Domiciliary Care Assistant

Domiciliary Care
Summary

To give practical help, care, guidance and support to all service users needing assistance in their home to aid their continued independence in the community and wherever possible consistent with their wishes.

To attend to the personal care and rehabilitation and social needs of service users aiming at creating an environment where service users can achieve maximum independence.

Download application form

To apply, either download the application form above or fill in the form below.

Application form

Personal details


Title
Surname
First name:
Date of birth:
Address 1:
Address 2:
City or Town:
County:
Post Code:
Telephone (day):
Telephone (evening):
Place of birth:
Maritial Status:
Do you have a bank account?
Do you hold a UK passport?
Do you have a full driving licence?
Do you own or have use of a car?
Do you have any endorsements?
If yes, give details
Are you involved in any activity which might limit your availability to work or your working hours?
If yes, give details:
Are you subject to any restrictions which might restrict your working activities?
If yes, give details:
Are you wiling to work shifts and weekends?
Please give details of any hours which you would not wish to work:
If required are you prepared to undergo a medical examination prior to employment?
Have you ever worked for this Organisation/Company before?
Are you related to any person employed by the Organisation/Company?
Have you ever applied for employment with this Organisation before?
Do you need a work permit to take up employment in the UK?

Education details


Schools attended since age 11:
Examinations and results passed at school:
College or University:
Examinations and results passed at college or university:
Further formal training:
Job related training courses - name of organisation:
Please give details of membership of any technical or professional associations:
Please list any foreign languages spoken and the level of competence:

Employment details


Please give details of your past employment, excluding your present or last employer, stating the most recent first:

Present or last employer


Are you currently employed?
Name of present or last employer:
Address:
Telephone no:
Nature of business:
Job title and a brief description of your duties:
Length of service:

Interests, achievements and leisure activities


Hobbies or interests:
(e.g. hobbies, sports, club membership)

Supplementary information


Please set out any further information to support your application, e.g. past achievements, future aspirations, personal strengths

Supplementary information
Have you ever been convicted of a criminal offence:
(You should note that under the Rehabilitation of offences Act 1974 Nurses must declare all convictions)
Due to the nature of the business, it is a requirement that you agree to the Society conducting a police check for inappropriate convictions.

Declaration


I declare that the information given in this form is complete and accurate. I understand that any false information, deliberate omissions will disqualify me from employment or may render me liable to summary dismissal.

Declaration:

References


Can we approach your current employer before an offer of employment is made:
Name of 1st reference:
Position:
Address:
Tel no:
Name of 2nd reference:
Position:
Address:
Tel no:

References


How did you hear of this vacancy?

= Required

0121 706 3630

81-83 Warwick Road, Olton, Solihull, B92 7HP