Apply For A Job – Portal – Sulem Care Limited

Carer STANDARDS

In order to guide the interview process, we would like you to indicate your personal philosophy of Care by completing the following statement:

I believe that the purpose of Care from a Care service is:

If I were a Service User in The Agency I would like:

As a member of The Agency Care team I feel valued when:

I believe that a good relationship between me and the Service User depends on:

I believe that I learn best when:

I believe that a good working team is made by:

My other beliefs and values of relevance to my job are:

I believe that my role in relation to the Service User is:

I believe that the Service User’s family and relatives would like from The Agency:

I believe that I can support a Service User in The Agency because:

APPLICATION FORM

Sulem care Limited OFFICE 5, SECOND FLOOR 66 LONG LANE LIVERPOOL L9 7BN 07471861724

The recruitment process within this organisation has a minimum of two stages.

The completion of this application form is part of stage one. This application will be reviewed, and a decision made as to whether to proceed to stage two, the interview, based on this information. PLEASE COMPLETE FULLY

Full Name

Other Names

Supply documentary evidence e.g. marriage certificate, deed of name change etc

Email Address:

Address

Address Information

Current Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

When did you move into this address?

Contact numbers

Telephone number (home):

Telephone number (work):

Transport

Do you have your own transport:

Yes
No

Do you have a clean Driving License?

Yes
No

How long has your licence been held?

Education

Upload Copies of your qualifications

Please upload original copies of your certificates in the upload section

Qualifications

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School / College / University

Exam Board - Subject

Grade / Result

TRAINING HISTORY / PROFESSIONAL STATUS

Training History

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Date of Graduation / Qualification

Location / Details

Additional Notes

ADDITIONAL COURSES ATTENDED

Additional Courses

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Subject

Location

EMPLOYMENT HISTORY

Current/most recent first. Information must cover the whole of your working life to date. State the reasons for any breaks in employment.

Employment

Name and address of your most recent/last employer:

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Date employed:

Position held:

Reason for leaving:

Nature of business:

Salary / Rate:

Leaving date:

Brief description of role

ASSISTANCE WITH INTERVIEW AND ASSESSMENT

This information will not be used in reaching a decision on whether to offer employment.

Do you require us to make any special arrangements for you to participate in the recruitment process? For example, large print forms? Or additional time to complete forms?

GP’s name:

GP’s Address:

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

GP Contact Number:

(Your GP will never be contacted without your permission)

Next of Kin

For emergency purposes, please fill out your next of kin information

Full Name

Contact number

Relationship to you

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Are you a registered Nurse/Midwife

Yes
No

National Insurance Number:

Capacity to work in the UK

Note: Minimum age legislation dictates that Care workers in general must be 16 years old or older. Please inform your interviewer immediately if you do not meet these specifications.

Are there any restrictions to your residence in the UK which might affect your right to take up employment in the UK?

Yes
No

If you are successful in the application, would you require a work permit prior to taking up employment?

Yes
No

REFEREES

You must provide references from your two most recent employers. Please provide an additional character referee. All will be contacted, therefore please inform the referees of the fact that you have used their name. If you are unable to provide the required references, please discuss the matter with us.

The order is as followed:

1) Current / Most recent employer
2) Previous employer to the one above
3) Character Reference

Repeater

Full Name:

Address:

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

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Contact Number:

Email Address:

Job Position

The job position of the referee

CRIMINAL RECORD

Workers of The Agency are subject to the Health and Social Care Act 2008, and will be subject to a Police Record Check through the DBS. Please declare all criminal convictions, whether spent or not, charges, whether proceeded with or not, and warnings and cautions.

Please note, you may not be eligible for work in a Care setting if you are on the DBS Register(s).

Please declare all criminal convictions, whether spent or not, charges, whether proceeded with or not, and warnings and cautions in the space provided below.

SIGNATURE and DECLARATION – IMPORTANT – READ BEFORE Agreeing

Signature and declaration

I agree

I declare that to the best of my knowledge and belief the information given by me in this application is true, and I understand that the above information forms the basis of my contract of employment. I understand that if any of the information supplied by me is found to be falsely declared, my contract may have been fundamentally breached and my employment may be terminated immediately.
I understand that I may not be offered a post until a satisfactory response has been received with respect to my DBS Register status, and that should I subsequently be offered a post, that offer will be subject to receipt of two satisfactory references, one of which must be from my previous employer, and that confirmation of the employment will be subject to a satisfactory criminal record check from the DBS.
I understand that until a satisfactory response is received from the DBS, and my employment is confirmed, I will be supervised always at work, and will not seek or have unsupervised access to vulnerable people. If the post I have applied for is as a Registered Nurse, my confirmation of employment will also be subject to a satisfactory search of the Nursing and Midwifery Council records and registers. By my signature, I authorise Sulem Care Ltd to request a DBS Register check and a criminal record check from the DBS, on initial employment and at any time during my employment thereafter. I undertake to inform my employer immediately if my DBS Register status or criminal status changes at any time during my employment, such as by being charged with an offence (other than motoring offences), the administering of a warning, criminal conviction, referral to any register of barred Care workers, or withdrawal of any registration required by my employment status.

EMPLOYMENT CONTINUITY CHECK

It is essential to check the continuity of employment, as stated in the application form, and to note and investigate any gaps in employment. Failure to carry through such checks has been identified as a significant factor in several recent abuse cases.

Employment Continuity Check

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Date:

Reason for gap:

IDENTITY CHECK

Identity is established by selecting one item from sections 1 or 2 and one from section 3

Section 1 - Photographic

Passport
New Style Driving License

Section 2 - Birth Certificate

Birth Certificate with the correct name
Birth Certificate in another name, with evidence of change of name

Section 3 - Proof of address

Utility bill, correct name and address, and no less than 3 months old, and paid
Credit card statement, correct name and address, and no less than 3 months old
Bank statement, correct name and address, and no less than 3 months old
Council tax bill, correct name and address, and no less than 3 months old
Other

Thank you for completing the application.

All your information will now be processed and a member of our team will soon be in touch! Please press Submit Application to submit your application