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APPLICATION FOR THE POSITION OF PERSONAL ASSISTANTThank you for your interest in applying for a position as a Personal Assistant / Carer.Please take time to fill in this application form fully. The more information you provide the better. Please don’t forget to give the reference number for the job you want to apply for. Once you have completed the application form then please email it to admin@.uk.Alternatively post to the address at the head of this letter. If you need any help filling in this application form, or if you have any questions, then please ring 01723 588002. Once your application form has been received, we will contact you to arrange an interview with the person who will be employing you (often by telephoning you). If you do not hear within four weeks of sending in your application form, then please assume that you have been unsuccessful on this occasion but accept our thanks for your interest in this vacancy.By law, we have to check that anyone offered a job has the legal right to work in the UK. This means that if you are invited to an interview we will need you to bring one of the following:A British passport, ORA national passport or national identity card showing that you are a national of a European Economic Area country, ORAn official document with your national insurance number on it (e.g. P45, P60, National Insurance card) AND your birth certificate or an official document from the Home Office saying that you can stay in the UKIf you do not have any of these documents then please ring 01723 588002 to discuss other documents that can be accepted.Please note that you may be required to have a Disclosure and Barring check for this post. This check for disclosure of criminal history includes spent convictions/pending prosecutions/current court proceedings and police enquiries. Having a criminal record will not necessarily bar you from working. This will depend on the nature of the position and the circumstances and background of your offences.We look forward to receiving your application soon!0-342900STRICTLY CONFIDENTIAL00STRICTLY CONFIDENTIAL1371600114300PERSONAL ASSISTANT - CARER00PERSONAL ASSISTANT - CARER457200011430000Post applied for: Ref:Please fill this form in with BLACK PEN. Please use CAPITAL LETTERS.If you are unable to fill in this form, someone else can fill it in for you but you must sign it.ABOUT YOU [Contact Details]Your FULL NameTitle: Mrs FORMCHECKBOX Miss FORMCHECKBOX Ms FORMCHECKBOX Mr FORMCHECKBOX [Tick as appropriate]Address:Post CodeTel. No. Best time to ring?Age : Are you over 16 and under 65? YES FORMCHECKBOX NO FORMCHECKBOX Work Permits: Do you need a UK work visa / permit for this job?YES FORMCHECKBOX NO FORMCHECKBOX Driving: Do you have a full and current driving licence valid in the UK?YES FORMCHECKBOX NO FORMCHECKBOX Do you have the use of a car?YES FORMCHECKBOX NO FORMCHECKBOX Health:How many days off work have you had over the past two years?Please tell me about any serious illness that you have, or have had, that could affect your work.[I reserve the right to check this information with your current or previous employer]POSITIVE ABOUT DISABILITYWe positively welcome applications from people with disabilities.Do you consider yourself to have a disability as defined in the Disability Discrimination Act 1995?YES FORMCHECKBOX NO FORMCHECKBOX If yes, please give details.Please tell us about any help you would need at an interview e.g. signer, induction loop etc?WHEN DO YOU WANT TO WORK?It is very important that you tell us clearly when you want to work so that we can match what you want with what we need.How many hours do you want to work each week?Please tell us when you want to work each day. [tick the appropriate box over the page to say when you would like to work each day]MONDAYMornings FORMCHECKBOX Afternoons FORMCHECKBOX Evenings FORMCHECKBOX All Day FORMCHECKBOX TUESDAYMornings FORMCHECKBOX Afternoons FORMCHECKBOX Evenings FORMCHECKBOX All Day FORMCHECKBOX WEDNESDAYMornings FORMCHECKBOX Afternoons FORMCHECKBOX Evenings FORMCHECKBOX All Day FORMCHECKBOX THURSDAYMornings FORMCHECKBOX Afternoons FORMCHECKBOX Evenings FORMCHECKBOX All Day FORMCHECKBOX FRIDAYMornings FORMCHECKBOX Afternoons FORMCHECKBOX Evenings FORMCHECKBOX All Day FORMCHECKBOX SATURDAYMornings FORMCHECKBOX Afternoons FORMCHECKBOX Evenings FORMCHECKBOX All Day FORMCHECKBOX SUNDAYMornings FORMCHECKBOX Afternoons FORMCHECKBOX Evenings FORMCHECKBOX All Day FORMCHECKBOX Would you be willing to work bank holidays? YES FORMCHECKBOX NO FORMCHECKBOX Sleepover work is usually from 10.00pm to 8.00am. If the job description says that some sleepover work is needed, please tick the appropriate boxes below to tell me which nights you could do.MON FORMCHECKBOX TUES FORMCHECKBOX WED FORMCHECKBOX THU FORMCHECKBOX FRI FORMCHECKBOX SAT FORMCHECKBOX SUN FORMCHECKBOX CURRENT OR MOST RECENT EMPLOYMENTJob Title:Employer’s name:Employer’s address:What work did you do?When did you start? When did/can you finish?PREVIOUS EXPERIENCEPlease tell me about any work you have done so far, or any relevant experience you may have had. This could be paid work, voluntary work or work at home.StartedFinishedType of Work/Relevant Experience[Please tell me what sort of work you did]Employer’s NameIf you need more space, please use a separate sheetABILITIES , SKILL, KNOWLEDGE AND EXPERIENCEPlease use this space to tell us about anything else that you have done which you would like me to know about.Please say why you would like this job.If you need more space, please use a separate sheet REFERENCESAll jobs offers are subject to two satisfactory references. Please give names and addresses of two people I can contact for a reference for you. One of these should be you current or previous employer. If you do not want me to contact anyone without asking you first. Please tick this box. FORMCHECKBOX REFERENCE 1REFERENCE 2Has any previous employer expressed concerns and/or taken any action, whether informal or formal[including suspension from duty] on either of the following:* Capability/Performance Yes FORMCHECKBOX No FORMCHECKBOX * Disciplinary Yes FORMCHECKBOX No FORMCHECKBOX CRIMINAL CONVICTIONSHave you ever been convicted, cautioned or bound over for a criminal offence in any country? YES FORMCHECKBOX NO FORMCHECKBOX If you have answered yes, please give full details on a separate sheet and place in a sealed envelope marked STRICTLY CONFIDENTIAL.Has your name been referred to or included on: (Please tick if applicable)* The DoH Consultancy List, known as the Protection of Children Act List Yes FORMCHECKBOX No FORMCHECKBOX * The DCSF List 99: Yes FORMCHECKBOX No FORMCHECKBOX * The Protection of Vulnerable Adults List: Yes FORMCHECKBOX No FORMCHECKBOX STATEMENTI understand that if I am appointed, this application form will become part of my personal file and that if I am not appointed it will be stored for 3 months and then destroyed in accordance with the 1998 Data Protection Act.To the best of my knowledge, the information I have provided on this form is true and accurate. I understand that if the information I have supplied is false or misleading in any way, or I fail to disclose previous convictions or cautions it will automatically disqualify me from appointment or may render me liable to dismissal without notice.706755260350040214552603500Signed: Date:-62230141605THANK YOU FOR TAKING THE TIME TO FILL IN THIS FORM00THANK YOU FOR TAKING THE TIME TO FILL IN THIS FORM ................
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