Section 2 : Equality and Diversity Monitoring

Revive Rise is committed to promoting equality and diversity. This information is for monitoring purposes only and will not affect your application.

1. Gender:

MaleFemaleNon-binaryPrefer not to say

2. Ethnicity:

WhiteMixed/Multiple Ethnic GroupsAsian/Asian BritishBlack/African/Caribbean/Black BritishOther Ethnic GroupPrefer not to say

3. Do you consider yourself to have a disability?

YesNoPrefer not to say

(Life Touch Care is a Disability Confident employer and will make reasonable adjustments to support your application.)

4. Do you have any criminal convictions, cautions or reprimands, bind-overs or have you been given a warning for a criminal offence?

YesNo

5. Do you currently have criminal charges pending or are you under a criminal investigation?

YesNo

6. Have you ever been disqualified from working with children or vulnerable adults, or are sanctions imposed on you by a regulatory body?

YesNo

If your answer to any of the above questions is ‘Yes’, please provide details below.

If you are providing additional details, please mark your application as “PRIVATE AND CONFIDENTIAL FOR THE ATTENTION OF THE HR MANAGER” (either on the envelope or in the subject of the email).

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Section 3: Employment History

1. Current/Most Recent Employer:

Employer Name:

Job Title:

Dates of Employment: From To

Reason for Leaving:

2. Previous Employment:

Employer Name:

Job Title:

Dates of Employment: From To

Reason for Leaving:

3. Previous Employment:

Employer Name:

Job Title:

Dates of Employment: From To

Reason for Leaving:

4. Previous Employment:

Employer Name:

Job Title:

Dates of Employment: From To

Reason for Leaving:

5. Gaps in Employment:

Please explain any gaps in your employment history.

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Section 4: Qualifications and Training

1. Relevant Qualifications:

Qualification:

Institution:

Date Achieved:

2. Relevant Qualifications:

Qualification:

Institution:

Date Achieved:

3. Relevant Qualifications:

Qualification:

Institution:

Date Achieved:

4. Relevant Qualifications:

Qualification:

Institution:

Date Achieved:

5. Care-Related Training:

Training Course:

Date Completed:

6. Care-Related Training:

Training Course:

Date Completed:

7. Care-Related Training:

Training Course:

Date Completed:

8. Care-Related Training:

Training Course:

Date Completed:

9. Do you hold a valid driving license?

YesNo

10. Do you have access to a vehicle?

YesNo

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Section 5: Skills and Experience

1. Please describe your experience in domiciliary care or a similar role:

2. What skills do you possess that make you suitable for this role?

3. How would you handle challenging situations with clients?

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Section 6: References

Please provide two people who we may contact for a reference on your suitability for the role. One must be your most recent line manager or supervisor, and the second should also be a previous manager/supervisor. Please ask your referees for permission to give their details before submitting your application.

1. Reference 1:

Name:

Relationship to You:

Contact Number:

Email Address:

2. Reference 2:

Name:

Relationship to You:

Contact Number:

Email Address:

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Section 7: Declaration

1. Disclosure and Barring Service (DBS) Check:

(This role requires an enhanced DBS check. Do you consent to this?)

YesNo

2. Declaration:*

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Section 8: Additional Information

1. Is there anything else you would like to tell us about your application?

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