1st Call Recruitment Services

0800 772 0083

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Health Care Assistant-Support Worker

Previous Employment

A full employment history must be detailed beginning with your current employment, and covering all reasons for gaps in any given year.

From:

To:

Employer’s name:

Position held:

Salary:

Reason for leaving:

From:

To:

Employer’s name:

Position held:

Salary:

Reason for leaving:

From:

To:

Employer’s name:

Position held:

Salary:

Reason for leaving:

From:

To:

Employer’s name:

Position held:

Salary:

Reason for leaving:

From:

To:

Employer’s name:

Position held:

Salary:

Reason for leaving:

Education and Professional Qualifications

(Original documents as proof of qualification will be required at interview)

Secondary School / College / University:

Examinations taken:

Result:

Secondary School / College / University:

Examinations taken:

Result:

Secondary School / College / University:

Examinations taken:

Result:

Secondary School / College / University:

Examinations taken:

Result:

Secondary School / College / University:

Examinations taken:

Result:

Rehabilitation of Offenders Act 1974 – Notice To Offenders

Because of the nature of the work involved, the post for which you are applying is exempt from Section 4(2) of the Rehabilitation of Offenders Act 1974 by virtue of the Rehabilitation Offenders Act (Exemption Order 1975). This means that you are not entitled to withhold information relating to any convictions you may have had.

Do you have any convictions to disclose?

Yes

No

Any information should be given on a separate sheet and sent with this application form. This information will be treated as confidential and will not necessarily preclude you from employment.

Name as Signature:

Additional Personal Details

Outside interests, leisure time activities and other personal information which you think may assist us in evaluating your application.

More about me:

References

Please give the name and address of two referees, one of whom must be your present employer, or your previous employer.

Name:

Status:

Address and Telephone No:

Name:

Status:

Address and Telephone No:

Name:

Status:

Address and Telephone No:

This organisation seeks to work in a flexible and family friendly manner with its staff, however unsocial hours are part and parcel of a quality care service. Weekend working is a requirement for all staff, the frequency of which will be determined

Please indicate holiday dates if already booked:

Period of notice required in present post:

Earliest start date:

Thank you for completing this application form. I declare that to the best of my knowledge, all of the information contained and documented herein is complete and truthful.

Name as Signature:

DBS Consent Form

This new subscription service lets individuals keep their DBS certificate up-to-date so you can take it with you when you move jobs or roles.

As a Registered Body, 1st Call Recruitment Services can then carry out online, instant checks to see if any new information has come to light since the certificate’s issue - this is called a status check.

The DBS update service check will allow you to have greater control of your own information and allow DBS certificates to be reused when applying for similar jobs. You will also be able to see who has carried out a status check, and when they did, from your online account.

What should you do now?

Subscribe to the update service. An annual fee of £13.00 will be payable to the DBS. You can subscribe 28 days of DBS receiving your application or 14 days after the issue date of the Certificate.

By signing below, you give ongoing consent to:
VCare staffing Solution Limited to carryout a Status check (DBS and Regulated Activity) on you each time it is necessary,in accordance with the DFE and DBS guidelines.

Should you wish for the consent to be withdrawn, please provide 1st Call Recruitment services with written notice confirming your withdrawal.

Name as Signature:

Skills Checklist – Carer

Please Tick the Box in accordance w the level of expertise as indicated below:
1. Familiar with procedure and can perform alone
2. Familiar with procedure but needs supervision
3. Understand theory of the procedure but never performed task
4. No knowledge of the procedure

Speciality

Grade:

Personal Hygiene	1	2	3	4
Bath/Shower/Assisted wash
Use of Bath aids
Mouth Care (Including Dentures)
Care of feet (Exluding toe nails)
Dressing/Undressing of patients
Bed Bath
Shaving
Care of hair
Care of Finger nails
Care of eyes
Pressure area care

Toileting	1	2	3	4
Emptying and changing a catheter bag
Catheter care
Stoma care
Use of bedpans/urine bottles/commodes
Collection of stool/urine/sputum
Incontinence care

Mobility	1	2	3	4
Moving and Handling
Use of Hoists
Use of Walking aids
Use of Wheel Chair

Nutrition	1	2	3	4
Preparation of food
Special diets
Supervision with eating
Assistance with feeding

Infection Control	1	2	3	4
Caring for MRSA positive patients
Barrier nursing
Isolation
Universal precautions
Hand washing
Cross Infection

Observations	1	2	3	4
Observing Patients Confidentiality
Taking temperatures
Checking Blood Pressure
TPR/BP recording chart
Checking pulse/Respiration
Blood sugar Testing
Urine Testing
Observing/recording changes in patient
condition and reporting to senior sta

General	1	2	3	4
First Aid
Awareness of Health & Safety Precautions
Bed Making
Simple Dressing
Report writing handover
Laundry
Shopping
Domestic Duties

Knowledge of Service User Groups	1	2	3	4
Elderly people
Dementia
Palliative care/ care of terminally ill
People with Physical disabilities
People with mental health problems
People living with HIV/AIDS
Children/families

Working Time Regulations Form & Student Declaration

If you choose not to sign this document, you are restricting your hours available to work to no more than 48 hours in any one week period.

If you choose to sign this declaration, 1st Call recruitment Services will not hold you to working more than 48 hours per week. It is your choice and at you personal discretion if you choose to work more or less than 48 hours.

I agree that I may work for more than an average of 48 hours per week.

If I choose to change this agreement, I will give 1st Call recruitment Services one months notice in writing to end this agreement.

Student declaration form

Strictly confidential
UK Students: Please complete sections A, C and D
Overseas Students: Please complete sections A, B and D

Section A: All students

I am a UK/Overseas (delete as appropriate) Student currently studying

Course

At: College/University

Section B: Overseas students

My permit allows me to work no more than ________ hours a week.

Section C: UK students

I am allowed to work no more than _______ hours a week

I am allowed to work outside term time only

I have no restrictions on my working hours/times

Section D: All students

Declaration: I confirm that the information I have provided is correct. Any misleading or inaccu- rate information given may result in 1st Call recruitment Services terminating my employment.

Bank Payment Details Form

Authorisation For Payment Directly Into Your Bank Account - Please Write Clearly As Any Errors May Result In Payment Being Sent To Wrong Account

Title:

Name

Address:

Post code

National Insurance Number

Phone Number

Email

Paye or Contractor

Bank Details

Name of Bank/Building Society

Bank / Building Society Address

Branch Name

Account Name

Sort Code

Account Number

Staff Consent

This consent is to protect staff information which is currently held under the Data Protection Act 2018 and the Freedom of Information Act 2000.

a) I understand that as part of the contractual arrangements between 1st Call Recruitment services Limited and the Local Authority contracts team, that the monitoring of the contract gives access to my personal file during their monitoring visits.

Name as Signature

b) I understand that the Care Quality Commission has the right to access my file as part of the compliance review process.

Name as Signature

c) The EU Working Time Directive allows workers to “opt out” of working a maximum of 48 hours in any week. Please indicate your choice.

I wish to work a maximum of 48 hours in any week

Or

I wish to “opt out” of the working time directive and be able to work more hours should I wish to do so.

If I wish to change these arrangements I understand that I must give 4 weeks’ notice in writing of any changes.

Within the current legislative framework, the Care Quality Commission has a right to view all and any forms, correspondence, paperwork which is kept and held under the Data Protection Act 2018 and the freedom of Information Act 2000 within the offices of 1st Call Recruitment Services Limited. Within the service specification of the contract with the Local Authority, the same right is conferred to the monitoring function.

Payment Deduction Authorisation

I authorise 1st Call Recruitment Services Limited to deduct the sum of (Pounds) as payment towards Hospital Training/Manual Training

/CPR Training / CRB Processing / Staff Advance before giving me my salary / wages

Name as Signature

Photo Verification

PLEASE ATTACH 2X PASSPORT PHOTOS HERE OR IF YOU ARE SENDING THEM ELECTRONICALLY JUST COMPLETE THE SECTION BELOW.

Add Photo (.png or .jpg)

Please sign to verify that the photographs copied above are a true copy of the ones that you have brought with you today.

Name as Signature

Casual Worker Agreement

Following our recent meeting I am delighted to be able to offer you casual work with the Company under the following terms and conditions.

Status of this Agreement
This contract governs your engagement from time to time by 1st Call Recruitment Services as a Casual Worker. This is not an employment contract and does not confer any employment rights on you (other than those to which workers are entitled). In particular, it does not create any obligation on you to perform work for the Company (even if offered) or on the Company to provide work to you and therefore there will be no mutuality of obligation between the Company and you.
Company’s discretion as to work offered
It is entirely at the discretion of the Company whether to offer you work and it is under no obligation to provide work to you at any time. The Company reserves the right to give or not give work to any person at any time and is under no obligation to give reasons for such decisions.
No presumption of continuity
Each offer of work by the Company which you accept shall be treated as an entirely separate and severable engagement (an assignment). The terms of the contract shall apply to each assignment but there shall be no relationship between the parties after the end of one assignment and before the start of any subsequent assignment. The fact that the Company has offered you work, or offers you work more than once, shall not confer any legal rights on you and, in particular, should not be regarded as establishing an entitlement to regular work or conferring continuity of employment.
Arrangements for work
If the Company wants to offer you any work it will call, text or email you the details of the assignment. You are under no obligation to accept any work offered by the Company at any time. However, if you accept an assignment you must inform the Company immediately if you will be unable to complete it for any reason.
The Company reserves the right to terminate an assignment at any time for operational reasons. You will be paid for all work done during an assignment up to the time it is terminated. In order to assist the Company in organising work, please complete the personal information sheet attached to this contract and return it to manager by _____________. It is your responsibility to inform the Company of any changes to these details.
Work
The Company may offer you work from time to time as Health Care Assistant/Support worker. If you accept work your duties will include providing care to service users and you will usually report to manager. The precise description and nature of your work may be varied with each assignment and you may be required to carry out other duties as necessary to meet business needs. You will be informed of the requirements at the start of each assignment.
Before offering you an assignment the Company will require certain documents from you in order to satisfy itself that you are legally entitled to work in the UK.
You confirm that you are legally entitled to work without any additional immigration approvals and agree to notify the Company immediately if you cease to be so entitled at any time.
Place of work
During each assignment your place of work will be Preston OR the Company may offer you work at various locations. You will be informed of the relevant place of work for each assignment.
Hours of work
During each assignment your hours of work will vary depending on the operational requirements of the Company. You will be informed of the required hours for each assignment.
You will be entitled to an unpaid break of (one hour) where your assignment requires you to work more than (six hours) in any one day.
Company timesheets recording the actual hours worked are to be completed and submitted to the office on a weekly basis.
Working Time Opt-Out
Please complete the attached from to confirm whether you wish to put out of the 48 hour limit on a week’s work. If you do not opt out, the Company must ensure that it does not offer you work which would result in you working for more than 48 hours in any week. You must then keep the Company informed of the hours that you work for third parties so that it can comply with this obligation.
Pay
You will be paid for the hours that you work. The Company’s current rate of pay for casual workers is £ ______________ an hour gross. You will be paid weekly/monthly in arrears on or about the last day of each month, directly into your bank account for the hours worked in the previous month. The Company will make all necessary deductions from your pay as required by law and shall be entitled to deduct from your pay or other payments due to you any money which you may owe to the Company at any time.
Holidays
Your holiday entitlement will depend on the number of hours that you actually work and be pro-rated on the basis of a full time entitlement of 28 days holiday during each full holiday year. This entitlement includes the usual 8 public holidays in England and Wales. The Company’s holiday year runs from (01/01) to (21/12).
At the end of each assignment the Company will pay you in lieu of any accrued but untaken holiday for the holiday year in which the assignment ends. The amount of the payment in lieu will be calculated by taking 12.07% of the hours worked during the assignment and multiplying this by your hourly rate of pay. (See paragraph 9 above).
For operational reasons you will not normally be entitled to take leave during an assignment, but permission may be granted in exceptional circumstances.
If you have taken and been paid for more holiday than your accrued entitlement at the date your assignment ends, the Company shall be entitled to deduct from you any overpayment which has been made.
Sickness
If you have accepted an offer of work but are subsequently unable to work the hours agreed, you must notify the manager of the reason for your absence as soon as possible but no later than (time) on the first day of absence
You will not be entitled to receive any pay in respect of any period of sickness or injury during an assignment. As you are not an employee you have no entitlement to Statutory Sick Pay.
Data Protection
You consent to us holding and processing, both electronically and manually, the data that we collect about you, in the course of your working relationship with us, for the purposes of administration and management of our staff and our business and for compliance with applicable laws, procedures and regulations.
Company rules and procedures
During each assignment you are required at all times to comply with relevant Company rules, policies and procedures in force from time to time including but not limited to those contained in the staff handbook, a copy of which has been given to you OR which is available from the staff portal of the website.
Confidential Information
You shall not use or disclose to any person, either during or at any time after your engagement by the Company, any confidential information about the business or affairs of the Company (or any of its business contacts) or about any other matters which may come to your knowledge as a result of carrying out assignments. For the purposes of this clause confidential information means any information which is not in the public domain and which relates to the affairs of the Company (or any of its business contacts).
The restriction in this clause does not apply to:
a) Prevent you from making a protected disclosure within the meaning of section 43A of the Employment Rights Act 1996; or
b) Use or disclosure that has been authorised by the Company or is required by law or in the course of your duties.
Company property
All documents, manuals, hardware and software provided for your use by the Company, and any data or documents (including copies) produced, maintained or stored on the Company’s computer systems or other electronic equipment (including mobile phones) remain the property of the Company.
Any Company property in your possession and any original or copy documents obtained by you in the course of your work for the Company shall be returned to the manager at any time on request and in any event at the end of the assignment.
Termination
If you wish your name to be removed from the Company’s staff bank or no longer wish to be considered for casual work by the Company you should inform the manager as soon as possible.
The Company may remove your name from its staff bank if you are unable to accept an assignment on (three) occasions OR work for (four) consecutive weeks.
The Company may terminate this contract immediately by giving notice in writing to you if it reasonably considers that you have committed any serious breach of its terms or committed any act of gross misconduct. Non-exhaustive examples of gross misconduct include (dishonest, theft, fighting, mis-use of drugs or alcohol or any acts or omission which) might bring the Company into disrepute).
Changing Terms and conditions
The Company may review its requirement for casual workers from time to time and/or may update the terms on which it offers such work. In the event of any changes to the terms on which it is prepared to engage casual workers the Company may terminate this contract with immediate effect by giving notice to you and you may, at the Company’s absolute discretion, be offered a new contract for casual work.
Governing law
This contract will be governed by English law. If you wish to accept casual work from the Company on the terms stated above you are requested to sign and date one copy of this agreement and return it to manager as soon as possible. We look forward very much to you joining the team and trust that we shall have an enjoyable and satisfying relationship.

Position:

Name as Signature:

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