Name

First Name

Last Name

Date of Birth *

* MONTH DAY YEAR

MM

DD

YYYY

Are you working with The Employability Team? *

Yes

No

Are you in employment? *

Yes

No

Driver? *

I am a Driver - Full UK License with Access to Vehicle, vaild Insurance, Tax and MOT.

I am a Non - Driver

DBS (Disclosure and Barring Service) *

Due to Covid-19 www.gov.uk is process Free DBS application relevant to the role for a limited time.(From 31/03/2020)

I have a Online DBS that is regularly updated (proof required)

I have a DBS less than 3 months old (proof required)

I have a DBS 3-12 months old and will require a new one

I will Require a New DBS

Address *

This can determine if work is available in/ near your area

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Absences in the last 18 months? *

Zero Absences

I have been on sick for over 28 days (Long term)

I have been on sick

I have been absent

I have been absent due to family commitments

COVID-19 Questionaire *

Tick any that is relevant to you

I have tested positive and clear of Covid (state date and duration below)

I have had to isolate (state date below and reason)

I have had numerous of tests (state date below and reason)

I currently live with others that are vulnerable (state below which member of your household is vulnerable below e.g. father, children, grandma etc).

None is relevant as I've never been in contact with anyone, shown no symptoms, not needed a test.

I am fully vaccinated

I have only had first vaccination

How are you around animals/pets? *

As we care for service users in their homes some may have pets.

No to Pets

I have Allergies

Fine - no issues

Can you perform personal care on a male and female? *

No

Yes - experienced in this area

Maybe - require training

Can you deliver care to service user that is COVID-19 positive? *

Yes

No

Declaration *

The information in this application form is true and complete. I agree that any deliberate omission, falsification or misrepresentation in the application form will be grounds for rejecting this application or subsequent dismissal if employed by Yorkshire Care At Home. Where applicable, I consent that Yorkshire Care At Home can seek clarification regarding professional registration details. During the recruitment process anything deemed untrue could result immediately withdrawel.

I understand the rolling rota

I understand this role requires to travel to different locations

I know the rates of pay

I understand they will be 5 days training 3 days office based and 2 days shadowing is unpaid

I have declared all my health issues

I declare all answers at the best of my knowledge and belief

I declare all submitted is true