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Job Application Form

Vacancy Title *

How did you hear about us? *

Personal Details

First Name *

Last Name

Date of Birth *

Select *

Nationality *

National Insurance No. *

Country of Birth *

Street Address *

City *

State/Province *

ZIP / Postal Code *

Country *

Email Address *

Phone Number *

Bank Details

Account Number *

Sort Code *

Bank Name *

Street Address *

City *

State/Province *

ZIP / Postal Code *

Country *

All details are held in the strictest confidence under the Data Protection Act 1998. I authorise W4U SOLUTIONS LTD to make payments to this account for work done *I agree

Identification

Residential Address *

City *

State/Province *

ZIP / Postal Code *

Country *

Professional Qualifications *

Education/Qualifications *

Employment History

Name and Address of Employer and Nature of Busines *

Job Title: job Functions/Responsibilities *

Dates To and From employed *

Final Salary and Reason for Leaving *

Proficiency In Languages

Native Language *

Second Language (optional) *

Proficiency In Speaking Second Language *

Proficiency In Reading Second Language *

Proficiency In Writing Second Language *

Do You Hold a Full Uk Driving License Or Equivalent *

Select *

Soft Skills *

References

Name of reference 1 *

Email Address Reference 1 *

Position Of Reference 1 *

Telephone/Fax No of Reference 1 *

Email Address Reference 2 *

Position Of Reference 2 *

Name of reference 2 *

Telephone/Fax No of Reference 2 *

Health Questionnaire

An answer must be provided for all questions. The information will be treated in confidence.

General Practitioner Information` *

GP Address *

County *

Post Code *

Select *

Tel Number *

Medical History

Please complete the following questions by ticking the appropriate box. If the answer is ‘yes’, give details including (a) date, (b) amount of time lost from work/school, (c) treatment, as appropriate.

Have you ever suffered from any of the following illnesses?

Have you ever suffered from any of the following illnesses?

Visual defects/eye conditions (including colour-blindness) *

Hearing defects/ear conditions *

Severe anxiety, depression, other psychiatric disorder *

Paralysis or other neurological disorder *

Fainting attacks, blackouts, epilepsy or fits *

Recurrent headaches, migraine *

Vertigo, giddiness or tinnitus *

Heart disease, high blood pressure *

Asthma, bronchitis, tuberculosis or other chest disease *

Peptic ulcer or other digestive or bowel disorder *

Liver disorder No Paralysis or other neurological disorder *

Kidney of bladder problems *

Gynecological problems *

Recurrent backache, arthritis, rheumatism *

Eczema, dermatitis, other skin conditions *

Diabetes, thyroid or other gland problems *

Hayfever, allergies to drugs, animals etc *

Any recurrent infections No Any impairment of immunity to infection *

Any alcohol or drug related problems or illness *

Hernia No Varicose veins causing trouble *

Any other medical condition, physical or mental, not mentioned above *

Ever undergone a surgical operation or been admitted to hospital for any reason? *

Had more than 20 days sickness absence in the past 2 years? *

Received a Disability Pension? *

Ever been, or are a Registered Disabled Person? *

Suffered from an Industrial Disease/Accident? *

Had a chest X-ray in the past 12 months – If so state place / date / result *

Supporting Statement

Have you had any criminal convictions (including spent convictions under the rehabilitation of offenders Act 1974)? *

Are you subject to any restrictions from previous employers which may restrict your working activities? No Have you ever been employed by this company or its affiliates before? *

Have you applied for employment with this company before? No Are you related to any employee working at this company? *

Do you have any physical impairment or health problem *

Have you been dismissed No or suspended from the service of any employer? *

Have you been dismissed or suspended from the service of any employer? *

Interview Questionnaire

First Name *

Last Name

Position Applied For *

What are your weaknesses? *

What are your goals? *

If you encountered a service user who was upset what would you do? *

If you encountered a service user who was being aggressive towards you or another resident how would you deal with it? *

How would you transfer a resident from a bed to a wheelchair? *

What is the purpose of a hand-over? *

Describe what you would do if a service user were to have an accident? Who would you report this to? *

How would you promote infection control? *

What items do you use to prevent the spread of infection? *

How would you dispose of clinical waste? *

What would you do if you witnessed another employee stealing? *

What would you do if witnessed another employee being aggressive with a service user? *

What would you do if you witnessed another employee not abiding by health, safety and infection control policies? *

You confirm that everything completed in this section is correct and attest to your character? *

Today's Day

Terms Of Engagement

First Name

Middle Name

Last Name

Today's Date *

Select *

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Address

123 5th Avenue, New York, US

Call Us

+1 123 456 7890

Email Us

[email protected]

Our Main Services

Home Care Service
Supported Living Accommodation
Health Care Recruitment

Contact Us

Key Court 82-84 Moseley Street Birmingham B12 0RT
+447471849345
[email protected]

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Care Service Solution Limited, registered in England and Wales under company number: 13837523. Keys Court Business Centre, 82-84, Moseley Street, Digbeth, Birmingham, England, B12 0RT

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