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Care Assistant
Horsham, West Sussex | Full-time | Salary: £9.50 to £24.00 /hour

PERSONAL DETAILS

*Position Applied For:

Highest Level of qualifications acheived

*Title:

*First Name:

*Last Name:

*Address:

*Post Code:

*Telephone Number:

*Mobile Number:

*Date of Birth:

*National Insurance Number:

*Email:

ADDRESS HISTORY

Address History - Previous Address 1:

Dates From and To (1):

Address History - Previous Address 2:

Dates From and To (2):

Address History - Previous Address 3:

Dates From and To (3):

NEXT OF KIN OR EMERGENCY CONTACT

*Next of Kin Full Name:

*Relationship to you:

Address (if difference from above):

*Emergency Telephone Number:

HOW DID YOU HEAR ABOUT ASCOT CARE?

*How did you hear about Ascot Care:

TRANSPORT

*Do you have a full driving license:

*What are your usual means of transport:

*YOUR RIGHT TO WORK IN THE UK

*Your right to work in the UK

DISABILITY

*Do you consider yourself to have a Disability:

Nature of the Disability:

WORKING TIME REGULATIONS

*I am looking for the following amount of hours:

EMPLOYMENT HISTORY

*Company Name (1):

*Company Email (1):

*Line Manager (1):

*Your Job Title (1):

*Main Duties (1):

*Dates of Employment (1):

*Reason for Leaving (1):

*Can we contact for a reference (1):

*Company Name (2):

*Company Email (2):

*Line Manager (2):

*Your Job Title (2):

*Main Duties (2):

*Dates of Employment (2):

*Reason for Leaving (2):

*Can we contact for a reference (2):

Company Name (3):

Company Email (3):

Line Manager (3):

Your Job Title (3):

Main Duties (3):

Dates of Employment (3):

Reason for Leaving (3):

Can we contact for a reference (3):

TRAINING, QUALIFICATIONS & PROFESSIONAL DEVELOPMENT

*Relevant Training:

*Do you have a relevant NVQ:

*Are you currently studying for a relevant NVQ:

*Would you be interested in NVQ training:

ABOUT YOU

*Please tell us why you want to do this type of work:

Hobbies and Interests:

HEALTH DETAILS

GP's Name:

Surgery Address:

Have you ever had mental health problems:

Have you ever had addiction problems:

Do you have any dietary Preferences:

If Yes, please specificy:

Have you ever suffered from any of the following listed below?

*Asthma, Bronchitis or Lung Disease

*Heart Disease

*High Blood Pressure

*Loss of consciousness or Epileptic Fits

*Mental Disease or disease of the nervous system

*Rheumatic Fever, Rheumatism or Arthritis

*Typhoid or Dysentry

*Lumbago, Scathia, Slipped Disc, Back Trouble

*Skin disease or Eczema

*Diabetes

*Hearing or Sight defects

*Any serious physical accidents

*Any major surgery

*Any disability not listed anywhere

*Are you on the NHS waiting list

*Do you smoke

*Do you drink

WORK UNIFORM

*Uniform Size:

*Glove Size:

DISCLOSURE

*I confirm that I do not have any cautions, charges or criminal convictions:

CONSENT

*I consent to my personal data being made available to authorised third parties in order to comply with current regulations and for the purpose of auditing

*I have no objection to my details being held on computer records and utilised by the company in pursuit of its legitimate business

PROOF OF IDENTITY & ADDRESS

Passport or Birth Certificate:

Driving License:

Copy of National Insurance Number:

Proof of your current home address:

COSTS

*The cost of the DBS is £63 20, which we ask you to pay for initially, Ascot Care will refund this cost to you on completion of your first 6 months employment with us

COMMUNICATION

*How would you like Ascot Care to communicate with you?

Please note that when you submit your application, our recruitment team will review the application and get in touch accordingly within the next 2 working days

Fields with (*) are compulsory.

May

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