Job Applied For

Area

Title

Forename

Surname

Address

Postcode

Contact Telephone Number

Email Address

Do you need a work permit to take up this post?

Are you eligible to work in the UK?

Are you an existing member of the PVG scheme?

If yes, what is your PVG number?

Do you have a full valid UK driving licence?

Prior Training - Please list all your prior training and qualifications you have received. Please note that we will ask you to provide certificates if you are successful in obtaining an interview.

About You

The following part of the application form asks you to rate yourself on a scale of 1 to 10, 1 being ‘not at all’ and 10 being ‘very’. The statements are aimed at determining how well you will fit in with the Home and how you rate your skills within the care environment.

I am well qualified for this job:

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I am experienced in care:

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I am a good communicator:

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I am flexible with my time:

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I am flexible with my work and that tasks that I do:

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I am/have the potential to be a good leader:

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I am a good problem solver:

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I enjoy caring for people:

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I am punctual:

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I have a good sense of humour and am at home working in a fun relaxed atmosphere:

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I am open to learning and accept constructive criticism that will improve my performance:

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I am highly motivated and will not accept work that is anything other than the highest standards of care:

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Statement in Support of Application

Please tell us your personal qualities, skills and attributes, experience and any major achievements and show how they match those needed for this job in line with the job description and person specification.

Referees

Your referees will include your present (or most recent) employer. Please identify below the person in your organisation who is authorised to confirm your employment and the details given in your application. Please identify a second referee who may have closer knowledge of your skills, knowledge and abilities and who may offer opinion on your suitability for this post. You should not use family members or friends.

Referee 1 Name

Designation

Address

Telephone Number

Email Address

Referee 2 Name

Designation

Address

Telephone Number

Email Address

Employment History

Please use this section to describe your past experiences and show how they have prepared you with the relevant skills for the position you are applying for. Please include start and end dates. You may also attach a CV with this information.

CV Upload

Most Recent Employment

Previous Employment 1

Previous Employment 2

Previous Employment 3

Declaration

If any item of information given on this form is subsequently found to be false, I understand this could result in the Termination, Summary dismissal or Variation of any offer of employment. I agree the company may approach my current/past employers for references*. I understand that completion of this form does not imply intent or obligation on the part of this organisation to provide employment.

• I have completed all pages of this application form and the details I have supplied are, to the best of my knowledge, true and complete;

• I understand that if appointed to this post the information on this form will be kept as part of my personal file record;

• I understand that details of educational qualifications, membership of professional bodies and referee reports may be verified through the establishments and individuals I have indicated;

• I consent to my details being kept confidentially and used for specific and lawful purposes as specified in the Data Protection Act 1998;

• I declare that I have no previous convictions, or have identified any I have below.

Signed

Date Input

Convictions

As in accordance with the Rehabilitation of Offenders Act 1974 (Exclusions and Exceptions) (Scotland) Order 2013 all applicants to Home Care Scotland are not entitled to withhold information about convictions, which for other purposes of the Act are “spent”. Please declare any convictions in the space provided or write “none” as appropriate, then sign and date below.

Signed

Date Input

Submit