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Spectrum Healthcare Limited
Work For Us
Our Services
Community Services (Care at Home)
Specialist Nursing Agency
Central Surgery Nursing Home
Brookside Residential
Bedwellty Residential
Compliments
Contact Us
Healthcare Assistant Application
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*
" indicates required fields
Personal Details
Name
*
Title
Mr.
Miss
Mrs.
Ms.
Other
First Name
Middle Name(s)
Last Name
Date of Birth
*
DD/MM/YYYY
Phone Number
*
Email
*
Address
*
Address Line 1
Address Line 2
City
ZIP / Postal Code
Do you currently hold a full UK driving license?
*
Yes
No
Do you have any current endorsments?
*
Yes
No
Do you require a work permit to work in this country?
*
Yes
No
Emergency Contact Name / Relationship
*
Emergency Contact Number
*
GP Details
GP Name
GP Telephone Number
GP Address
Address Line 1
Address Line 2
City
ZIP / Postal Code
Education & Training History
Please upload a copy of your current CV
Max. file size: 512 MB.
Past School/College/University and Dates
*
Examinations Passed / Qualifications Gained
*
Employment History
Name of most recent employer
*
Start Date
*
Day
Month
Year
End Date
*
Day
Month
Year
Position held, main duties and reason for leaving
*
Name of employer previous to above
Start Date
Day
Month
Year
End Date
Day
Month
Year
Position held, main duties and reason for leaving
Name of employer previous to above
Start Date
Day
Month
Year
End Date
Day
Month
Year
Position held, main duties and reason for leaving
Please list any other roles such as voluntary positions
Are there any gaps in your work history? If yes, please explain
*
Medical Information
Do you have any mental / physical disability or illness (current or recurring) which is relevant to the position that you are applying for?
*
Yes
No
If yes, please give details
What adjustments (if any) need to be made to the working environment to accomodate your disability?
Please give details of all absences from work (not including holidays)
Please give details of any illness/accidents/injuries in the past 2 years
Capacity to Work in the UK
Are there any restrictions to your residence in the UK which might affect your right to take up employment in the UK
*
Yes
No
If yes, please provide details:
If you are successful in the application would you require a work permit prior to taking up employment?
*
Yes
No
Please tell us in your own words why you think you would suit the role of a Healthcare Assistant for Spectrum Healthcare Limited. You might want to tell us about any formal or informal experiences you might have had while supporting another individual.
References
Name of previous employer
*
Telephone number (UK)
*
Email
*
Job Title
*
Previous Employer to the One Named Above
Telephone number (UK)
Email
Job Title
Character Reference (Neighbour, Teacher, ex-Colleague, Family Friend etc)
*
Telephone Number (UK)
*
Email
*
Relationship to You
*
Applicant's Declaration - Read and Understand Before Signing
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1. I confirm that the information given above is complete and correct, and that I understand that any incomplete, untrue or misleading information will entitle the employer to reject my application, withdraw any employment offer made, or, if I am employed, dismiss me without notice.
2. I agree that the employer reserves the right to require me to undergo a medical examination to assess my suitability for work.
I CERTIFY THAT I HAVE READ AND UNDERSTOOD THE ABOVE AND THAT THE INFORMATION I HAVE GIVEN IS TRUE AND CORRECT
CONFIDENTIAL DECLARATION FORM
Spectrum Healthcare aims to promote equality of opportunity and is committed to treating all applicants for positions fairly and on merit regardless of race, gender, marital status, religion, disability, sexual orientation, age or offending history. We undertake not to discriminate unfairly against on the basis of criminal conviction or other information declared.
Prior to making a final decision concerning your application, we shall discuss with you any information declared by you that we believe has a bearing on your suitability for the position. If we do not raise information with you, this is because we do not believe that it should be taken into account. In that event, you remain free to discuss any of that information or any other matter that you wish to raise. As part of assessing your application, we will only take into account relevant criminal records and other information declared.
The Data Protection Act 1998 requires us to provide you with certain information and to obtain your consent before processing sensitive data about you. Processing includes: obtaining, recording, holding, disclosing destruction and retaining information. Sensitive personal data includes any of the following information: criminal offences, criminal convictions, criminal proceedings, disposal or sentence. The information that you provide in this Declaration Form will be processed in accordance with Data Protection Act 1998, and will only be used for the purpose of determining your application for this position. Once a decision has been made concerning your appointment, we will not retain this declaration form longer than is necessary.
This declaration form will be kept securely and in confidence, and access to it will be restricted to designated persons within Spectrum Healthcare and other persons who need to see it as part of the selection process and who are authorised to do so.
Please ensure that you read the “Guidance Notes for Applicants” that accompanied your application form carefully before completing this Declaration Form. They provide you with further and more detailed information concerning how your application will be processed, and include details for which information about you will be processed, the persons to whom it will be disclosed and the checks that will be undertaken to verify the information provided before you are offered a position if your application is successful.
PLEASE ANSWER ALL OF THE FOLLOWING QUESTIONS
If you answer ‘Yes’ to any of the questions, please provide full details in the space indicated. Also use the space below to provide any other information that may have a bearing on your suitability for the position for which you are applying.
The position for which you have applied is exempted from the Rehabilitation of Offenders Act 1974. This means that you must declare all criminal convictions, including those that would otherwise be considered “spent”. With the exception of question 7, answering ‘Yes’ to any of the questions below will not necessarily bar you from appointment. This will depend on the nature of the position for which you are applying and the particular circumstances.
Are you currently bound over or have you ever been convicted of any offence by a court or court-Marita in the United Kingdom in any other country?
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You do not need to tell us about parking offences. If yes, please include details of the order bounding you over and/or the nature of the offence, the penalty, sentence or order of the court and the date and place of the court hearing.
Yes
No
Have you ever received a police caution, reprimand or final warning?
*
If yes, please include details of the caution, reprimand or final warning, including the date and reason administered.
Yes
No
Have you been charged with any offence in the United Kingdom or in any other country that has not yet been disposed of?
*
Please note: you must inform us immediately if you are charged with any offence in the United Kingdom or in any other country after you complete this form and before taking up any position offered to you. You do not need to tell us if you are charged with parking offences.
Yes
No
Are you aware of any current police investigation in the United Kingdom or in any other country following allegations made against you?
*
If yes, please include details of the nature of the allegations made against you and if known to you, any action to be taken against you by the police.
Yes
No
Have you ever been previously dismissed by reason of misconduct from any employment or other position previously held by you?
*
If yes, please include details of the employment or position held, the date that you were dismissed and the nature of the allegations of misconduct made against you.
Yes
No
Have you ever been disqualified from practice, or required to practice subject to specified limitations, following fitness to practice proceedings by a regulatory or licensing body in the United Kingdom or in any other country?
*
If yes, please include details of the nature of the disqualification, limitation or restriction, the date and the name of the licensing regulatory body concerned.
Yes
No
Are you subject to any other prohibition, limitation, or restrictions that mean we are unable to consider you for the position for which you are applying?
*
If yes, please include details of the nature of the prohibition, restriction, or limitation when and by whom it was made.
Yes
No
Please use this space to provide details to any of the above questions that you have answered "Yes" to. Please clearly indicate the number of the question that you are referring to.
Equal Opportunities
Spectrum Healthcare Limited is opposed to discrimination on any grounds. In particular, we oppose discrimination on the grounds of race, religion, ethnic origin, sex, sexuality, marital status, disability or age. Spectrum Healthcare is committed to ensuring that ability and potential for the job are criteria used for all staff selection. The Company has adopted the provisions contained in the Code of Practice published by the Equal Opportunities for Racial Equality and the Code of Practice published by the Equal Opportunities Commision that employers should regularly monitor the effects of selection decisions to assess whether equal opportunities is being achieved.
For this purpose you are asked to complete the small questionnaire below.
This information is for statistical purposes only and will be treated as confidential.
Applicant Name
*
Post Applied For
*
Location
*
Sex
*
Male
Female
Non-binary
Agender
Prefer not to answer
Other
Marital Status
*
Single
Married
Divorced
Widowed
Domestic Partnership
Other
I would describe my ethnic origin as
White British
White Irish
Other
Black or Black British
Caribbean
African
Other
Asian or Asian British
Indian
Pakistani
Bangladeshi
Other
Chinese or other Ethnic Group
Chinese
Other
Do you consider yourself to have a disability?
*
Yes
No
What is your first language?
*
Are you fluent in any other language? If so, please specify all
Comments
This field is for validation purposes and should be left unchanged.
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