Application Form

1. Application Form
Position applied for*
Date available to take up employment*
Date Format: DD slash MM slash YYYY
Salary expectations
2. Prepared for work
Full time*
Shift work*
Part time*
3. Personal details
Full name*
Title*
Address*
Telephone number (home)
Telephone number (mobile)*
Email address*
Enter Email Confirm Email
National insurance Number
Passport number/ Identity card
Issue date
Date Format: DD slash MM slash YYYY
Do you own a car?*
Have a current licence?*
If yes, licence type
Driving licence number
Do you have any current driving convictions*
If yes, give details including dates

4. Secondary education
School name, address and date attended*
Examinations (subject, result, etc.)
5. Further education and training
Type of course
University/College and date attended
Subjects
Qualification or class of degree
6. Occupational qualifications
College/Institute or other name and date attended
Qualification/Level
7. Membership of professional body
Name
Level
Date
Date Format: DD slash MM slash YYYY
8. General
Interests/hobbies (give details of pastimes, sports, etc.)*
Public duties (local councillor, etc.) undertaken
Offices held in social/sports clubs, etc.
If offered this position will you continue to work in any other capacity?*
If yes, give details

9. Permission to work in the UK
Are there any restrictions to your residence in the UK that might affect your right to take up employment in the UK?*
If you are successful in your application would you require permission to work in the UK?*
10. Community/volunteer experience
Name and address of organisation
Position/title
Duties
11. Next of kin
Emergency contact name*
Relationship to you*
Contact number*
12. Previous employment
Present/last employer
Address
Job title
Duties/responsibilities
From (month & year)
Date Format: MM slash DD slash YYYY
To (month & year)
Date Format: MM slash DD slash YYYY
Reason for leaving
Gaps in Employment.
Can we contact your most recent employer after your interview if successful

13. Referees
Work reference 1 (most recent employer) – not members of your own family
Name
Address
Organisation
Occupation
Telephone number
Email address
Work reference 2 – not members of your own family
Name
Address
Organisation
Occupation
Telephone number
Email address
Work, personal or educational – not members of your own family
Name
Address
Organisation
Occupation
Telephone number
Email address

WORKING TIME DIRECTIVE OPTING OUT OF WORKING TIMES
I understand that I do not have to work more than 48 hours per week legally

However, through my own choice I would like to work more than 48 hours per week.
I will work over 48 hours per week as required*
If yes, I will not work anymore than:
I understand and agree that I can change or terminate this agreement at any time, subject to 28 days’ written notice.
Applicant Name:*
Signature:*
Date*
Date Format: DD slash MM slash YYYY

APPLICANT PROFILE: AVAILABILITY AND WORK HISTORY
Please complete this section to let us know when you are available to work.

AVAILABILITY – when will you be available to work?
Hours of Work / Types of Shifts
Full time*
Part time*
Live in*
Nights*
Breakfast and lunch (06.00 – 14.00) | To select (ctrl+click)
Teas and beds (16.00 – 22.00) | To select (ctrl+click)
GENERAL INFORMATION
Are you willing to work in a customer’s home or environments where there are smokers? (Please be aware that Sunshine Homecare Stafford operates a No Smoking policy*
Are you willing to work where there are domestic pets?*

The General Data Protection Regulations 2018 requires that any staff handling personal data must follow certain principles in relation to the data that they hold. Individuals have rights of access to data that is held and rights to claim for damages if various offences occur. This covers manual as well as computerized records. In implementing the legislation, Sunshine Homecare Stafford adopts a simple and straightforward policy. If you are unsuccessful in this application, we will keep this form on file for 6 months should you wish to be considered for other vacancies within Sunshine Homecare Stafford
Please tick to show your agreement to this.*
- I agree
Date of previous application
Date Format: DD slash MM slash YYYY
Previous position applied for
Did the application go through to interview
If yes, what was the outcome
Criminal Record Check
I have completed an application for a criminal record check and can further state that to the best of my knowledge and belief, there will not be any positive disclosure made that will preclude me from working with vulnerable adults or children.I also give permission for a copy of the disclosure to which I am subject, being made available to a named authorised person upon written request, who acts on behalf of a National Government or Local Government Department for auditing purposes.
If you have an offence registered, please give brief details here:
Applicant Name:*
Signature:*
Date*
Date Format: DD slash MM slash YYYY

RECRUITMENT OF EX-OFFENDERS ENGLAND & WALES
What our customers can expect

Sunshine Homecare’s recruitment of ex-offenders’ policy is in place to ensure all customers and employees are protected from potential harm.

Aims

The aims of this policy and procedure are:
- To ensure a safe environment for all customers and employees;
- To comply with statutory requirements.
Scope

This policy applies to all employees of Sunshine Homecare including those still in their probationary period.

Policy

Sunshine Homecare works within the Disclosure and Barring Service’s Code of Practice always. Sunshine Homecare will treat all disclosure applicants who have a criminal record fairly and will not discriminate because of a conviction or other information.

Procedure

A copy of this policy MUST be given to all candidates at the outset of the recruitment process.
- Sunshine Homecare complies fully with the DBS Code of Practice and undertakes to treat all applicants fairly. Sunshine Homecare does not discriminate unfairly against any subject of a disclosure based on a conviction or other information revealed.
- Sunshine Homecare is committed to the fair treatment of employees, potential employees and customers, regardless of race, gender, religion, sexual orientation, responsibilities for dependants, age, physical/mental disability or offending background.
- Sunshine Homecare actively promote equal opportunities for all with the right mix of talent, skills and potential and welcome applications from a wide range of candidates, including those with criminal records. interview selection is based on skills, qualifications and experience;
- For those positions where a disclosure is required, all application forms, job adverts and recruitment briefs will contain a statement that a disclosure will be requested in the event of the individual being offered the position;
- Where a disclosure forms part of the recruitment process, all applicants are encouraged to provide details of their criminal record at an early stage in the application process. Sunshine Homecare guarantees that this information will remain confidential and will only be used as part of the recruitment process.
- Sunshine Homecare ensures that all employees involved in the recruitment process have been suitably trained to identify and assess the relevance and circumstances of offences. This will include guidance and training in the relevant legislation relating to the employment of ex-offenders, e.g. the Rehabilitation of Offenders Act 1974;
- At interview, or in a separate discussion, Sunshine Homecare ensures that an open and measured discussion takes place about any offences or other matters that might be relevant to the position. Failure to reveal information that is directly relevant to the position sought could lead to withdrawal of an offer of employment;
- Sunshine Homecare make every subject of a DBS disclosure aware of the existence of the DBS Code of Practice and make a copy available on request.
- Sunshine Homecare undertake to discuss any matter revealed in a disclosure with the person seeking the position before withdrawing a conditional offer of employment.
- Having a criminal record will not necessarily bar you from working with Sunshine Care. This will depend on the nature of the position and the circumstances and background of your offences. However, a risk assessment will be undertaken to determine if further supervision will be required.
This policy statement was developed with the assistance and guidance of the Disclosure and Barring Service (DBS).

I have read and understood this statement:
Applicant Name:*
Signature:*
Date*
Date Format: DD slash MM slash YYYY

WORKING EXPERIENCE CHECKLIST
Have you had training and/or experience of: Please tick:
(Please only tick the trained box if you can provide certificates and/or evidence of this)
Personal Care
Dressing/undressing*
Washing*
Bathing*
Bed baths*
Bath aids*
Use of bedpans/commodes*
Hair care*
Specialist Care
Eye care*
Pressure area care*
Continence*
Catheter bags*
Mouth care*
Colostomy care*
Mobility
Moving and handling*
Use of hoists*
Walking aids*
Nutrition
Meal preparation*
Feeding*
PEG Feeding*
Practical
Housework*
Laundry / Washing*
Bed making*
Shopping*
Specialist
Palliative care*
Dementia care*
Learning disabilities*
Physical disabilities*
Child care*
Mental health*
Other - Please specify
Applicant Name:*
Signature:*
Date*
Date Format: MM slash DD slash YYYY

Working with Sunshine Homecare

It is Sunshine Homecare’s policy to employ the best qualified personnel and provide equal opportunity for the advancement of employees including promotion and training and not to discriminate against any person because of race, colour, ethnic origin, national origin, sex, sexual orientation, religion or belief, pregnancy, trans-gender status, marital or civil partnership status, age or disability.

I authorise Sunshine Homecare to obtain references to support this application once an offer has been made and accepted and release sunshine Homecare and referees from any liability caused by giving and receiving information.

Personal Care
DECLARATION
I confirm that the information given on this form is, to the best of my knowledge, true and complete. Any false statement will be sufficient cause for rejection or, if employed, dismissal.
Applicant Name*
Signature*
Date*
Date Format: DD slash MM slash YYYY
APPLICANT PROFILE
Please write about yourself, your interests-just as an introduction to us about yourself. Please make this a short description.*
Submit your CV
Accepted file types: pdf, doc.

Call Today

Mon-Fri: 09:00– 17:00

Step 1 of 10

1. Application Form

2. Prepared for work

3. Personal details

4. Secondary education

5. Further education and training

6. Occupational qualifications

7. Membership of professional body

8. General

9. Permission to work in the UK

10. Community/volunteer experience

11. Next of kin

12. Previous employment

13. Referees

Work reference 1 (most recent employer) – not members of your own family

Work reference 2 – not members of your own family

Work, personal or educational – not members of your own family

WORKING TIME DIRECTIVE OPTING OUT OF WORKING TIMES

I understand and agree that I can change or terminate this agreement at any time, subject to 28 days’ written notice.

APPLICANT PROFILE: AVAILABILITY AND WORK HISTORY

GENERAL INFORMATION

Criminal Record Check

RECRUITMENT OF EX-OFFENDERS ENGLAND & WALES

What our customers can expect

Aims

Scope

Policy

Procedure

WORKING EXPERIENCE CHECKLIST

Personal Care

Specialist Care

Mobility

Nutrition

Practical

Specialist

Working with Sunshine Homecare

DECLARATION

APPLICANT PROFILE