Konnect - Optimised SQL Server systems for Non Technical People

Carer Application Form

Your Details
Title
First Name
Surname
First line of address
District
Town or City (place,region,district,country listed) *
County
Postcode
Telephone
Mobile
Email
Date Of Birth
National Insurance Number

Work History

Work history

Employer	Dates Worked	Responsibilities

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Education

Education History

School / College / University	Qualification	Grade / Result	Date Of Qualification

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Referees

Please give the names of two referees who can provide professional or educational references. • The first must be from your present or last employer/voluntary organisation. If you cannot give an employer, please provide the name of someone who can provide an educational reference. • The second should be a previous employer. If you cannot provide a previous employer, please give either an educational referee or the name of someone who has known you for 3 years who can provide a character reference. • If neither of the two referees given have known you for a period of 3 years or more, please provide an additional referee. This could be a further previous employer, an educational referee, or someone who has known you for 3 years who can provide a character reference.

Referees - two please

Referee Name	Job Title	Address	Telephone	Email

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Ticklist
Are you okay to travel within 10 miles of your home ?
Are you free of any legal restrictions in respect of your employment in the UK ?
Are you subject to a sanction or have you been at any time barred from working with vulnerable adults by the DfES, HCPC or been placed on List 99, POVA or PoCA?
Are you free of any criminal convictions that could restrict your employment with us ?
Can you work without supervision ?
Do you have good oral and written communication skills ?
Can you work under own initiative and under pressure ?
Have the ability to carry out physical care tasks, handling and moving techniques (experience of manual handling is preferred, but training will be given).
Flexibility when called upon ?
Must be able to work effectively as a team member
Have a current driving license and use of a vehicle

Job Notes
In your own words, please tell us why you want this position, what you can bring to the team, and the values it would give yourself

Signature
I hereby give my consent to Made To Measure Care Finder to process the data supplied in this form for the purpose of equal opportunities monitoring in recruitment and selection. I acknowledge that my application will be treated the same regardless of whether or not I complete this form. I understand that I may withdraw my consent to the processing of this data at any time by notifying the Data Protection Officer.
Signature
Date Of Application
Approved