Don’t worry, it’ll only take a few minutes!

Alternatively, if you wish to print out the application form for yourself and send it in, click below.

Click here to download printable application form.

Please complete to the best of your ability. If you cannot complete any of the required fields, please input (N/A).

Personal Information

Training

Employment

References

Legal

  • Personal Information
  • Training
  • Employment
  • References
  • Legal

Details

Where did you hear about us?

What position are you applying for?

Upload a CV/Cover Letter (Not Required)

Title

Full Name

Contact Number

Email

Home Address

Postcode

Do you hold a full UK Driver's License?

Do you have a legal right to work in the UK?

What is your national insurance number?

Do you consider yourself to have a disability?

Are you a member of the PVG scheme?

PVG Membership Number

Are you registered with the SSSC?

SSSC Membership Number

Have you had any disciplinary action taken against you in previous employment?

Do you have any live formal warnings / pending disciplinary action in another employment?

If you answered Yes to any of the above 2 questions, please provide details.

Training

Please check YES if you have completed any of the following courses. If so, please select a date.

Moving and Handling

Date Completed

Adult Support & Protection

Date Completed

Emergency First Aid

Date Completed

Health & Safety

Date Completed

Food Hygiene

Date Completed

Infection Control

Date Completed

Dementia Awareness

Date Completed

Fire Safety

Date Completed

Medical Administration

Date Completed

Catheter/Stoma Care

Date Completed

Epilepsy Awareness

Date Completed

PEG Feeding

Date Completed

Challenging Behaviour

Date Completed

Palliative Care

Date Completed

Education History

Please list any relevant qualifications/certifications you have achieved ie: SVQ's/HNC's relating to care.

Date From

Date To

Provider

Qualification/Subject

Grade

Employment History

Please list your employment history within the past 10 years. Please attach your CV below if you have one.

Job 1

If you have a CV you wish to upload, please do so.

Position

Start Date

Leaving Date

Reason for Leaving

Notice Period

Current/Most Recent Salary

Manager

Employer

Employer's Address

Description of duties, responsibilities and achievements.

Job 2

Position

Start Date

Leaving Date

Reason for Leaving

Notice Period

Current/Most Recent Salary

Manager

Employer

Employers Address

Description of duties, responsibilities and achievements.

Job 3

Position

Start Date

Leaving Date

Reason for Leaving

Notice Period

Current/Most Recent Salary

Manager

Employer

Employers Address

Description of duties, responsibilities and achievements.

Job 4

Position

Start Date

Leaving Date

Reason for Leaving

Notice Period

Current/Most Recent Salary

Manager

Employer

Employers Address

Description of duties, responsibilities and achievements.

Job 5

Position

Start Date

Leaving Date

Reason for Leaving

Notice Period

Current/Most Recent Salary

Manager

Employer

Employers Address

Description of duties, responsibilities and achievements.

References

Minimum 2 references will be sought. Minimum of 1 must be your current or most recent employer. A character reference may be sought where applicable.

First Reference

Name of Referee

Position of Referee

Company Name

Address

Telephone

Email

Start Date (month/year)

Finish Date (month/year)

May we approach prior to interview?

Second Reference

Name of Referee

Position of Referee

Company Name

Address

Telephone

Email

Starting Date

Finishing Date

May we approach prior to interview?

Third Reference

Name of Referee

Position of Referee

Company Name

Address

Telephone

Email

Starting Date

Finishing Date

May we approach prior to interview?

Supporting Statement

Please describe which of your personal qualities and experiences are relevant to your application.

Rehabilitation of Offenders Act 1974

The provisions relating to the non-disclosure of criminal convictions do not apply to certain occupations. The position for which you are applying may be included in the excepted type of employment under the Rehabilitation of Offenders Act (Exceptions) 1974 order 1975. Please answer the following questions, read carefully and sign the declaration below.

Have you ever been convicted of any criminal offence(s) currently and/or do you have any criminal charge(s) pending?

If YES, please provide details

General Data Protection Regulation

Scottish Recruitment Solutions (SRS Group Ltd) will use the information you provide in this application pack for the purpose of processing your application and monitoring the recruitment process. Should your application be successful, we may be required to share some of the information you provide with statutory bodies including the Care inspectorate and the Department of Work and Pensions. The information you provide in this pack will be stored securely and will not be retained longer than necessary. Unsuccessful applications will not normally be kept for longer than a year. You have a right to access the information that SRS Care Solutions holds on you. SRS Care Solutions has a written policy on the recruitment of ex-offenders, which is available to all applicants. Having a criminal record will not necessarily bar you from working, this will depend on the nature of the position together with the circumstances and background of any particular offences.

Declaration

I certify that all the information contained in this form and any attachments are true and correct to the best of my knowledge. I have not withheld any information which may affect my application for employment. I realise that false information or omissions may lead to dismissal. I agree to the information (which may include sensitive personal data) being used for legitimate purposes connected with recruitment and selection, including PVG Scheme membership. The information supplied above may be verified by SRS Care Solutions. I consent to the processing of data in accordance with the current GDPR legislation.

Signature (Enter Full Name)