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Personal Details











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Yes




Availability




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Comments

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.



Knowledge, Skills and Experience

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

Care for close relative or loved oneHome CareLive in care workOther Care Work

Very BasicConversationalFluent


Education




Employment

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.


Details of your Doctor






References

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)



Additional Personal Details


Other Information

If you consider yourself, as having a disability, is there any support you would require attending for interview?


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YesNo

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Rehabilitation of Offenders Act 1974 - Notice to Offenders

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.


YesNo

This information will be treated as confidential and will not necessarily preclude you from employment.


Health Screening

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.

Declaration of Health


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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.

Yes



Equal Opportunities

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.


BritishIrish

IndianPakistaniBangladeshiAny Other Asian Background

CaribbeanAfricanAny Other Black background

ChineseAny other ethnic group

Not Stated

MaleFemale

Next of Kin

Due to the specific nature of the role, it is useful to have recorded details of a contact person /s in case of Emergency









Alternative Contact










Confidentiality Statement

CLIENTS

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.



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Live In Care Areas That We Cover

UK Areas:

Live In Care Job Application Form Berkshire

Live In Care Job Application Form Berkshire

Live In Care Job Application Form Berkshire, from Bracknell to Reading, Slough to Windsor and Wokingham to Newbury

Live In Care Job Application Form Cornwall

Live In Care Job Application Form Cornwall

Live In Care Job Application Form Cornwall, from Penzance to Bodmin, Newquay to St Austell and Truro to Camborne

Live In Care Job Application Form Devon

Live In Care Job Application Form Devon

Live In Care Job Application Form Devon, from Plymouth to Paignton, Exeter to Exmouth and Torquay to Tiverton

Live In Care Job Application Form Dorset

Live In Care Job Application Form Dorset<

Live In Care Job Application Form Dorset, Bournemouth to Bridport, Poole to Portland and Dorchester to Christchurch

Live In Care Job Application Form Gloucestershire

Live In Care Job Application Form Gloucestershire

Live In Care Job Application Form Gloucestershire, from Cheltenham to Stroud, Gloucester to Tewkesbury and Cirencester to Dursley

Live In Care Job Application Form Hampshire

Live In Care Job Application Form Hampshire

Live In Care Job Application Form Hampshire, from Ringwood to Basingstoke, The New Forest to Portsmouth and Winchester to Southampton

Live In Care Job Application Form Oxfordshire

Live In Care Job Application Form Oxfordshire

Live In Care Job Application Form Oxfordshire, from Banbury to Oxford, Bicester to Didcot and Witney to Abingdon

Live In Care Job Application Form Somerset

Live In Care Job Application Form Somerset

Live In Care Job Application Form Somerset, from Bath to Bridgwater, Chard to Minehead and Taunton to Yeovil

Live In Care Job Application Form Surrey

Live In Care Job Application Form Surrey

Live In Care Job Application Form Surrey, from Camberley to Dorking, Egham to Epsom and Farnham to Guildford

Live In Care Job Application Form West Midlands

Live In Care Job Application Form West Midlands

Live In Care Job Application Form West Midlands, from Birmingham to Coventry, Dudley to Sutton Coldfield and Walsall to Wolverhampton

Live In Care Job Application Form Wiltshire

Live In Care Job Application Form Wiltshire

Live In Care Job Application Form Wiltshire, from Swindon to Melksham, Salisbury to Trowbridge and Chippenham to Amesbury

Areas Outside the UK:

Live In Care Job Application Form Gibralter

Live In Care Job Application Form Gibralter

Live In Care Job Application Form Gibraltar, from Punta Pasajes to Trinity Lighthouse, camp bay to sandy bay and Queensway Quay Marina to The Rock Of Gibraltar

Live In Care Job Application Form Jersey

Live In Care Job Application Form Jersey

Live In Care Job Application Form Jersey, from St.Helier to Grouville, St. Brelade to St. Peter and St Clement to St. Saviour

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