Please ensure that you complete the application form in full. This form will be kept in confidence. Please note that no applicant will be unfairly discriminated against. This includes discrimination on account of age, cultural/religious/political belief, disability, ethnicity, gender, race, relationship status, sexual orientation, and/or Trade Union membership or stewardship. If you have any special requirements to support you to complete this form (e.g. need a printed copy or large print) please contact HR at recruitment@centrumcarehomes.co.uk.
Phone Number
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Preferred employment type (e.g. part time, full time)
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Do you have your own Transport?
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If yes, How long has your licence been held?
Are you a United Kingdom (UK), European Community (EC) or European Economic Area (EEA) National?
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If no, please detail current immigration status and the relevant visa currently held (including Visa number, date of birth and share code)
National Insurance Number
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Are you related to a member of staff or Service User at Centrum Care Homes? If yes, please provide the relative's name
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Equality Act 2010 Under the Equality Act 2010 the definition of disability is if you have a physical or mental impairment that has a “substantial” and “long term adverse effect” on your ability to carry out normal day-to-day activities. Further information regarding the definition of disability can be found at: www.gov.uk/definition-of-disability-under-equality-act-2010.
For the purposes of this application and the interview stage only, is there anything you would like us to be aware of so that we can make reasonable adjustments during the process?
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Education All relevant qualifications will be subject to a satisfactory check and production of original certificate.
List here Schools/Colleges/Universities attended
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Please include Subjects passed and date passed
List here examinations passed, qualifications gained and year obtained
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Please include Subject / Location / Date passed
Training Courses Attended or Completing List Subject, location details and dates. Any care related training will require certificate evidence.
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Please include Subject / Location / Date
Have you worked before?
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Employment History Please record below the details of your full employment history beginning with your current or most recent first. Please detail a career history from the age of first employment. This information may be in the form of a Curriculum Vitae (CV) which you may attach to your application. Employment Information must outline, reasons for leaving, all periods of employment or self-employment, showing beginning and end dates, (actual or approximated month and year), together with an explanation of periods of non-employment. Note* If you are attaching a CV that has all details mentioned, you will only need to supply details from dates or gaps not covered by your CV.
Please record employment history in the following format: Organisation name and address (Branch worked at if different from above) Nature of business eg Care, hospitality, marketing Start Date - End Date Position Held Reason for Leaving
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Supporting statement/ Cover letter Please add here your reasons for applying. You should refer to the job description to guide you. It would also be of value to describe particular strengths and talents that set you apart from others as well as including skills gained from work, home and other activities
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Referees You must provide references from your two most recent employers. Please provide a character reference if you are unable to obtain two professional references, e.g. in the case of an applicant who has been raising children for ten years. All will be contacted, therefore please inform the referees of the fact that you have used their name. If you are unable to provide the required references, please discuss the matter with us. *Please note, it is a CQC requirement that we contact ALL previous employers involving healthcare, social care, children or vulnerable adults.
Most recent employer - Organisation, Name, Job title, Address, Phone Number, Email Address
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Previous employer to one above - Organisation, Name, Job title, Address, Phone Number, Email Address
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Character Referee - Name, Address, Phone Number, Email Address, Relationship to you, how long have you known them
This may be a friend, neighbour, teacher or tutor, work colleague and must NOT be a family member.
Safeguarding - Ex-Offenders Declaration Please note this section will only be seen by those involved in the recruitment process and will be treated with the strictest of confidence. Rehabilitation of Offenders Act 1974 Centrum Care Homes aims to promote equality of opportunity and is committed to treating all applicants fairly regardless of ethnicity, disability, age, gender or gender re-assignment, religion or belief, sexual orientation, pregnancy or maternity and marriage or civil partnership. Centrum Care Homes undertakes not to discriminate unfairly against applicants on the basis of a criminal conviction or other information declared. Answering 'yes' to the question below will not necessarily prevent your employment. This will depend on the relevance of the information you provide in respect of the nature of the position and the particular circumstances.
Conviction history
Overseas history
Have you ever lived, worked, or volunteered outside the United Kingdom? If Yes, Do you have any overseas convictions?
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If you have lived or worked overseas, will you be willing to produce an overseas police clearance for any Country you have resided in for over a year in the past 10 years?
Past Conduct
Barred lists checks Your role may involve engaging in regulated activity with children or adults with care and support needs (vulnerable adults) or line managing someone else that does so you need to complete the below section
Are you or have you been barred from working with children or adults with care and support needs (vulnerable adults)?
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DBS Declaration I consent to a standard/enhanced DBS check if appointed to the position for which I have applied. I have read the Standard/Enhanced Check Privacy Policy for applicants. I understand how the DBS will process my personal data and the options available to me for processing an application. I am aware that if I am being asked to apply for an enhanced disclosure it will shows spent and unspent convictions and adult cautions, from the Police National Computer which have not been filtered in line with legislation plus any information held by local police that’s considered relevant to the role I agree to inform the person within the organisation responsible for processing disclosure applications if I am convicted of an offence after I take up any post within the organisation. I understand that failure to do so may lead to the immediate suspension and/or the termination of my employment.
Application Declaration Centrum Care will only collect data for specified, explicit and legitimate use in relation to the recruitment process. By signing this application form, you consent to Centrum Care holding the information contained within this application form. If successfully shortlisted, data will also include shortlisting scoring and interview records. We would like to keep this data until the vacancy is filled. (We cannot estimate the exact time period, but we will consider this period over when a candidate accepts our job offer for the position for which we are considering you). When that period is over, we will either delete your data or inform you that we would like to keep it in our database for future roles. We have privacy policies that you can request for further information. Please be assured your data will be securely stored by the Registered Manager and only used for the purposes of recruiting for this vacant post. You have a right for your data to be forgotten, to rectify or access data, to restrict processing, to withdraw consent and to be kept informed about the processing of your data. If you would like to discuss this further or withdraw your consent at any time, please contact HR at recruitment@centrumcarehomes.co.uk
