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info@top-notchhealthcareservices.com

Mobile: 0753 451 9515 | 0796 001 9418 | 0753 451 9706

0207 998 9091
0207 998 9091
Top Notch Healthcare Services Limited
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info@top-notchhealthcareservices.com

Mobile: 0753 451 9515 | 0796 001 9418 | 0753 451 9706

Top Notch Healthcare Services Limited

Application Form

Step 1 of 11

9%
Work Preference:
I understand this role may include: Shift work, Unsociable Hours, Lone working involved. (Please select your availability below)
Day(s)
Time
Shift

Personal Details

Name(Required)
Extra Names
Address(Required)
Date Of Birth(Required)
Are you a driver?
Own Transport
Any Endorsements:

Section

*Are you a United Kingdom (UK) National?(Required)
Are you related to any of our current members of staff or Service Users?
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-actu00022010.
For the purposes of this application and interview stage only, is there anything you would like us to be aware of so that we can make reasonable adjustments during the process?(Required)

Education

Examinations, Qualifications*(Required)
(All qualifications will be subject to a satisfactory check).
School / College / University
Date From:
Date To:
Examinations, Qualifications*
 
Training Courses
(attended or completing (evidence of attending courses is required)
Subject
Location
Date
Details
 
Professional Memberships / Registrations
Name of Organisation
Registration Number
Renewal Date
Details
 
Drop files here or
Max. file size: 256 MB.

    Employment History

    Please record below the details of your full employment history beginning with your current or most recent first. Any gaps must be explained. Use a separate attached sheet if required; please sign the sheet(s)

    Current / Most recent employer

    Start Date
    End Date
    Duties:
    Address

    Employment History

    Start Date:
    End Date:
    Duties:
    Address
    Additional Employment History
    Start Date:
    End Date:
    Salary:
    Job Role:
    Employer Name:
    Reason for Leaving:
    Contact Name:
    Duties:
    Address:
    Postcode:
    Telephone:
    Email:
     

    Explanation of Gaps

    (Use this section to detail any gaps in employment and why)

    References

    Please provide names, addresses and telephone numbers for referees below who we may approach for a reference. In line with CQC requirements, we require references (or other satisfactory evidence as the employer may determine) from all previous employers concerned with the provision of services relating to health or social care, or children or vulnerable adults which should include details of why their employment came to an end (note that this is not time limited). If your previous employment does not concern the provision of services relating to health or social care, or children or vulnerable adults, you must provide references from your two most recent employers. Please provide two-character references 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.

    Referee One

    Full Names(Required)
    Address(Required)

    Referee Two

    Full Names(Required)
    Address(Required)
    Additional References
    Contact Name:
    Address:
    Postcode:
    Telephone:
    Email:
    Professional / Character:
    Capacity in which known
     

    Safeguarding / Ex-Offenders Declaration

    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 confidence.
    The Rehabilitation of Offenders Act 1974 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. Top-Notch Healthcare Services 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.
    *Are you currently bound over or do you have any current UNSPENT convictions that have been issued by a Court or Court-Martial in the United Kingdom or in any other country?(Required)
    *Do you have any current UNSPENT police cautions, reprimands or final warnings in the United Kingdom or in any other country?(Required)

    Privacy Statement

    We will only collect data for specified, explicit and legitimate use in relation to the recruitment process. By signing this application form, you consent to us 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 that 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 the Registered Manager to discuss.

    Declaration

    The information in this application form is true and complete. I agree that any deliberate omission, falsification or misrepresentation in the application form will be grounds for rejecting this application or subsequent dismissal if employed. Where applicable, I consent that can seek clarification regarding professional registration details.
    Full Name(Required)
    Consent(Required)
    I agree that any deliberate omission, falsification or
    misrepresentation in the application form will be grounds for rejecting this application or subsequent dismissal if
    employed. Where applicable, I consent that can seek clarification regarding professional registration details.
    Date(Required)

    Supporting Statement

    Please add here your reasons for applying. You should refer to the job description and person specification 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.

    Optional Section

    Top-Notch Healthcare Services is committed to equality of opportunity and fair treatment in all aspects of employment. We aim to provide a working and learning environment which is free from unfair discrimination and will enable staff to fulfil their personal potential. The Equality Act 2010 protects people from discrimination and promotes equality on the basis of a number of ‘protected characteristics’. We ask for information on your ‘protected characteristics’ in order to help us monitor our performance on equality. In line with Government policy, and in accordance with the provisions of GDPR, the information you provide will be held confidentially and It will help us to comply with the law under the relevant Acts and to ensure that our employment policies and practices are fair and effective.
    IMPORTANT - Please Note: You do not have to complete this form. The information is given on a voluntary basis and the information provided will only be used for the monitoring purpose. Please do not enter any identifying marks on this form, so that your information remains confidential. This information will be stored on a computer.

    Ethnic Origin:

    Please indicate your Ethnic Origin
    Asian or Asian British

    Mixed

    Other Ethnic Background

    Black or Black British

    White

    None

    Gender:

    Gender:
    Please indicate your Gender

    Sexual Orientation:
    Please indicate your Sexual Orientation

    Religion or Belief:
    Please indicate your Religion or Belief

    Marital Status:
    Please indicate your Marital Status

    As per Equality Act 2010:
    Do you consider yourself to have a disability
    Under the terms of the Act, a disability is defined as a “physical or mental impairment which has a substantial and long-term effect on a person’s ability to carry out day-to-day activities”
    Caring Responsibilities:
    Do you have any care responsibilities for anyone
    If yes

    Please answer the following questions

    Do you have or have you ever had any significant health problem, impairment / disability (physical or mental) or learning difficulties that may affect your ability to undertake the tasks set out in the job description of the post offered?
    Do you have or have you ever had any illness, impairment of disability that may have been caused or made worse by your work?
    Have you ever left or been denied employment in an organisation on the grounds of ill health or been medically retired on the grounds of ill health?
    Are you having, or waiting for any medical treatment or investigations at present?
    Will you need any special aids or adjustments or assistance to enable you to undertake the tasks set out in the job description of the post offered?

    Applicant's Declaration

    Kindly select 'Yes' / 'No' as appropriate if you read and understood
    I confirm that the information given above is complete and correct. I understand that any incomplete, untrue or misleading information given will entitle the employer to reject my application, withdraw any offer of employment, or, if I am employed, dismiss me without notice.(Required)
    By my signature, I give authority to the employer to contact my GP for further details regarding any of the potential health problems I have declared above.(Required)
    I agree that Top-Notch Healthcare Services reserves the right to require me to undergo a medical examination to assess my suitability for work.(Required)
    I do not wish to complete the questionnaire and I do not wish to have a free health assessment.(Required)
    Will you need any special aids or adjustments or assistance to enable you to undertake the tasks set out in the job description of the post offered?(Required)
    Name(Required)
    Date(Required)

    Let's get in touch

    About

    We offer care & support options starting from a carer who can come in for as little as 30min a day upwards to a carer living with you providing care 24hrs a day.  Learn more.

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    Telephone: 0207 998 9091
    Mobile: 0753 451 9515
    Mobile: 0796 001 9418
    Mobile: 0753 451 9706

    25 Croombs Road, London, England, E16 3RN.

    Branch: Regus Building Windmill Hill Business Park Whitehill Way Swindon SN5 6QR

    Copyright © 2023 Top Notch Healthcare Services Limited

    Email:  info@top-notchhealthcareservices.com

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    • Home
    • Complex Care
    • Home Care
    • Mental Health Support
    • Careers
    • About
    • Contact
    0207 998 9091
    0207 998 9091