Please complete the following application form to the best of your ability (along with any supporting documents), and we will contact you if successful for an interview to be an introduced self-employed carer.
Please tell us why you would succeed in this position, setting out relevant knowledge, skills and experience you have gained from current/previous employment or voluntary/community work.
You should also provide any other information that may be of interest and relevant to the position. Please also describe your aspirations and ambitions.
I have the following care skills, care qualification and care experience. Please select all the relevant boxes that apply (Proof maybe required)
AspergersBehaviours That ChallengeCancer CareCatheter CareCOSHH TrainingDementia (Alzheimer, Vascular)End of life / Palliative CareEpilepsy / Buccal midazolamIncontinenceLearning Disability (Autism, Down Syndrome etc)Manual HandlingMedication TrainingMental Health (Schizophrenia, Depression, Bi-Polar)Multiple SclerosisOlder PeoplePalliative Care (Cancer, Brain Tumours, End Of Life)Parkinson’sPeg FeedingPersonal CarePhysical DisabilitiesSensory Disabilities (Blind / Deaf)Spinal InjuryStomaStroke / Brain InjuryTracheostomy
MedicalNursingNVQ Health and Social CareOccupational Therapy
General Care Experience
Care for close relative or loved oneHome CareLive in care workOther Care Work
English Language Level
You must provide a full employment history from the last ten years. If you were not working for any point within these periods please indicate.
Please give the name and address of two referees, one of whom should be your present employer.(By completing this section, you agree to Living Carers Ltd contacting them before, during or after an offer of employment has been made)
If you consider yourself, as having a disability, is there any support you would require attending for interview?
Please specify (e.g. wheelchair, accessible rooms, etc.)
Because of the nature of the work involved, the post for which you are applying is exempt from Section 4(2) of the Rehabilitation of Offenders Act 1974 by virtue of the Rehabilitation Offenders Act (Exemption Order 1975). This means that you are not entitled to withhold information relating to any convictions you may have had.
This information will be treated as confidential and will not necessarily preclude you from employment.
The appointment of any post is subject to satisfactory health screening. You will therefore be asked to complete a Declaration of Health and may be asked to undertake a medical examination if successful.
I declare that the information given is correct to the best of my knowledge, and has been completed by myself.
I also understand that any omissions or false statements is a criminal offence to gain employment and may disqualify me from employment or lead to dismissal.
I give the employer the right to investigate all references.
This information will not in any way affect your application.
How would you describe your ethnic origin?
This applies to people who share the same cultural background and identity, NOT country of birth or nationality. These categories are the same as used in the National Census.
Due to the specific nature of the role, it is useful to have recorded details of a contact person /s in case of Emergency
I fully understand that all matters concerning clients, their personal, financial and other affairs are confidential and are NOT to be disclosed to other persons, staff members or any other party.
I also understand the clients sometimes wish to keep information from relatives and I will respect that wish.
There is a bit of a time delay when you submit this form. Click ‘Submit’ and then wait until you see the message saying that it has been submitted. There is no need to click submit multiple times.
I agree that everything above is correct to the best of my knowledge - SUBMIT
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