Application Form

Care Home Application Form

This form is for applications to work with Avante Care & Support and any of its subsidiaries. Please note that Avante Care & Support will only consider application forms that have been completed in full.

Location

Please select the location and job type you wish to apply for.

Job Location(required)

Please select the care home you wish to apply for.

Job Type(required)

Please specify the job type you are applying for.

How did you find out about this Job?(required)

Website

Facebook

Newspaper

Poster

*Friend (employee)

Word of mouth

Please let us know where you found this post (website, newspaper, friend or other).

*Refer-a-friend

If you found out about the job from a friend (Avante Employee) please state their name here.

Address details

Please provide your contact details below.

Title(required)

Forename(s)(required)

Surname(required)

Are you aged 18 or over?(required)

Address Line 1(required)

Please provide your current address.

Address Line 2

City/Town(required)

County(required)

Postcode(required)

Contact Details

Daytime / Work telephone

Evening / Home telephone

Mobile

Email address(required)

How would you prefer to be contacted?(required)

Daytime/Work

Evening/Home

Mobile

If you have had no contact within four weeks of the closing date of the position unfortunately on this occasion your application has been unsuccessful.

Availability to Work

Please provide details of your availability to work.

Day(required)

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Hours

Please specify the hours you are available for the chosen days.

Education and Qualifications

Please upload any photocopies/scans of any further education for professional qualifications. (Please state subjects, grades class, distinctions etc., where applicable.)

Level

Subject

Grade Obtained

Level

Subject

Grade Obtained

Level

Subject

Grade Obtained

Level

Subject

Grade Obtained

Employment Record (1)

Please give details of your previous employment, commencing with your most recent and accounting for any gaps across a 5 year period.

1. Employers name(required)

Employers name, address and business. If none please state as 'n/a'.

1. Date held from(required)

If none please state as 'n/a'.

1. Date held to(required)

1. Position and main responsibilities(required)

Position held and main responsibilities. If none please state as 'n/a'.

1. Notice period required / Reason for leaving? (required)

Notice period required / Reason for leaving? If none please state as 'n/a'.

Employment Record (2)

Please give details of your previous employment.

2. Employers name

Employers name, address and business. If none please state as 'n/a'.

2. Date held from

If none please state as 'n/a'.

2. Date held to

2. Position and main responsibilities

Position held and main responsibilities. If none please state as 'n/a'.

2. Notice period required / Reason for leaving?

Notice period required / Reason for leaving? If none please state as 'n/a'.

Employment Record (3)

Please give details of your previous employment.

3. Employers name

Employers name, address and business. If none please state as 'n/a'.

3. Date held from

If none please state as 'n/a'.

3. Date held to

3. Position and main responsibilities

Position held and main responsibilities. If none please state as 'n/a'.

3. Notice period required / Reason for leaving?

Notice period required / Reason for leaving? If none please state as 'n/a'.

Please tell us why you want to work in care?

Please use the box above to write in support of your application. This should include reasons for applying, details of your work experience and any relevant training in so far as it relates to the job. In addition, if you have undertaken any voluntary work (paid or unpaid), have any hobbies or interests, please include details.

General Information

Do you possess a current driving licence?(required)

Details of endorsements

Do you have a National Insurance Number?(required)

If yes please state(required)

Are you eligible to work in the UK?(required)

Are you subject to immigration restrictions?(required)

If you are subject to immigration restrictions, do you have permission to work in the UK?

Please state the grounds upon which you are eligible to work in the UK

If you do not have a National Insurance Number, and you do not require, or do not have, a current work permit, please state the grounds upon which you are eligible to work in the UK (i.e. UK/EU Citizen or relevant visa).

Have you previously worked or applied to work for Avante Care & Support or its sub-brands?(required)

Are you, to the best of your knowledge, related to someone who is, or has been, an employee, Director or Board member of Avante Care & Support?(required)

If yes to either of the questions above, please give details

References

Please give details of two referees, one of whom should be your current/last employer. If you have worked for any other health and social care employers during the last 7 years, please provide the details below. Avante Care & Support do expect to write to the formal and recognised addresses of all the employers you have listed.

Work Reference

Company name

Contact name

Ref Email address

Address

Telephone

How is this person known to you?

Personal Reference

Name

Ref Email address

Address

Telephone

How is this person known to you?

Health & Social Care Employer Reference

Name

Ref email

Address

Telephone

Email address

How is this person known to you?

May we contact your referees prior to an offer of employment?(required)

Declaration

Any appointment offered will be on the basis of your application and interview. The employer reserves the right to terminate your employment, without notice, in the event that it is discovered that the information provided was not accurate in some material way. I can confirm that, to the best of my knowledge, the information given on this form is true and correct and can be treated as part of my subsequent Contract of Employment. I understand that the appointment will be subject to satisfactory health clearance from your occupational health advisors. I understand that the post for which I am applying is exempt from the Rehabilitation of Offenders Act 1974, and I shall be required to complete a confidential Declaration Form regarding any convictions and cautions; I understand that I will be required to consent to disclosure of confidential information from the Criminal Records Bureau which will be sent to both myself and Avante Care & Support. Please give details of two referees, one of whom should be your current/last employer. Avante Care & Support do expect to write to the formal and recognised address of your last employer. Please give details of two referees, one of whom should be your current/last employer. Avante Care & Support do expect to write to the formal and recognised address of your last employer.

Name(required)

Date(required)

Criminal Convictions and 'Spent' Criminal Convictions

Avante Care & Support are responsible for the provision of services to vulnerable people. You will appreciate that the Organisation must be particularly careful to enquire into the character and background of applicants for appointment to posts which involve working with these people. Due to the nature of the work for which you are applying, this post is exempt from the provisions of Section 4(2) of the Rehabilitation of Offenders Act 1974, by virtue of the Rehabilitation of Offenders 1974 (Exceptions) Order 1975. Applicants are therefore not entitled to withhold information about convictions which for other purposes are deemed as being ‘spent’under the provisions of the Act. You must therefore disclose whether you have ever been convicted of a criminal offence and if so, state the exact nature of the offence(s). In the event of your employment with Avante Care & Support, any failure to disclose such convictions could result in dismissal. You must therefore tick one of the statements on the declaration form below, at A or B. If the answer is A, then please sign, print your name and date the form at the bottom of the declaration. If you tick answer B, you must give details, which should be enclosed, in a separate sealed envelope marked ‘Confidential’, with your name beneath, and attach the envelope to your application. You must also remember to sign, print your name and date the form at the bottom of the declaration. Please note that your nominated referees will be asked to confirm any relevant information to sections A and B in so far as they are able. In addition, in line with the above, this post will require you to consent to the disclosure of information from the Criminal Records Bureau which will be sent to both yourself and Avante Care & Support. The Organisation have a Criminal Records Bureau Disclosure Policy on the recruitment of ex-offenders which will be made available to all disclosure applicants on request, and will also make a copy of the CRB Code of Practice available on request. Any information given to, or received by, Avante Care & Support will be treated in the strictest confidence with access strictly controlled and limited to those who are entitled to see it as part of their duties. The Organisation complies fully with the Data Protection Act 1998, the Criminal Records Bureau Code of Practice, and other relevant legislation in this regard. The Organisation has a written policy on both data protection and the correct handling, use, storage, retention and disposal of disclosures and disclosure information which are available to those who wish to see them on request. The object of this Notice is not, in any way, to reflect upon an applicant’s integrity, but is necessary to protect both clients and the Organisation. Avante Care & Support are willing to consider persons with a criminal record on their merits and as such, having a criminal record will not necessarily bar you from consideration for this appointment. This will depend on the nature of the position and the circumstances and background of your offence(s).

I can confirm that I have read the information supplied to me inAvante Care & Support’s Notice concerning criminal convictions, cautions and ‘spent’criminal convictions and state that:(required)

I have none to declare

I have information to declare and attach a separate sealed envelope marked ‘Confidential’ containing details.

Name(required)

Date(required)

This field should be left blank

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