Application Form

Milford Del Application Form

1. Application Form

Select which one you want to work

Multiple choice

2. Personal Details

Previous surnames (Supply documentary evidence e.g. marriage certificate, deed of name change etc): Please state name used from and to month and year inclusive.

Note: For Criminal Record check purposes, addresses covering the five years up to the application date must be supplied. If necessary, attach another sheet of paper. Please always include month and year for date period.

3. Education/Qualifications

Please supply copies of certificates

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Maximum size 10MB

4. Education/Qualifications

Please supply copies of certificates/membership details

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Maximum size 10MB

5. Additional Courses Attended
6. Employment History
7. Assistance with Interview and Assessment

This information will not be used in reaching a decision on whether to offer employment.

8. Next of Kin
9. Identity Details

Nurses only

All applicants

10. Capacity to work in the UK

Minimum age legislation dictates that care workers in general must be 16 years old or older. Please inform your interviewer immediately if you do not meet these specifications.

11. Referees

• You must provide references from your two most recent employers. Please provide an additional character referee. All will be contacted, therefore please inform the referees of the fact that you have used their name. If you are unable to provide the required references, please discuss the matter with us.

Current or most recent employer
Previous employer to the one above
Character Reference
12. Criminal Record

• Workers of The Home are subject to the Health and Social Care Act 2008, and will be subject to a Police Record Check through the DBS. Please declare all criminal convictions, whether spent or not, charges, whether proceeded with or not, and warnings and cautions.

• Please note, you may not be eligible for work in a care setting if you are on the DBS Register(s).

Signature and Declaration - IMPORTANT - Read before signing

I declare that to the best of my knowledge and belief the information given by me in this application is true, and I understand that the above information forms the basis of my contract of employment. I understand that if any of the information supplied by me is found to be falsely declared, my contract may have been fundamentally breached and my employment may be terminated immediately. I understand that I may not be offered a post until a satisfactory response has been received with respect to my DBS Register status, and that should I subsequently be offered a post, that offer will be subject to receipt of two satisfactory references, one of which must be from my previous employer, and that confirmation of the employment will be subject to a satisfactory criminal record check from the DBS. I understand that until a satisfactory response is received from the DBS, and my employment is confirmed, I will be supervised at all times at work, and will not seek or have unsupervised access to vulnerable people. If the post I have applied for is as a Registered Nurse, my confirmation of employment will also be subject to a satisfactory search of the Nursing and Midwifery Council records and registers. By my signature, I authorise Park Mews T/A Sea Gables Residential Care Home to request a DBS Register check and a criminal records check from the DBS, on initial employment and at any time during my employment thereafter. I undertake to inform my employer immediately if my DBS Register status or criminal status changes at any time during my employment, such as by being charged with an offence (other than motoring offences), the administering of a warning, criminal conviction, referral to any register of barred care workers, or withdrawal of any registration required by my employment status.

13. Rehabilitation of Offenders Act

Please Complete This Next Section As You Are Applying For A Post Where You Will Have Contact With Children/Young People Or Vunerable Adults As a general rule, no-one need answer questions about spent convictions. However this general rule does not apply to specific professions, employments and occupations. By virtue of the Rehabilitation of Offenders act 1974 (Exceptions) (Amendment) Orders, the exemption rule does not apply to: A) any employment or other work which is concerned with the provision of health services and which is of such a kind as to enable the holder of that employment of the person engaged in that work to have access to persons in receipt of such services in the course of his normal duties, or B) any employment or other work which is concerned with the provision of care services to children or vulnerable adults and which is of such a kind to enable the holder of that employment or the person engaged in that work to have access to children or vulnerable adults in receipt of such services in the course of his normal duties One or both of the above apply to work at the service, and covers all occupations. You are therefore requested to provide details of all convictions, including those which would otherwise be considered as “spent”. All employment applications will be considered carefully, and the disclosure of a conviction does not imply that this employment application will be rejected. Please tick as appropriate below:

14. Declaration

I declare that the information given on this application is true to the best of my knowledge; I understand that my deliberate, misleading statements or omissions my lead to withdrawal of any offers of employment or render me liable for dismissal if appointed.

15. Data Protection Statement

The personal information collected on this form, and on the attachments, (which includes the collection of sensitive personal data) are collected for the purposes of recruitment, personal administration (for new employees) and monitoring. Unless you direct otherwise the application forms (and attachments) of unsuccessful applicants will be destroyed after 3 months. It is the policy of the company organisation to protect, and keep secure, all personal data collected. All personal data is processed to the purposes of recruitment, and, in the case of successful applicants, for the satisfactory administration of their employment at the service, and for no other purpose.

16. Diversity and Equal Opportunities Monitoring

Policy

Milford Del Support Agency will take measures to ensure that its Equal Opportunities Policy is observed, and will ensure that all those involved in the selection process are aware of the obligations and duties imposed by relevant employment legislation (including Equal Opportunities, Discrimination and Data Protection). In order to satisfy these obligations and duties and to monitor the effectiveness of this policy, certain personal sensitive data will be collected from Job Applicants. This information will not be used in order to select individuals for employment, but some sensitive personal data (regarding criminal convictions and physical/mental health) may be used in order to verify the safety of proceeding with either an application or a job offer.

Procedure

The Data Protection Act sets out a series of conditions, at least one of which has to be met before an employer can collect, store, use, disclose or otherwise process sensitive personal data. The Information Commissioner, in the guidance document “The Employment Practices Data Protection Code – recruitment and selection” (March 2002) as provided guidance as to what constitutes sensitive personal data.
Sensitive personal data are information concerning an individual's:

  • Racial or ethnic origin
  • Political opinions
  • Religious beliefs or other beliefs of a similar nature
  • Trade Union membership
  • Physical or mental health or condition
  • Sexual life
  • Commission or alleged commission of any offence, or
  • Proceedings for any offence committed or alleged to have been committed, the disposal of such proceedings or the sentence of any court in such proceedings
In addition to the above, the collection of information about an individual’s age, sex, or marital status is potentially suspect if it is used to support unlawful discrimination.
As an employer, and as a facility in which vulnerable adults entrust their care, the Service has a duty to ensure that appropriate and satisfactory checks have been made regarding an employee’s:

  • Criminal record
  • Physical and mental health
In ensuring that relevant information is made available during the recruitment and selection process, and in order to collect information which allows monitoring on the equal opportunities policy of the company, sensitive personal data will be collected separately from all the other information at the application stage. This information will be treated in the strictest confidence and will not be used as part of the selection process. However certain information (typically from information regarding physical/mental health or criminal records) may come to light which could result in the application process being halted, or an offer being withdrawn.
Sensitive personal date collected will include:

  • Criminal record
  • Physical and mental health, including details about any disability
  • Ethnic origin
  • Age
  • Gender
  • Marital status
All Job Applicants will be asked to consent to the disclosure of such information EQUAL OPPORTUNITIES MONITORING.

The company will take measures to ensure that its Equal Opportunities Policy is observed, and will ensure that all those involved in the selection process are aware of the obligations and duties imposed by relevant employment legislation (including Equal Opportunities, Discrimination and Data protection) In order to satisfy these obligations and duties and to monitor the effectiveness of this policy, certain personal sensitive data will be collected from Job Applicants. This information will not be used in order to select individuals for employment, but some sensitive personal data regarding criminal convictions and physical/mental health may be used in order to verify the safety of proceeding with either an application or a job offer.

The following information is requested in order to allow the company to monitor the effectiveness of its equal Opportunities Policy. You are requested to complete this form, and sign it. This will indicate your explicit consent to the collection and processing of such data in accordance with the principles of the Data Protection Act.

Thank you for your co-operation.

This information is used for monitoring purposes only and will not be available during the selection process.

Data Protection Statement

The above information is used to enable us to monitor and reinforce our promoting Diversity policy. Please note that disability is defined in relation to the Equality Act 2010 which covers any sensory, physical and mental health impairments, which could affect your ability to perform normal duties at work.

Data Protection Statement

The personal information collected on this form, and on the attachments, (which includes the collection of sensitive personal data) are collected for the purposes of recruitment, personal administration (for new employees) and monitoring. Unless you direct otherwise the application forms (and attachments) of unsuccessful applicants will be destroyed after 3 months. It is the policy of the company organisation to protect, and keep secure, all personal data collected. All personal data is processed to the purposes of recruitment, and, in the case of successful applicants, for the satisfactory administration of their employment at the service, and for no other purpose.

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