Commit2Care Services Ltd

Phone

0333 355 1213

Email

info@commit2care.co.uk

Facebook Twitter Instagram Youtube

Supported Living

Home

Get to Know Us

24 Hour Home Care

Live In Care

Day and Night Care

Hospital Discharge Service

Make Care Enquiry

Contact Us

Home

Get to Know Us

Our Services

24 Hour Home Care

Live In Care

Day and Night Care

Hospital Discharge Service

Make Care Enquiry

Contact Us

Apply Online

Application Form

1Your Personal Details

2Employment

3Education & References

4Skills & Training

5Health & Criminal Record Details

6Statement in Support of Application

7Declaration & Terms

Post Applying for:*
How did you hear about this job?*
Personal Details 1
Name*
Title First Name Middle Name Last Name
Phone*
Mobile No*
Email*
Date of birth*
DD slash MM slash YYYY
National Insurance No:
NMC Pin No:
Address
Your Address*
Street Address City ZIP / Postal Code Country
Personal Details 2
Naitionality*
Gender*
Religion*
Race/Ethnicity*
Sexual Orientation
Upload Current ID Photo*
Accepted file types: jpg, gif, png, docx, doc, pdf, Max. file size: 2 GB.
This Photo will be used on your ID badge as well as your profile, make sure you face is clear.
Employment Eligibility
Are you permitted to work in the United Kingdom?*
- Yes
- No
Can you provide evidence to prove eligibility?:*
- Yes
- No
What visa/permit/status do you currently hold?:*
- Working Holiday
- Work Permit
- Visiting Visa
- Student Visa
- Spouse Visa
- Graduate Visa
- Leave to Remain
- Other
- Not Applicable
Please state what visa/permit you hold:*
Permit/Document No:
Visa/Permit Expiry Date:
DD slash MM slash YYYY

If it has no expiry please put a day 10 years from today.
Upload a copy of your passport/pemit*
Drop files here or

Accepted file types: jpg, gif, png, pdf, docx, doc, Max. file size: 2 GB, Max. files: 4.
You can also take a clear picture from your phone
Upload a proof of address and other relevant documents*
Drop files here or

Accepted file types: jpg, gif, png, pdf, docx, doc, Max. file size: 2 GB, Max. files: 4.
Driving Details
Do you have full Driving Licence that allows you to drive in the UK?*
- Yes
- No
Do you have access to a car that you can use for work?*
- Yes
- No
Have you been banned from driving. or do you have any current endorsements on you licence?*
- Yes
- No
Does you car insurance include Class 1 business insurance? (in order to use you vehicle for work you must have class 1 business insurance)*
- Yes
- No
Are all your documents up to date and valid?*
- Yes
- No
How would you travel to work if assigned?*
Langauages
English - Spoken*
- Fluent
- Good
- Fair
English - Written*
- Fluent
- Good
- Fair
Other Languages Spoken
Next of kin details
Name*
Prefix First Last
Relationship:*
Phone*
Mobile No*
Email*
Address*
Street Address City ZIP / Postal Code Country
Date available to start*
DD slash MM slash YYYY

Save and Continue Later

Employment History
Please give satisfactory explanations of any gaps in employment.
Employer 1
Previous Employer Name:*
Position*
Address*
Street Address City ZIP / Postal Code Country
Employment History
Phone Email Date From and To
Brief Description of Duties Undertaken:
Employer 2
Previous Employer Name:
Position
Address
Street Address City ZIP / Postal Code Country
Employment History
Phone Email Date From and To
Brief Description of Duties Undertaken:
Employer 3
Previous Employer Name:
Position
Address
Street Address City ZIP / Postal Code Country
Employment History
Phone Email Date From and To
Brief Description of Duties Undertaken:

Save and Continue Later

Education
Please supply documentary evidence.
Education*
Institution Course Year Grade
Reference 1
Relationship
Name
First Last
Email
Enter Email Confirm Email
Phone
Address
Street Address City ZIP / Postal Code
Reference 2
Relationship
Name
First Last
Phone
Email
Enter Email Confirm Email
Address
Street Address City ZIP / Postal Code

Save and Continue Later

Skills Experience & Training
Please check which training you have completed and the date on the notes (certificates must be provided).*
- Manual Handling
- Basic life support
- Health and Safety
- Infection Control
- First Aid
- Medication
- DOLLS & Mental Capacity
- Diploma in Health & Social Care L2
- Diploma in Health & Social Care L3
What your Uniform/Tunic Size?

Save and Continue Later

Health Declaration
Do you or have ever suffered from long term illness?:*
- Yes
- No
Have you ever required sick leave for a back or neck injury?:*
- Yes
- No
Do you suffer with any back or neck injuries?:*
- Yes
- No
Have you been in contact with anyone who is suffering from a contagious illness within the last six weeks?:*
- Yes
- No
Do you suffer with a communicable disease?:*
- Yes
- No
Are you currently receiving active medical attention?:*
- Yes
- No
Do you suffer with a communicable disease?:*
- Yes
- No
If you have answered ‘yes’ to any of the above, please give details:
Are you registered disabled?:*
- Yes
- No
How many days have you been absent from work due to illness in the last 12 months?:
State reason(s) for absence:
GP Details
GP Name:
GP Address
Street Address City ZIP / Postal Code Country
May we contact your Doctor for health check?:
- Yes
- No
The above information will be held in strict confidence. If you aware of any health issue that you feel may affect your ability to undertake responsibilities of the post it is your responsibility to inform the Care Manager immediately. Again any details discussed in the meeting will be held in strict confidence.
- I understand that my GP may be contacted for details about my health.
Declaration of Criminal Record
You are required to disclose of any criminal records held against you. Only relevant convictions and other information will be taken into account so disclosure need not necessarily be a bar to obtaining this position. Have you ever been convicted by the courts or cautioned, reprimanded or given final warning by the police? (Note that the work you have applied for is exempt from the Rehabilitation of Offenders Act 1974, which means that all convictions, cautions reprimands and final warnings on your criminal record need to be disclosed.)
*
- Yes
- No
If the answer is yes please give details:*
Have you ever had a police check/Enhanced Criminal Records Bureau DBS check ?:*
- Yes
- No
If the answer is yes please give details / DBS Certificated:*
- I understand that a DBS check will be sort in the event of a successful application.

Save and Continue Later

Statement in Support of Application
Please use this section to provide information to support your application. Refer to the job description and person specification to support your application and provide specific examples where possible.
What motivates you to work in Social Care?*
Why do you want to work for our organisation?*
What skills and values would you bring to the role?*
How would you promote our clients’ independence?*
Give an example of how you have promoted dignity and respect.
Give an example of how you have demonstrated compassion.*
Give an example of something you have achieved as part of a team.*
Please use this space to provide any other information in relation to your application. This could include voluntary work, life experience or transferable skills.*

Save and Continue Later

Terms of employment
I hereby declare that all of the information given above is correct and that I would be legally responsible for with holding any important information or misrepresentation of any relevant facts. An incomplete application form may result in this application not being processed. I also accept that, should my application be successful, I will be required to obtain a satisfactory and acceptable Enhanced Disclosure from the Criminal Records Bureau. I have read and agree to abide by the Terms & Conditions of Engagement as defined in the attached ‘Terms of Engagement’ document. I have no objection to my details being held on computer records and utilised by Commit2Care in the pursuit of its legitimate business
*
- I have read and agree to the terms
Signature
Print Name:
Date:
DD dash MM dash YYYY
Name
This field is for validation purposes and should be left unchanged.

Save and Continue Later

Facebook Twitter Instagram Youtube

Copyright 2016-2024 © All Right Commit2Care Services Ltd

Insert/edit link

Enter the destination URL

URL

Link Text

Open link in a new tab

Or link to existing content

Search

No search term specified. Showing recent items. Search or use up and down arrow keys to select an item.