CANDIDATE APPLICATION FORM

PLEASE COMPLETE THIS FORM IN BLACK INK, IN YOUR OWN HANDWRITING AND RETURN TO CTC HOME CARE LTD, 291, HIGH STREET, EPPING, ESSEX CM16 4DA.

JOB DETAILS
PERSONAL DETAILS

PLEASE REFER TO THE DOWNLOADABLE ASYLUM AND IMMIGRATION DOCUMENT FOR MORE INFORMATION. UNDER THE IMMIGRATION, ASYLUM AND NATIONALITY ACT 2006 IT IS A CRIMINAL OFFENCE TO EMPLOY SOMEONE WHO DOES NOT HAVE PERMISSION TO WORK IN THE UK. ANY OFFER OF EMPLOYMENT WILL BE SUBJECT TO PRODUCTION OF APPROPRIATE IDENTITY DOCUMENTATION. ALL DOCUMENTS NEED TO BE ORIGINALS.

CURRENT OR MOST RECENT EMPLOYMENT
LIST THE FIVE MAIN DUTIES AND RESPONSIBILITIES OF THIS POST:
PREVIOUS EMPLOYMENT

PLEASE LIST FULL EMPLOYMENT HISTORY, EXCLUDING YOUR CURRENT OR MOST RECENT [WHICH SHOULD BE NOTED ABOVE].

DETAILS OF ANY GAPS IN YOUR JOB HISTORY:

EXPLAIN ANY GAPS IN EMPLOYMENT- [INFORMATION REQUIRED UNDER HEALTH & SOCIAL CARE ACT 2008]

DETAILS OF ANY PROFESSIONAL QUALIFICATIONS, RELEVANT COURSES
AND/OR ANY OTHER INFORMATION YOU THINK MAY BE RELEVANT
SUPPORTING INFORMATION

PLEASE GIVE DETAILS OF ANY PREVIOUS EXPERIENCE VOLUNTARY OR OTHERWISE WHICH YOU CONSIDER
PROVIDES EVIDENCE OF YOUR ABILITIES FOR THE POST FOR WHICH YOU HAVE APPLIED

REFERENCES:


PLEASE GIVE DETAILS OF THREE REFEREES – ONE SHOULD BE YOUR CURRENT OR MOST RECENT EMPLOYER. WHERE POSSIBLE AT LEAST 2 REFEREES SHOULD BE EMPLOYERS AND ONE PERSONAL. AN OFFER OF EMPLOYMENT WILL BE SUBJECT TO RECEIPT OF THREE SATISFACTORY REFERENCES TO CTC AND WE RESERVE THE RIGHT TO CONTACT ANY FORMER EMPLOYERS BEFORE A CONDITIONAL OFFER OF EMPLOYMENT IS CONFIRMED.

DISABILITY DISCRIMINATION


THE DISABILITY DISCRIMINATION ACT 1995 [DDA] PROTECTS DISABLED PEOPLE. THE DDA DEFINES A PERSON AS DISABLED IF THEY HAVE A PHYSICAL OR MENTAL IMPAIRMENT, WHICH HAS A SUBSTANTIAL AND LONG TERM [I.E. HAS LASTED OR IS EXPECTED TO LAST AT LEAST 12 MONTHS] AND ADVERSE EFFECT ON THE PERSON’S ABILITY TO CARRY OUT NORMAL DAY-TO-DAY ACTIVITIES.

THIS LIST BELOW CONTAINS EXAMPLES OF THE TYPES OF IMPAIRMENT:

+ PHYSICAL IMPAIRMENT, SUCH AS DIFFICULTY USING YOUR ARMS OR MOBILITY ISSUES WHICH MEANS USING A WHEELCHAIR OR CRUTCHES.
+ SENSORY IMPAIRMENT, SUCH AS BEIING BLIND/HAVING A SERIOUS VISUAL IMPAIRMENT OR BEING DEAF/HAVING A SERIOUS HEARING IMPAIRMENT.
+ MENTAL HEALTH CONDITION, SUCH AS DEPRESSION OR SCHIZOPHRENIA.
+ LEARNING DISABILITY SUCH AS DYSLEXIA OR COGNITIVE IMPAIRMENT SUCH AS AUTISM
+ LONG-STANDING ILLNESS OR HEALTH CONDITION SUCH AS CANCER, HIV, DIABETES, CHRONIC HEART DISEASE, OR EPILEPSY.
+ OTHER, SUCH AS DISFIGUREMENT.

IF YOU ANSWERED YES, DO YOU REQUIRE ANY PARTICULAR FACILITIES OR ADJUSTMENTS TO ASSIST YOU:

WHAT IS YOUR WEEKLY AVAILABILITY?
NAME AND ADDRESS OF YOUR NEXT OF KIN:
I CONFIRM THAT THE INFORMATION I HAVE GIVEN IS, TO THE BEST OF MY KNOWLEDGE, TRUE AND COMPLETE AND CAN BE TREATED AS PART OF MY SUBSEQUENT CONTRACT OF EMPLOYMENT. I AGREE THAT THE INFORMATION GIVEN ON THIS JOB APPLICATION MAY BE USED FOR REGISTERED PURPOSES WITH THE DATA PROTECTION ACT 1998.
CTC IS REGISTERED UNDER THE DATA PROTECTION ACT TO HOLD INFORMATION ABOUT THEIR WORKFORCE. THE INFORMATION PROVIDED ON THIS FORM WILL BE USED AS PART OF OUR SELECTION PROCESS AND WILL BE RETAINED FOR A PERIOD AFTER THE SELECTION PROCESS HAS BEEN COMPLETED.
CRIMINAL CONVICTIONS

Because of the nature of the work you are applying for, this post is exempt from the provision of section 4 [2] of the Rehabilitation of Offenders Act 1974 [Exceptions] [Amendment] Order 1986. Applicants are therefore NOT entitled to withhold information about convictions or cautions, which for other purposes are ‘spent’ under provisions of the Act and in the event of a job offer. Any failure to disclose such convictions or cautions could result in termination of contract. As a registered body, we have access to Criminal Records through the Criminal Records Bureau and the successful applicant will undergo an Enhanced Criminal Record Check. Have you ever been convicted of a Criminal Offence, received a caution, reprimand, final warning or do you have any pending criminal charges?

PLEASE READ AND SIGN THE FOLLOWING STATEMENT:

I CONFIRM THAT THE INFORMATION I HAVE GIVEN IS, TO THE BEST OF MY KNOWLEDGE, TRUE AND COMPLETE AND CAN BE TREATED AS PART OF MY SUBSEQUENT CONTRACT OF EMPLOYMENT.

I AGREE THAT THE INFORMATION GIVEN ON THIS JOB APPLICATION MAY BE USED FOR REGISTERED PURPOSES WITH THE DATA PROTECTION ACT 1998.
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