Application Pack (Care at Home)


 

 

Application Form

Your Details

 


Job Applying For:  

Title:  

First Name(s):  

Full Address:  

Surname:  

Date of Birth:

Email Address:  

Gender:  

Mobile Number:  

 

Work History

 

Please provide details covering FULL previous work/educational experience, including any gaps, starting with the present position. YOU MUST INCLUDE ALL PREVIOUS WORK/EDUCATION EXPERIENCE. A FULL WORK HISTORY (INCLUDING GAPS) MUST BE PROVIDED FROM THE DATE YOU LEFT EDUCATION.

 

Most Recent Employer

Name & Address of Employer:  

Position:  

Date Started:

Date Finished:

Reason for Leaving:  

Previous Employer 

Name & Address of Employer:  

Position:  

Date Started:

Date Finished:

Reason for Leaving:  

Previous Employer 

Name & Address of Employer:  

Position:  

Date Started:

Date Finished:

Reason for Leaving:  

Previous Employer 

Name & Address of Employer:  

Position:  

Date Started:

Date Finished:

Reason for Leaving:  

Other

Next of Kin Details

Full Name:  

Relationship:  

Mobile Number:  

References

1st Reference

Organisation Name:  

Referee Full Name:  

Referee Email:  

2nd Reference

Organisation Name:  

Referee Full Name:  

Referee Email:  

Payment Details

 

National Insurance Number:  

You need to select only one of the following statements A, B or C.

A. This is my first job since last 6 April and I have not been receiving taxable Jobseeker’s Allowance, Employment and Support Allowance, taxable Incapacity Benefit, State or Occupational

 

B. This is now my only job, but since last 6 April, I have had another job, or received taxable Jobseeker’s Allowance, Employment and Support Allowance, or taxable Incapacity Benefit. I do not receive a State or Occupational

 

C. As well as my new job, I have another job, or receive a State or Occupational

 

Do you have student loan which is not fully repaid?

 

If yes, go to next question.

If no, go to bank details.

Are you repaying your Student Loan direct to the Student Loans Company by agreed monthly payments?

 

If yes, go to bank details.

If no, go to question 11.

Student Loan Plans

You will have a Plan 1 Student Loan if:

  • You lived in Scotland or Northern Ireland when you started your course, or
  • You lived in England or Wales and started your course before September 2012

You will have a Plan 2 Student Loan if you lived in England or Wales and started your course on, or after 1 September 2012.

What type of Student Loan do you have?  

Did you finish your studies before the last 6 April?

 

For further guidance about repaying Student Loans go to www.gov.uk/new-employee/student-loans

Bank Details

Name of Account Holder:  

Bank Sort Code:  

Bank Account Number:  

Criminal Record Checks

 

Applicants who are applying for roles in the Healthcare Sector are exempt from the Rehabilitation of Offenders Act 1974. You are therefore required to declare any prosecutions or convictions, including any considered 'spent' under this Act.

  1. Do you have 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 2013 1198?  
  2. Do you have any convictions, cautions, reprimands or final warnings which would not be filtered in line with current guidance?  
  3. Have you had a Police check in another country within the last 6 months? If so, please provide details and enclose a copy if held.  
  4. Have you ever been suspended or are you currently under investigation by an NHS Trust, professional body or any other organisation?  
  5. Have you ever had an Enhanced Disclosure and Barring Service (DBS) check?  

If you have answered yes to any of the above questions, please provide details below.

Company Who Conducted the Check:  

If you have signed up to the DBS Update Service, please provide your DBS Number:  

Smeaton Healthcare will undertake an Enhanced DBS Check on your behalf. You will not begin working with the company until the company receives a completed DBS check. Smeaton Healthcare work with uCheck Ltd for all DBS checks. You will be directed to a link to complete the DBS check, in due course. Please note that at any stage whilst working with Smeaton Healthcare, if we receive any indication that highlights information you have not declared, you will be removed from the organisation with immediate effect.

Medical Questionnaire

GP Details

GP Full Name:  

GP Practice Name:  

GP Address:  

Medical History

  1. Do you have any physical or psychological problems that may affect your performance or ability to do the required job?  
  2. Have you ever been unable to work because of back injuries?  
  3. Have you any pre-existing problems either physical or psychological which have been caused by your job?  
  4. Do you require any special assistance because of Health problems?  
  5. Are you currently waiting for treatment for any ailment?  

If you have answered yes to any of the above questions, please provide full details below:

 

Declaration 

Health 

I declare that the information I have given is true. I agree to inform Smeaton Healthcare Limited of any changes to my health and other circumstances.

 

myPortal 

Anyone who joins the organisation will be asked to create an account on our staff portal (www.smeatonhealthcare.co.uk/myportal), you will be given access to over 100 Policies & Procedures including our Staff Handbook. It is essential to your role that you read the Policies, Procedures & Handbook. 

Please confirm the following: 

I agree I am responsible for, and I agree I will read the Policies & Procedures on myPortal.

 

I agree I am responsible for, and I agree I will read the Staff Handbook which can be found by clicking here.

 

 Working Time Regulations 1998

Under the Working Time Regulations 1998 a worker’s average weekly working time (including overtime) calculated over a rolling 17 week period must not exceed 48 hours. The Regulations provide that this limit will not apply where a worker has agreed with his Employer, in writing, that it should not apply in his case. We are therefore asking you to agree to opt out to enable you to decide on your own hours of work.

You may withdraw your agreement by giving the Company three months advance notice in writing. Please confirm your agreement by signing where indicated on the section below.

____________________

I agree that the limit specified in Regulation 4 (1) of the Working Time Regulations 1998 shall not apply in my case.

 

 References

I hereby give my permission for Smeaton Healthcare Limited to contact my referees to confirm my dates of employment  immediately to establish my suitability for the role which I have applied for.

 

Documentation

Please upload the following documents (if applicable), please note that without the correct documentation, you will not be able to commence work - therefore if you haven't got the required documentation, you must get in touch immediately.

  • Passport
  • Driving License
  • Birth Certificate
  • Proof of Address (utility bill, driving license, payslip etc)
  • National Insurance Evidence

Job Description

Position:                         Homecare Worker/ Support worker

Responsible to:             Registered Manager

Purpose of Position

To share with other staff in meeting the personal care needs of service users in a way that respects the dignity of the individual and promotes independence. Care provided by care assistants is expected to include care that would reasonably be given by members of the service user’s own family and will not include tasks that would normally be undertaken by a trained nurse.  Only when trained to do so would care workers undertake any specialist tasks.

Principal Responsibilities

  1. To assist service users with all personal care needs including, undressing, washing, bathing and toileting needs.
  2. To assist service users with mobility problems and other physical disabilities, including incontinence and help in use and care of aids and personal equipment.
  3. To support and care for service users who are dying.
  4. To engage in the promotion of mental and physical well being of service users through talking to them, taking them out, sharing with them in activities such as reading, writing, hobbies and recreations.
  5. To make and change beds and all domestic tasks within the household.
  6. Where required, to assist with service user’s laundry, including using a laundrette where necessary.
  7. To read and write reports and take part in staff and service users’ meetings and in training activities as directed.
  8. To perform such other duties as may reasonably be required.
  9. To comply with the organisation’s policies and procedures at all times, which includes the service users care plan and medication needs.
  10. To report to the registered manager any significant changes in the health or circumstances of a service user.
  11. To encourage service users to remain as independent as possible.
  12. All staff are required to attend mandatory training where appropriate, this includes induction and National Vocational Qualifications or their equivalent.
  13. To enable and assist service users to maintain on a day to day basis as much autonomy and independence as possible.
  14. To support and assist service users in identifying risks and recording the support plan which minimizes and manages the identified risk
  15. To agree and record with the service user their needs wishes and preferences and how these will be met.
  16. Identify and support appropriately service users with capacity and those who lack capacity.
  17. Record appropriately all decisions which relate to service users who lack capacity.
  18. Involve and consult with service users, their families, representatives or advocates to ensure that the service user’s views are expressed and acted upon.
  19. Attend reviews of care as appropriate.
  20. Update and continually improve practice by a mutually agreed method which may include attendance at staff meetings, learning support briefings and one-to-one supervision.
  21. Take responsibility in conjunction with line manager for identifying further learning.
  22. Be aware of requirements regarding codes of practice and relevant codes of conduct where appropriate issued by professional bodies.
  23. Understand the requirement of the New Fundamental Standard Regulations 9 – 20, in relation to the Care Quality Commission Inspect regime and its importance to your workplace practice.
  24. Promote good practice and be vigilant in recognising and reporting practice which does not meet the defined standard.
  25. To assist and contribute to any regulatory body inspection or monitoring visit.
  26. To act always, to safeguard service users from any form of abuse and to report such concerns immediately.

Please Note

The above list is not exhaustive but should be used as a template of chosen tasks to form the required job description e.g. care worker, care assistant and support worker. This job description should be a minimum of 12 principle responsibilities and any from a current job description can still be included.

 

 

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Signature Certificate
Document name: Application Pack (Care at Home)
lock iconUnique Document ID: ec53424ad5a2474181c01a813f8cba9d2a6aa5c8
Timestamp Audit
13/04/2022 18:29 BSTApplication Pack (Care at Home) Uploaded by Central Recruitment Team - benjaminwakefield@smeatonhealthcare.co.uk IP 82.45.105.245
13/04/2022 22:04 BSTAndrew Sweet - andrewsweet@smeatonhealthcare.co.uk added by Central Recruitment Team - recruitment@smeatonhealthcare.co.uk as a CC'd Recipient Ip: 82.45.105.245
27/04/2022 21:44 BSTAndrew Sweet - andrewsweet@smeatonhealthcare.co.uk added by Central Recruitment Team - recruitment@smeatonhealthcare.co.uk as a CC'd Recipient Ip: 82.45.105.245
11/05/2022 20:05 BSTAndrew Sweet - andrewsweet@smeatonhealthcare.co.uk added by Central Recruitment Team - benjaminwakefield@smeatonhealthcare.co.uk as a CC'd Recipient Ip: 82.45.105.245