview unless otherwise requested.