APPLICATION FORM

SECTION 1: PERSONAL DETAILS

  • Volunteer experience

  • Languages spoken

  • Education

  • Post registration / Mandatory training

  • Skill check list (Carers & support workers only)

 

SECTION 2: GENERAL INFORMATION

  • Nursing Registration (Registered Nurse only)

 

SECTION 3: EMPLOYMENT HISTORY

  • Please print clearly details of the last 3 years employment history. If you have worked in health and social care prior to 3 years please also include details of this employment. You must state reasons for any breaks in employment. Please start with your most recently held position. Continue on separate sheet if necessary and enclose a copy of your current CV.
  • EMPLOYMENT HISTORY 1:

  • EMPLOYMENT HISTORY 2:

  • EMPLOYMENT HISTORY 3:

  • EMPLOYMENT HISTORY 4:

  • EMPLOYMENT HISTORY 5:

 

SECTION 4: REFERENCES

  • Please supply the names and contact addresses of three referees. One of these must be from your current or most recent employer.
  • REFERRAL 1:

  • REFERRAL 2:

  • REFERRAL 3:

  • Please supply the names and contact addresses for a character reference:
 

SECTION 5: SECURITY

    DBS

  • In view of the nature of your employment, it is exempt from provision of Section 4(2) of the Rehabilitation of Offenders Act 1974, by virtue of the Rehabilitation of Offenders Act 1974 (Exemption) Order 1975. Your employment is therefore subject, at all times, to having no criminal convictions – spent or otherwise – which may affect your suitability for employment within the care services. As such, it is an express term of your contract that you must disclose any convictions you incur during your employment with Dean Healthcare. The Employer cannot guarantee your continued employment if it is deemed that a conviction against you impacts upon your validity to remain working within the care services. Furthermore, failure to disclose convictions, will lead to the disciplinary procedure being invoked and could result in your dismissal. No decision will be made until you have had the opportunity to state your case.
  • Please note that this application will require a criminal background check by the criminal records bureau disclosure procedure at enhanced level. A fee will be charged for the Disclosure and Barring check.
 

SECTION 6: HEALTH

 

SECTION 7: IMMUNISATION INFORMATION

 

SECTION 8: TRAINING

  • Dean Healthcare actively encourages all employees to achieve their maximum potential. We provide opportunities for everyone to develop their skills and qualifications.
  • During the course of your employment you will attend both compulsory and voluntary courses some of which will be funded by the organisation. Staff will be expected to refund the cost of any course for which they do not attend and fail to give adequate notice. Dean Healthcare is committed to providing a high standard of training and in return your commitment to attend these courses. We would therefore ask you to sign the declaration in section 11.
 

SECTION 9: CODE OF CONDUCT, HEALTH & SAFETY, POLICIES & PROCEDURES

  • Dean Healthcare code of conduct, health & safety policies and procedure documents are available on request from Dean Healthcare head office should you require any clarification or further advice on them. It is each employee’s responsibility to ensure that they understand and comply with these policies, procedures and codes of conduct.
 

SECTION 10: ALCOHOL AND ILLEGAL SUBSTANCE ABUSE

  • Any employee found to be under the influence of alcohol whilst at work will be immediately suspended from work which may, after and investigation, lead to termination of employment. The taking or possession of illegal substances whilst on the premises of Dean Healthcare or on the premises of your placement is regarded as an act of gross misconduct and will be dealt with accordingly. In the event where illegal substances are discovered the police will be informed.
 

SECTION 11: FINAL STATEMENT AND DECLARATION

  • I (Fill in your name)
  • declare that all the information given on this application form is true in every aspect.
  • Any information about me and my application may be shared within Dean Healthcare South West Ltd. It will not be shared with any other parties unless it is in direct relation to my application and in accordance with the data protection act 1988.
 

Verification

HELP TO FIGHT COVID-19

To prevent the spread of COVID-19:
Clean your hands often. Use soap and water, or an alcohol-based hand rub.
Maintain a safe distance from anyone who is coughing or sneezing.
Wear a mask when physical distancing is not possible.
Don’t touch your eyes, nose or mouth.
Cover your nose and mouth with your bent elbow or a tissue when you cough or sneeze.
Stay home if you feel unwell.
If you have a fever, cough and difficulty breathing, seek medical attention.
Calling in advance allows your healthcare provider to quickly direct you to the right health facility. This protects you, and prevents the spread of viruses and other infections.
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