Care Assistant | Hope For Future Care

PERSONAL DETAILS

Tell us about yourself

Prefix

First Name

Middle Name

Last Name

Gender:

Date of Birth:

Nationality:

Martial Status:

Street Address

Apartment, suite, etc

City

Postcode

Date moved to address:

Phone

Mobile

Work Status:

Self Employed or PAYE:

National Insurance No:

Passport No:

Passport Expiry Date:

Driving License:YesNo

Car Owner:YesNo

Contact

We are open 24 hours a day, Please specify times at which you are not to be contacted below.

Contact Availability:

Is it Ok to Contact You at Work?:YesNo

How Did You Hear Of Us?:

Career History

Please confirm your career history details for the last 10 years. Please list using most recent first

Company 1

Employer:

Street Address

City

Postcode

Phone:

Start Date:

Date Left:

Job title:

Full or Part Time:

Grade:

Dept/Ward:

Reason for leaving:

Company 2

Employer:

Street Address

City

Postcode

Phone:

Start Date:

Date Left:

Job title:

Full or Part Time:

Grade:

Dept/Ward:

Reason for leaving:

QUALIFICATIONS & TRAINING

Tell us about your qualifications

Date Qualified:

Expiry Date:

Where did you train?

Please give details of training undertaken and qualifications obtained:

You should supply any certificates such as ENB or Diplomas etc -please note that we require manual handling/CPR certifications that have been updated in the last 12 months.

BAND (NEW TERMINOLOGY) 1-8:23

MEDICAL HISTORY

Have you ever suffered from any of the following:

REFERENCES

Hope For Future Care requires 2 professional references. It is essential that you have had professional dealings with both of your references within the last 2 years.

First Reference

Name Of Referee:

Place Of Work:

Position:

Street Address

City

Postcode

Phone

Mobile Phone:

Email Address

Second Reference

Name Of Referee:

Place Of Work:

Position:

Street Address

City

Postcode

Phone

Mobile Phone:

Email Address

OPT OUT AGREEMENT

DEFINITIONS

In this Agreement the following definitions apply:-

“Assignment” means the period during which the Temporary Worker is engaged in services to a Client.

“Client” means the person, firm or corporate body that has engaged the services of the Temporary Worker.

“Employment Business” means Ace 24 Consultancy.

“Temporary Worker” means a Qualified Nurse, care assistant or other Temporary Worker.

“Working Week” means an average of 48 hours each week as calculated over any 17 week period.

THE AGREEMENT

The Working Time Regulations of 1998 state that a Temporary Worker shall not work on an Assignment with a

client in excess of the Working Week unless they agree in writing that this limit should not apply.

The Temporary worker, by signing the declaration below, agrees that the Working Week shall not apply to their

Assignments.

The Temporary Worker can end this Agreement at anytime by giving the Employment Business 14 days notice in

writing. After the 14 day notice period has expired the Working Week shall apply immediately.

It should be noted, that any notice ending this Agreement does not mean that a Temporary Worker has ended an

Assignment with a Client.

These laws are governed by English Law and are subject to the jurisdiction of the English Courts.

THE DECLARATION

I have read and fully understand the above OPT OUT AGREEMENT.

I hereby consent that the Working Week limit shall not apply to my Assignments.

I understand that I can end this Agreement by giving the Employment Business 14 days' notice in writing.

I agree:YesNo

Date Confirmed:

NEXT OF KIN DETAILS

Field Group

Full Name:

Relationship:

Phone:

Email Address:

Street Address

City

Postcode

Other Special Notes:

DISCLOSURES

Rehabilitation of Offenders Act

Due to the nature of the work for which you are applying, this post is exempt from the provisions of section 4.2 of the rehabilitation of offender act 1974 (exemption order 1975). Applicants are, therefore, not entitled to withhold information about convictions that for other purposes are ‘spent’ under the provisions of the act and in the event of employment. Failure to disclose such convictions could result in dismissal or disciplinary action.

Any information given will be completely confidential and will be considered only in relation to an application for positions in which the order applies, and should be entered at the end of any particulars you give in support of your application.

A copy of our written policies is available upon request. A criminal record will not necessarily be a bar to obtaining a position.

Any conviction, caution, or reprimand will require a written statement of each and every event and how it does not affect your suitability for the role you are applying for.

Have you ever been convicted of a criminal offence?YesNo

Do you have any spent or unspent criminal convictions or cautions?YesNo

With an enhanced disclosure, under section 4.2 of the rehabilitation of offenders act 1974 (exemption order), all previous cautions, warnings and convictions will always be detailed regardless of how long ago.

Any conviction, caution, reprimand will require a written statement of each and every event and how it does not affect your suitability for the role you are applying for.

Have you supplied additional information with this application for any spent/ unspent convictions, cautions or reprimands?YesNo

Have you ever been involved in court proceedings?YesNo

Please give any additional information which you think may be relevant in support of your application :

IF YOU HAVE A CONVICTION/CAUTION RELATING TO A VIOLENCE OR THEFT OFFENCE, WE WILL BE UNABLE TO PROGRESS WITH YOUR APPLICATION.

DECLARATION

I confirm that the information I have provided in support of this application is complete and true and understand that knowingly to make a false statement could be a criminal offence.

Name:

Date:

I consent to Ace 24 consultancy checking the details I have provided against the various data sources in order to verify my identity and process the application. These details may be recorded and used to assist other organisations for identity verification purposes such as the CRB, and regulatory bodies such as NMC or GSCC.

Name:

Date:

Ace 24 Consultancy retains the right to hold this application and any other data required to process this application (whether in the UK, European Union or elsewhere) and keep for as long as necessary in line with the data protection act.

ADDITIONAL INFORMATION/CHECKLIST

On receipt of a satisfactorily completed application form, Ace 24 Consultancy will provide/send the following:-

LIMITED COMPANY BANK DETAILS OR IF PAYE PERSONAL BANK DETAILS

Account Holders Name:

Bank / Building Society Name:

Bank / Building Society Address:

City

Postcode

Account Number:

Sort Code:

Building Society Reference:

UTR Number:

WORKING TIME DIRECTIVE: WRT 48 HOURS WORKING WEEK OPT-OUT

The Working Time Directive requires that a worker’s average working time must not exceed 48 hours per week unless the worker agrees in writing to exceed the limit. Please sign the declaration below in order that we may lawfully employ you if your hours exceed 48. Please note that by signing this Opt-Out you are not committing to a working week of more than 48 hours, but rather allowing yourself to be offered assignments that could take you over this threshold.

TAX STATUS

Please note l wish to be paid gross for assignments with Ace24 Consultancy. I will take account of my own income tax and national insurance contributions. If I have not provided my self assessment number it is because this is my first year of self-assessment. Once the Inland Revenue.

Full Name:

Date:

Signature:

IMPORTANT INFORMATION PLEASE SIGN THE DECLARATION ABOVE AND SUBMIT TO CONFIRM THE ABOVE INFORMATION

UPLOAD YOUR DOCUMENTS HERE

We will also need details of your Bank / Building Society account for our Payroll Department.

We try to make our registration process as swift and painless as possible but we are sure that you understand that owing to the sensitive nature of your profession that our checks have to be thorough.

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Care Assistants

Please tick boxes:

Full Immunisation record:

Training Certificates including:

Company

Resources

Legal

Office