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Avondale Care & ACS Care at Home Employee Application Form

1. Avondale Care & ACS Care at Home Employee Application Form

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* 1. If your applying for Carrondale simply rank this No. 1 and leave all others blank, if you're applying for Fife please rank the facilities in your preferred order and leave Carrondale blank.

ACS Care at Home - Fife - Care in the Community

Benore Care Home - Fife - Frail & Elderly

Carrondale Care Home - Falkirk - Frail & Elderly and Younger Adults Complex Care

Lister House - Fife - Specialist Dementia

Robert Allan House - Fife - Younger Adults Complex Care

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* 2. Position Applied For:

ACS care at Home - Community Support Worker - NO EXPERIENCE

ACS Care at Home - Community Support Worker - WITH EXPERIENCE BUT NO SVQ's.

ACS Care at Home - Community Support Worker - WITH SVQII or Above.

Administrator

Carer - NO EXPERIENCE

Carer - WITH EXPERIENCE BUT NO SVQ'S

Carer - WITH SVQ II

Domestic

Kitchen

Maintenance

Nurse

Senior Carer with SVQ III & Medication Certificate

Care Home Manager

Care Home Deputy Manager

Activities Coordinator

Other (please specify)

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* 3. Personal Details:

First Name & Surname Including Title:

House Name / Number & Street Name:

Town:

Post Code:

Maiden Name:

Marital Status:

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* 4. Contact Details:

Landline:

Mobile:

Email Address:

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* 5. Please provide the following details:

Name of Next of Kin:

Relationship to Next of Kin:

Emergency Contact Number:

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* 6. Please provide the following details:

Current Nationality:

National Insurance Number:

NMC Pin Number or Work Permit Number (If Applicable):

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* 7. Do you have a current driving licence:

Yes - Have my own Car.

Yes - have access to a Car.

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* 8. Do you have a current PVG (Disclosure Scotland):

Yes

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* 9. Are you currently Employed?

Yes

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* 10. Please provide the name and address of your current employer or most recent employer along with the position you had.

Name:

Address:

Position:

Not Applicable:

Reason For Leaving if applicable:

Reason For Wanting to Leave:

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* 11. Please provide the name and address of any previous employment in the last ten years (approx):

1/Previous Employment - Company Name:

Contact Person - Name:

Company Address:

Contact Tel. No.:

Contact Email Address:

Position Held:

Employment Date From: (Month/Year)

Employment Date to: (Month/Year)

2/ Previous Employment - Company Name:

Contact Person - Name:

Company Address:

Contact Tel. No:

Contact Email Address:

Position Held:

Employment From: (Month/Year)

Employment To: (Month/Year)

3/ Previous Employment: - Company Name:

Contact Person - Name:

Company Address:

Contact Tel. No.:

Contact Email Address:

Position Held:

Employment From: (Month/Year)

Employment To: (Month/Year)

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* 12. Do you have any experience of the position you have applied for, if so please detail below.

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* 13. Please describe why you think you are suitable for this position.

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* 14. Please explain why you would like this job

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* 15. Please provide your Secondary Education Details:

Secondary Schools Attended:

Dates Attended:

Qualifications Achieved:

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* 16. Please provide your Further Education Details:

Not Applicable:

University/College Attended:

Dates Attended:

Qualifications Achieved:

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* 17. Do you have any friends or relatives currently employed with Avondale or are Residents within The Care Home

Yes

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* 18. Please give details of your leisure interests and any hobbies you may have:

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* 19. Do you have any future holiday commitments?

Yes

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* 20. Please provide details of any future holiday commitments you have:

Details with dates:

Not Applicable:

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* 21. Where did you hear about this vacancy?:

Courier Newspaper

Gumtree

Website: www.acscot.care

Facebook Page: www.facebook.com/avondalecare

Facebook Page: www.facebook.com/osborneandallan

Radio

Word of Mouth

Roadside Banner

Indeed

S1 Jobs

Other (please specify)

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* 22. THIS AVAILABILITY QUESTION RELATES TO ACS CARE AT HOME. - For The Care Homes go to question 22.

ACS Operates between the hours of 7.00am and 10.00pm. Please provide your availability each day between these hours. E.g.: 7.00am - 2.00pm / 2.00pm - 10.00pm

Monday:

Tuesday:

Wednesday:

Thursday:

Friday:

Saturday:

Sunday:

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* 23. THIS AVAILABILITY QUESTION RELATES TO THE CARE HOMES AND THE FOLLOWING POSITIONS: NURSE, SENIOR CARER & CARER
Our Nurses, Senior Carers and Carers work 12 Hour Shifts 8 - 8, so please state your availability by using the following abreviations each day: D = Dayshift / N = Nightshift & A = Any.

Monday:

Tuesday:

Wednesday:

Thursday:

Friday:

Saturday:

Sunday:

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* 24. When would you be available for Induction? (Induction runs over 3-5 days depending on what position you have applied for)

Immediately

1 week

2 weeks

3 weeks

4 weeks

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* 25. Please provide two employment references, one being your current or most recent employer.

The minimum requirement for references is:

TWO PAST EMPLOYER REFERENCES.
OR ONE PAST EMPLOYER AND 2 PROFESSIONAL CHARACTER REFERENCES.

Reference 1 Type: THIS MUST BE A PAST OR PRESENT EMPLOYER!

Reference 1 Contact Name:

Reference 1 First Line of Address:

Reference 1 Town:

Reference 1 Postcode:

Reference 1 Telephone Number:

Reference 1 Mobile Number:

Reference 1 Email Address:

Reference 2 Type: Employer or Character?

Reference 2 Name:

Reference 2 First Line of Address:

Reference 2 Town:

Reference 2 Post Code:

Reference 2 Telephone Number:

Reference 2 Mobile Number:

Reference 2 Email Address:

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* 26. Please provide two professional character references if you have been unable to provide two employment references.

Please Note - Close Friends or Relatives are NOT ACCEPTABLE.

Reference 1 Contact Name:

Reference 1 First Line of Address:

Reference 1 Town:

Reference 1 Postcode:

Reference 1 Telephone Number:

Reference 1 Mobile Number:

Reference 1 Email Address:

Reference 2 Contact Name:

Reference 2 First Line of Address:

Reference 2 Town:

Reference 2 Postcode:

Reference 2 Telephone Number:

Reference 2 Mobile Number:

Reference 2 Email Address:

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* 27. Privacy Notice

We process personal data relating to those who apply for job vacancies with us or who send speculative job applications to us. We do this for employment purposes, to assist us in the selection of candidates for employment, and to assist in the running of the business. The personal data may include identifiers such as name, date of birth, personal characteristics such as gender, qualifications and previous employment history.

We will not share any identifiable information about you with third parties without your consent unless the law allows or requires us to do so. The personal data provided during an application process will be retained for a period of at least six months or, if required by law, for as long as is required.

This privacy notice does not form part of an employment offer or contract between us. If we make an employment offer to you, we will provide further information about our handling of your personal information in an employment context separately.

If you would like to find out more about our data retention policy and how we use your personal data, you want to see a copy of the information about you that we hold or have any questions or issues regarding data protection, please email us with the Subject “Data Protection Request”.

Please confirm Yes/No that you have understood the Privacy Notice and accept the contents.

Yes - I understand and accept your Privacy Policy

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* 28. The position you have applied for is exempt from the provisions of the Rehabilitation of Offenders Act 1974 under section 4(2) of said 1974 Act. The position is considered to be regulated work with protected adults and a PVG check will be completed as part of the recruitment process.

You are therefore required to disclose any unspent convictions or cautions and any spent convictions for offences included in Schedule A1, ‘OFFENCES WHICH MUST ALWAYS BE DISCLOSED’ of the Rehabilitation of Offenders Act (Exclusions and Exceptions) (Scotland) Amendment Order 2015 No.2.　

You are not required to disclose spent convictions for offences included in Schedule B1, ‘OFFENCES WHICH ARE TO BE DISCLOSED SUBJECT TO RULES’ until such time as they are included in a higher level disclosure issued by Disclosure Scotland."

These lists of offences are available on the Disclosure Scotland website or at www.legislation.gov.uk.

Do you have any unspent convictions or spent convictions that you are required to disclose?

Charges Pending:

Convictions:

I confirm the information I have provided is true and accurate - Signature:

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100% of survey complete.

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* 1. If your applying for Carrondale simply rank this No. 1 and leave all others blank, if you're applying for Fife please rank the facilities in your preferred order and leave Carrondale blank.

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* 2. Position Applied For:

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* 3. Personal Details:

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* 4. Contact Details:

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* 5. Please provide the following details:

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* 6. Please provide the following details:

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* 7. Do you have a current driving licence:

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* 8. Do you have a current PVG (Disclosure Scotland):

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* 9. Are you currently Employed?

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* 10. Please provide the name and address of your current employer or most recent employer along with the position you had.

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* 11. Please provide the name and address of any previous employment in the last ten years (approx):

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* 12. Do you have any experience of the position you have applied for, if so please detail below.

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* 13. Please describe why you think you are suitable for this position.

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* 14. Please explain why you would like this job

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* 15. Please provide your Secondary Education Details:

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* 16. Please provide your Further Education Details:

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* 17. Do you have any friends or relatives currently employed with Avondale or are Residents within The Care Home

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* 18. Please give details of your leisure interests and any hobbies you may have:

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* 19. Do you have any future holiday commitments?

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* 20. Please provide details of any future holiday commitments you have:

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* 21. Where did you hear about this vacancy?:

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* 22. THIS AVAILABILITY QUESTION RELATES TO ACS CARE AT HOME. - For The Care Homes go to question 22.ACS Operates between the hours of 7.00am and 10.00pm. Please provide your availability each day between these hours. E.g.: 7.00am - 2.00pm / 2.00pm - 10.00pm

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* 23. THIS AVAILABILITY QUESTION RELATES TO THE CARE HOMES AND THE FOLLOWING POSITIONS: NURSE, SENIOR CARER & CAREROur Nurses, Senior Carers and Carers work 12 Hour Shifts 8 - 8, so please state your availability by using the following abreviations each day: D = Dayshift / N = Nightshift & A = Any.

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* 24. When would you be available for Induction? (Induction runs over 3-5 days depending on what position you have applied for)

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* 25. Please provide two employment references, one being your current or most recent employer.The minimum requirement for references is: TWO PAST EMPLOYER REFERENCES.OR ONE PAST EMPLOYER AND 2 PROFESSIONAL CHARACTER REFERENCES.

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* 26. Please provide two professional character references if you have been unable to provide two employment references.Please Note - Close Friends or Relatives are NOT ACCEPTABLE.

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* 22. THIS AVAILABILITY QUESTION RELATES TO ACS CARE AT HOME. - For The Care Homes go to question 22.

ACS Operates between the hours of 7.00am and 10.00pm. Please provide your availability each day between these hours. E.g.: 7.00am - 2.00pm / 2.00pm - 10.00pm

* 25. Please provide two employment references, one being your current or most recent employer.

The minimum requirement for references is:

TWO PAST EMPLOYER REFERENCES.
OR ONE PAST EMPLOYER AND 2 PROFESSIONAL CHARACTER REFERENCES.

* 26. Please provide two professional character references if you have been unable to provide two employment references.

Please Note - Close Friends or Relatives are NOT ACCEPTABLE.