Recruitment

Application Form

Care Worker

Personal Details

First Name *

Last Name *

Street Address *

Town

County

Post Code *

Email Address *

Phone *

Are you over 18 years old? *YesNo

Working Eligibility

Are you eligible to work in the UK? *YesNo

Do you have a valid work permit?YesNonot applicable

DBS Check

To maintain the safety of our Service Users, staff at Goodwin Healthcare are required to undergo an Enhanced DBS Check. This process provides information about an applicant's criminal record, inluding details of final warnings, reprimands, cautions and convictions.

Are you willing to undergo and confident that you will pass an enhanced DBS check? *YesNo

Mobility

We generally provide care to people living in their own homes. This means that our care staff are normally required to travel between their care delivery calls. To help us better understand how suitable that will be for you, please tell us about how you will likely get around

How might you travel between calls? (please tick all that apply) *

Walk (short distances only)Walk (up to 3 miles per day)Bicycle (up to 3 miles per day)Bicycle (up to 10 miles per day)Motorcycle / Scooter / MopedHave a full driving licence and a vehicleHave a full driving licence but no vehicle

Working Hours Requested

What sort of hours are you looking for? (please tick all that apply) *

Full TimePart Time

Availability

Do you want to work for another employer at the same time you are working for us? *YesNo

If so, please enter details here0 / 120

Current / Most recent employer

Company name

Nature of business

Position held

Month from

Year from

Month to

Year to

Reason for leaving0 / 120

Previous Employers

As an Organisation committed to safeguarding adults with care and support needs, we follow the Safer Recruitment practice of requiring a full employment history. Please fill in the details below. If you have had more than 3 previous employers, we will ask for their details later in the recruitment process.

Previous Employer 2

Company name

Nature of business

Position held

Month from

Year from

Month to

Year to

Reason for leaving0 / 120

Previous Employer 3

Company name

Nature of business

Position held

Month from

Year from

Month to

Year to

Reason for leaving0 / 120

Previous Care Experience

Do you have any previous care experience? (please tick all that apply) *

Yes - Paid care workYes - Voluntary care workYes - cared for a family memberNo

Qualifications / Training

What academic qualifications do you hold? (please tick all that apply)

GCSEA LevelDegreePostgraduate

Professional / Vocational

Relatives

Are you related to anyone that works for us? *YesNo

if so, please enter their name

Rehabilitation of Offenders Act 1974

The amendments to the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (2013 and 2020) provides that when applying for certain jobs and activities, certain convictions and cautions are considered ‘protected’. This means that they do not need to be disclosed to employers, and if they are disclosed, employers cannot take them into account. Guidance about whether a conviction or caution should be disclosed can be found on the Ministry of Justice website.

Do you have any unspent cautions or convictions under the Rehabilitation of Offenders Act 1974? *YesNo

if so, please give the details, including the date and place of the conviction(s).

Disability

In order to enable us to help anyone who has a disability to proceed their application and to subsequently fulfil the duties of the position, we need to know of any reasonable adjustments which may be necessary to help him/her attend an interview or undertake the duties of the position.

If you have (or think you may have) a disability, please give details below. This information will not be used to discriminate against disabled applicants.

References

Please provide the names and addresses of two referees. One of your referees should be your most recent employer or, if you are a school or college leaver, a form teacher or tutor. Please note that references will be immediately taken up for all short listed candidates.

Reference 1

First Name *

Last Name *

Street Address *

Town

County

Post Code *

Email Address *

Phone *

Job Title

Relationship (if any)

Reference 2

First Name *

Last Name *

Street Address *

Town

County

Post Code *

Email Address *

Phone *

Job Title

Relationship (if any)

Declaration

I authorise the Goodwin Healthcare to obtain references to support my application and confirm that the information given on this form is, to the best of my knowledge, true and complete. Any false statement may be sufficient cause for rejection or, if employed, dismissal. I also authorise Goodwin Healthcare to keep and use the information on this form and any subsequent information relating to my application and/or employment, in accordance with the Data Protection Act 1998. I understand that any offer of employment will be subject to a satisfactory disclosure and POVA check from the Disclosure & Barring Service (DBS), 2 satisfactory references, medical clearance and evidence of the right to work in this country.

Application Form

Care Worker

Personal Details

Working Eligibility

DBS Check

To maintain the safety of our Service Users, staff at Goodwin Healthcare are required to undergo an Enhanced DBS Check. This process provides information about an applicant's criminal record, inluding details of final warnings, reprimands, cautions and convictions.

Mobility

We generally provide care to people living in their own homes. This means that our care staff are normally required to travel between their care delivery calls. To help us better understand how suitable that will be for you, please tell us about how you will likely get around

How might you travel between calls? (please tick all that apply) *

Working Hours Requested

What sort of hours are you looking for? (please tick all that apply) *

Availability

When would you be available for work (please tick all that apply) *

Current / Most recent employer

Previous Employers

Previous Care Experience

Do you have any previous care experience? (please tick all that apply) *

Qualifications / Training

What academic qualifications do you hold? (please tick all that apply)

Relatives

Rehabilitation of Offenders Act 1974

Disability

In order to enable us to help anyone who has a disability to proceed their application and to subsequently fulfil the duties of the position, we need to know of any reasonable adjustments which may be necessary to help him/her attend an interview or undertake the duties of the position.

References

Please provide the names and addresses of two referees. One of your referees should be your most recent employer or, if you are a school or college leaver, a form teacher or tutor. Please note that references will be immediately taken up for all short listed candidates.

Declaration