Application Form

Mayfair care homes

Complete the form below to apply for a position with us

Personal Detail

Title

First Name

Middle Name

Last Name

Which of the following best describes you?

Male
Female

Date of Birth

Current Address

Address Line 1

Address Line 2

City

State / Province / Region

Zip / Postal Code

Country

Phone

Other phone

Email *

National Insurance Number

File Upload

Drop your file here or click here to upload

Are you legally entitled to work in the UK?

if you answered "yes"

What is you nationality?

Are you willing to relocate?

Have you recently worked in a care home?

Hourly Pay?

Driving History

Driving License

If yes, Type of license

License Number

Any current endorsement?

If yes, Type of endorsement?

Any motoring prosecutions pending?

If yes, Type of pending prosecutions?

Previous employment history

Please use this section to provide information about your previous employment starting with your current or most recent job.

Employment detail 1

Company Name

Supervisor

Job title

Phone

Email *

Address

Address Line 1

Address Line 2

City

State / Province / Region

Zip / Postal Code

Country

Employment start date

Employment end date

Responsibilities

Reason for leaving

Employment detail 2

Company Name

Supervisor

Job title

Phone

Email *

Address

Address Line 1

Address Line 2

City

State / Province / Region

Zip / Postal Code

Country

Employment start date

Employment end date

Responsibilities

Reason for leaving

Education

Please use this section to provide information about your previous education including the qualifications/certificates your have gained.

High School / College

Name

Start date

Finish date

Address

Address Line 1

Address Line 2

City

State / Province / Region

Zip / Postal Code

Country

Subject and Grades

University

Name

Start date

Finish date

Address

Address Line 1

Address Line 2

City

State / Province / Region

Zip / Postal Code

Country

Subject and Grades

References

Please use this section to provide a list of three professional references.

Work Reference 1

Company

First Name

Middle Name

Last Name

Phone

Email *

Address

Address Line 1

Address Line 2

City

State / Province / Region

Zip / Postal Code

Country

Work Reference 2

Company

First Name

Middle Name

Last Name

Phone

Email *

Address

Address Line 1

Address Line 2

City

State / Province / Region

Zip / Postal Code

Country

Character Reference

First Name

Middle Name

Last Name

Phone

Email *

Address

Address Line 1

Address Line 2

City

State / Province / Region

Zip / Postal Code

Country

Criminal Record

Care workers work with vulnerable people and we take our responsibility to protect them very seriously. Your appointment will depend on the satisfactory completion of a criminal records disclosure (see policy statement below), but at this stage, we need you to answer the following questions truthfully and honestly:

Have you received any convictions, cautions, reprimands or final warnings that are not ‘protected’ as defined by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975(as amended in 2013 by SI 210 1198)?

To your knowledge, are you currently the subject of any criminal proceedings (for example, charged or summoned but not yet dealt with) or any police investigation?

If you have answered YES to any of the questions above, please give further details.

Do you consent to our applying for an enhanced criminal records disclosure on you and to our retaining a copy of your disclosure certificate during the period of your employment or until a new disclosure is completed (whichever occurs first)?

Note

Once a criminal records disclosure has been completed, it is discovered that you have failed to accurately disclose the information requested above, the company reserves the right to terminate your employment without notice. Please be aware, however, that your having a criminal record will not necessarily mean we cannot employ you – if you would like to know more about our policy on the recruitment of ex-offenders, please ask.

Criminal records disclosures – Our policy

As an organization assessing applicants’ suitability for positions that are included in the Rehabilitation of Offenders Act 1974 (Exceptions) Order using criminal record checks processed through the Disclosure and Barring Service (DBS), we comply fully with the Code of Practice and undertake to treat all applicants for positions fairly. We will not discriminate unfairly against any subject of a criminal record check on the basis of a conviction or other information revealed. We can only ask an individual to provide details of convictions and cautions that we are legally entitled to know about. Where a DBS certificate at either standard or enhanced level can legally be requested (where the position is one that is included in the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 as amended) and where appropriate Police Act Regulations (as amended), we can only ask an individual about convictions and cautions that are not protected.

Suitability for the job

Please read the care worker job description and answer the following questions.

Have you read and understood the care worker job description?

The position for which you are applying requires physical effort (including sitting, standing, carrying, walking, moving and handling people), mental effort (including dealing with emergencies and short-notice changes to work in a fast-paced environment) and possible emotional/psychological effort (including dealing with bereavement and challenging behaviour in a potentially stressful environment)

Do you have any health conditions that would prevent you from meeting these intrinsic requirements for which the company might need to make reasonable adjustments? (If yes, please be aware that we may need to discuss these with you at your interview)

If you answered ‘yes’, please provide brief details

Other form of disability. Please specify

Declarations

Please read the following statements carefully. If there is anything you do not understand, please ask before you sign at the bottom of the page.

I, the job applicant named on the front of this form, confirm that the information I have given in this application is accurate and true to the best of my knowledge. I also understand and agree that:

1. The company may make checks to verify the information I have provided.

2. Providing misleading or false information in this form or at any other time during the application process may disqualify me from appointment or, if I have already been appointed, may result in my dismissal.

3. The personal information I have provided in this form (and any other personal information that I or my referees may provide) is confidential and will be handled in line with the Data Protection Act 1998.

4. The company will use the personal information I have provided to decide if I am suitable for the job I have applied for.

5. Until I am employed, the company will not use my personal information for any purpose other than monitoring its own recruitment processes, and that if the company does use my personal information for statistical analysis, it will be anonymised.

6. If my application is unsuccessful, the company will keep only basic information about me and destroy the rest.

7. If my application is successful, my personal information will be used for legitimate purposes in relation to my work (my contract of employment, which I will sign before I start work, will include further detail on how my information may be used).

8. The company may process my personal information for the purposes described above or as otherwise permitted or required by law in line with its registration with the Information Commissioner.

9. Any offer of employment will depend on the receipt of satisfactory employment references and the satisfactory completion of a criminal records disclosure (see part six above).

10. I will be liable for the cost of my initial criminal records disclosure but that the company will bear the cost of any future disclosures that need to be made.

11. I will be required to complete a pre-employment induction training programme prior to my starting work with the company.

12. My attendance on the induction training programme will not indicate any offer (on the part of the company) or acceptance (on my part) of employment and that the time I spend on the induction programme will therefore not count as working time for the purposes of calculating the company’s compliance with National Minimum Wage regulations.

13. I will be liable for the cost of my induction training (£200) and any uniform given to me (£15) if I leave the company’s employment within six months and that this sum may be deducted from my wages.

Full Name

Date

Signature

Message

Welcome to Mayfair Care Homes

Phone Number

Email Address

Mayfair care homes