Fields marked with an asterisk (*) must be filled out before submitting
Post applied for*Senior carerCare coordinatorCarer If you are applying for a Carer post, pelase select preferred area---StanleyConsettChester le streetDurham
Name* Surname* Email Address*
Address* City* Postcode* Home Tel Mobile Tel Work Tel Do you own a car?*YesNo Do you have a full driving licence?*YesNo Do you have any endorsements? (Give Details)
Education / Qualifications*
Work Related Training
Previous Employment*
Your Job Title Salary Date Commenced Notice Required Employer Name, Address and Nature of Business Please give brief description of your duties If currently unemployed, give reason for leaving and date left
Please use this section to describe particular skills, knowledge and experience RELEVANT TO THIS POST (including voluntary or community activity, public duties, member of professional organisation or research and published work). This section must be completed.*
Please state why you consider yourself suitable for this post and why you applied for it* Have you ever been dismissed from any employment? If yes, give details*
Name* Position* Organisation Address* Telephone No.* Email address
a) Do you need a work permit to be able to work in the UK?*YesNo b) Are you the spouse/dependant of someone who requires a work permit or visa to work or study in the UK?*YesNo c) Do you have a travel document, United Kingdom residence Permit or letter issued by the Immigration and Nationality Directorate of the Home Office which provides the appropriate endorsement in relation to residency and permission to work in the UK?*YesNo If you have answered ‘Yes’ to b or c, please provide Expiry Date If offered this position will you continue to work in any other capacity? (Give details)
Orchard Home Care Services Ltd is committed to making its Equal Opportunities policy fully effective. To assist in monitoring this policy please complete this section. This information is not used in selection for the post
GenderMaleFemale
Disability Status: Do you have a disability which fits the definition in the Disability Discrimination Act – a physical or mental impairment which has a substantial and long term (i.e. over at least 12 months) adverse effect on your ability to carry out normal day-to-day activities?
DisabilityYesNoPrefer not to provide information
If you have a disability, and if you were shortlisted, please indicate any reasonable adjustments that would be required for you to attend the interview
Reasonable adjustments required to attend interview
Ethnic Origin: This refers to people who share the same cultural background and identity, not country of birth or nationality. Please note these categories are those used in the National Census.
White BritishWhite IrishOther White backgroundAsian or Asian British – IndianAsian or Asian British – PakistaniAsian or Asian British – BangladeshiOther Asian backgroundChineseMixed – White and Black CaribbeanMixed – White and Black AfricanMixed – White and AsianOther Mixed backgroundOther Ethnic backgroundPrefer not to provide information Nationality
Have you ever been convicted of a criminal offence?*YesNo Convictions / Cautions – if yes to above, please include date, name of court / police station / unit , offence and result Enter details of any charge or summons at present outstanding against you, include date of alleged offence, nature of offence and court / police station / unit dealing:
I understand and digitally sign this application form*