Job Application

Step 1 of 11

Section 1: Personal Details

You are required to provide evidence of the above details at your interview by bringing with you:

Proof of eligibility to work in the UK (Passport / Visa etc.)
Driving License & Counterpart if applicable
Photo ID Card
Proof of NI number
Proof of address (dated within last 3 months)
Past 5 years of address (including postcode, moving in and out dates)
Dates of any name changes
Complete CV from high school to date, all gaps explained
2 x references (1 from your most recent employer, 1 from your next most recent employer)

Referees will be contacted to verify the references given.

All documents must be translated into English where applicable.

Step 2 of 11

Section 2: Rehabilitation of Offenders Act

It is important that you read the 'Filtering rules for criminal record check certificates' guidance prior to completing this section of the application form. A copy is available on the Disclosure and Barring Service website.



Filtering rules: As of 29 May 2013 you are no longer required to disclose information about any 'filtered' offences... Guidance can be found on the Disclosure and Barring Service website.



Subject to the filtering rules failure to declare a conviction may result in exclusion or termination of assignment if later discovered.



As an exception to the Rehabilitation of Offenders Act 1974, certain roles require disclosure of all spent and unspent convictions.

Not Applicable
Yes
Step 3 of 11

Section 3: Health

Ft care Agency Limited operates an equal opportunities policy

Flexible Employee Health & Safety Declarations

All employers must have a Health & Safety Policy stating who is responsible for Health & Safety and the Health & Safety arrangements in place. All Flexible Employees have a duty under The Health & Safety Act to take reasonable care to safeguard their own safety and the safety of anyone who may be affected by their work activities and actions and to co-operate with the Client and others in meeting statutory regulations.

It is your responsibility to familiarize yourself with the Clients policy, particularly the procedures for fire, first aid and accidents upon arrival at the Clients premises. The Act also requires Flexible employees not to interfere with or misuse anything provided to protect their health, safety or welfare in compliance with the Act.

Please complete the following questions to help FT Care Agency Limited provide you with a suitable working environment and ensure we can support any special requirements or reasonable adjustments you may need.

Health & Safety Assessment Declaration for Night Workers

In compliance with the working time regulation the purpose of this declaration is to assess your fitness to carry out night work whilst on assignment from FT Care Agency Limited. Whilst there is no difference in the physical demands of night work compared today work the human body is naturally programmed to sleep at night. The disruption to this sleep pattern can aggravate certain medical conditions, albeit often temporarily. Additionally, the reduced access to services and facilities that may be apparent both inside and outside the workplace at night can have an effect.

Please answer the following questions. If your answers raise doubts about your fitness for night work, then unfortunately you may not be assigned to Clients for night work unless you are able to provide proof that you are physically able to do so having been assessed by a suitably qualified health care professional.

If YES, are these based on:

Working Time Regulations 1998 – 48 Hour Opt Out Agreement

This agreement gives notice to my employer of my intention to opt-out of my statutory right to limit my working week to a maximum of 48 hours over a 17 week reference period.

I agree that I waive my statutory right not to be required to work more than an average of 48 hours per week over the relevant reference period as it may be defined from time to time and as provided in the Working Time Regulations 1998.

I confirm that I waive my statutory right entirely voluntarily and understand that I will not be treated detrimentally if I do not waive such right.

I understand that if I wish to exercise this right and limit my average working week to 48 hours over the relevant reference period, I will give my employer twelve weeks' notice of my intention to end this agreement. During the twelve weeks' notice period, I understand that I may still be asked to work more than 48 hours in any week.

Step 4 of 11

Section 4: Education


Please list all schools attended in chronological order, starting with the most current.


Step 5 of 11

Section 5: Employment Record


Please list your complete employment record including employment dates, positions, duties, and reasons for leaving.


Step 6 of 11

Section 6: Experience & Training Assessment

GENERAL

Residential
Nursing
Dementia
Brain Injury
End of Life
Learning Disabilities
Hospital Environment
Mental Health
Physical Disabilities
Support Work

MOBILITY

Moving and handling
Use of Hoist
Walking Aids
Slide sheets/transfer aids
Wheelchair
Transfer

FOOD/DRINK

Food Hygiene Regs
Meal preparation
Snacks

TOILETING

Catheter bags
Colostomy bags
Bed Pans
Commodes

OBSERVATIONS

BP
Pulse
Temperature

HEALTH & SAFETY

Risk assessment
COSHH
RIDDOR
PUWER
LOLER

DOMESTIC

Housework
Laundry
Bed making
Shopping
Payment of bills
Handling money
Ironing
Washing up
Care of pets
Home maintenance
Light gardening

PERSONAL TASKS

Washing
Bathing
Shaving
Teeth
Hair
Putting to bed
Getting up
Dressing
Undressing
Finger nails

HEALTH

Administration of medicines
Foot care
Infection control
Collecting medicines
Step 7 of 11

Section 7: Personal Attributes & Statement



Use this space to add further information about your suitability for this opportunity (e.g.: Mental health, Brain injury, Learning disability and reference any other areas that highlight your key skills)

Step 8 of 11

Section 8: Next Of Kin Information

Please provide details of an emergency contact that we can call in an unexpected incident, accident or emergency.


Step 9 of 11

Section 9: References

Please give the names and addresses of your two most recent employers (if applicable). If you are unable to do this, please clearly outline who your referees are.


Reference 1
Reference 2
Step 10 of 11

Section 10: Consent Forms, GDPR, DBS and Staff Handbook Receipt

Staff Consent

This consent is to protect staff information which is currently held under Data Protection Act 1998 and the Freedom of Information Act 2000.


GDPR – General Data Protection Regulations


In May 2018 the law changed about how companies record, store and use individuals' personal data. Currently the Data Protection Act covers how this is managed, but this new GDPR law means we have to change some of our working practices.


As a company we need to collect and hold data about you to enable us to process your job application. The GDPR laws places a further (and new) obligation for employers to tell their job applicants in more detail why we collect your data, what we do with it, and how long we expect to retain it.


We wish to obtain your informed consent about the data that we may hold about you as it provides you with a better understanding of how we will use your data. We are not planning to transfer your data outside the EU.


We would like to request your consent to hold personal and special data about you in order that we can process your employment application.

Type of data Why we wish to hold it How long it will be kept for
1 Recruitment data
  • Previous employers
  • Types of job held at other companies
  • Previous salaries
  • Skills and qualifications obtained

This will allow us to make a decision on your suitability for employment/engagement.

It will help us to decide which dept. you may be most suitable in.

Data obtained during recruitment will only be kept until either your application has been declined and then destroyed after 6 months.

If a job offer is made a more comprehensive GDPR consent form will be issued.
2 Health & Safety To assess candidates' fitness to carry out day/night work whilst on assignment. This data will be kept for the duration of this round of applications and will be anonymised and stored for 4 years afterwards.
3 Ethnic monitoring data

Data relating to your racial origin, religion, gender, sexual orientation, etc. that are classed as protected characteristics under the Equality Act 2010

 We use this data to understand the ethnic makeup of our workforce and job applicants and it allows us to inform our recruitment process if we believe we do not have the correct diversity This data will be kept for the duration of this round of applications and will be anonymised and stored for 4 years afterwards.

Agreement to Use My Data

DBS/Update Service

Please enter the details of DBS to check if you have one


Step 11 of 11

11. Declaration

I confirm that the information provided in this application (and within my Curriculum Vitae if applicable) is both truthful and accurate. I have omitted no facts that could affect my employment. I understand that any false misleading statements could place any subsequent employment in jeopardy. I understand that any employment entered is subject to documentary evidence of my right to work in the UK and satisfactory references. I expressly consent to personal data contained within this form being recorded for the purposes of assessing suitability for the post and may form the basis of any subsequent personnel file. I also consent to FT Care agency limited disclosing my personal information, such as, but not limited to: CV, forms of ID, proof of CRB, European Criminal Record, Diplomas/certificates, to a third party in order to find me suitable employment.

The personal information (data) collected on this form, and on the attachments, (which includes the collection of sensitive personal data) are collected for the purposes of recruitment, personnel administration (for new employees) and monitoring. Unless you direct otherwise (for example in a situation where you would like this Application kept on file for future vacancies) the Application Forms (and attachments) of unsuccessful applicants will be destroyed after 6 months. It is the policy of the Company to protect, and keep secure, all personal data collected. All personal data is processed for the purposes of recruitment, and, in the case of successful Applicants, for the satisfactory administration of their employment, and for no other purpose.

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