Speak to MSC Homecare today Care Workers are the essential members of the team, please take our mini assessment here if you think working as a care worker is something you could do? Or give us a call on 01782 823338 or email: firstname.lastname@example.org Current Vacancies Care Worker Care Worker Appplication Form MSC official care worker application form Step 1 of 11 9% Please complete each section, you will be prompted to any missing fields before you can move on to the next section. Alternatively you can download this application to print, complete and return. Section 1: Personal DetailsTitle*MrsMissMsMrOtherForename(s)*Surname*What name are you known by?Names that other people use to address you.Address* Street Address Address Line 2 City County Postcode Telephone Number*Mobile Phone Number*Email Address* Enter Email Confirm Email National Insurance No.*Date of Birth* Section 2: Working at MSC Home CareWhy do you want to work for us?*Please describe briefly why you want to work for MSC Homecare as a care worker Section 3: Proof of identity and right to workBefore MSC Home Care can offer employment it is required to verify your identity and right to work in the UK. We will use this on-line check list https://www.gov.uk/legal-right-work-uk to initially assess your right to work in the UK. You will also be required to produce the applicable original documents for examination and verification. For more information about the right to work in the UK, please see https://www.gov.uk/check-job-applicant-right-to-workDo you have the right to work in the UK?*YesIf so click yes, if not then you will not be able to apply to work for us. Section 4 : Previous criminal convictions and Enhanced Disclosure and Barring Service (DBS) checksApplication for employment as a Care Worker is regarded as a Regulated Activity; you are therefore exempt from the provisions of the Rehabilitation of Offenders Act 1974 Section 4.2 (Exemption Order 1975). You are not entitled to withhold information about convictions which for other purposes might be considered ‘spent’ under the provisions of this Act. Current guidance regarding the Rehabilitation of Offenders Act can be found at: https://www.gov.uk/government/publications/new-guidance-on-the-rehabilitation-of-offenders-act-1974. Guidance regarding Regulated Activity can be found at: https://www.gov.uk/government/publications/new-disclosure-and-barring-servicesHave you been or are you currently the subject of any criminal proceedings or police investigation?*YesNoPlease provide details of the criminal proceedings and/or police investigationMSC Home Care is required to review a current enhanced DBS check to establish that you are an appropriate person to undertake work as a care worker with vulnerable adults which is regarded as a Regulated Activity. You will need to provide documents to prove your identity and addresses for at least the last 5 years. MSC Home Care uses an on-line system to submit your details. You may not be able commence employment until MSC Home Care has received a satisfactory enhanced disclosure. For guidance about enhanced DBS checks please see; http://dbs.services/enhanced-dbs-check Section 5 : Your employment historyPlease state the details of your present, most recent and previous employer.Employer Name*Address* Street Address Address Line 2 City County Postcode Employer Telephone No.*Job Title or Role*Date Started* Date Finished* Reason For Leaving*Employer Name*Address* Street Address Address Line 2 City County Postcode Employer Telephone No.*Job Title or Role*Date Started* Date Finished* Reason For Leaving*Employer Name*Reason For Leaving* Section 6 : Employment ReferencesMSC Home Care requires a minimum of two references; one must be from your present or most recent employer. The reference should be completed by your present or previous Manager, Director or the Human Resources Department. If you are unable to provide a reference from previous employers, we may be able to accept references from professional persons that have known you for at least 5 years.Please state the contact details for your present or most recent employerEmployer Name*Job Title or Role*Company or Organisation Name*Address* Street Address Address Line 2 City County Postcode Telephone No.Mobile No.Email Address* If you are currently employed, please indicate your agreement to MSC Home Care contacting your employer for a reference. Do you agree we can contact your current employer?*YesNo, please contact at a later datePlease confirm a date we can contact your current employer Please state the contact details for your previous employerEmployer Name*Job Title or Role*Company or Organisation Name*Address* Street Address Address Line 2 City County Postcode Telephone No.Mobile No.Email Address* Section 7 : Your Availability To WorkWhen could you start work?* Do you have any holidays or other events that are already booked?*YesNoPlease provide details of holidays you have bookedMSC Home Care normally provides services, from 7.00am – 10.00pm, 7 days a week. We need carers available to cover these hours, working both full and part time hours. Weekly rotas start on Saturday morning, and continue until Friday.Please indicate how many regular hours per week you want to work*We expect carers to be available to work every other weekend. Please indicate by ticking the boxes for any shift (Morning, Lunchtime, Tea and Bedtime) or day(s) when you ARE regularly available to work. Please indicate if you would be available to work additional hours if required*YesNoSaturday Morning 7 -10am Lunchtime 12 - 2.00pm Tea 4-6.00pm Bedtime 7.10.00pm Sunday Morning 7 -10am Lunchtime 12 - 2.00pm Tea 4-6.00pm Bedtime 7.10.00pm Monday Morning 7 -10am Lunchtime 12 - 2.00pm Tea 4-6.00pm Bedtime 7.10.00pm Tuesday Morning 7 -10am Lunchtime 12 - 2.00pm Tea 4-6.00pm Bedtime 7.10.00pm Wednesday Morning 7 -10am Lunchtime 12 - 2.00pm Tea 4-6.00pm Bedtime 7.10.00pm Thursday Morning 7 -10am Lunchtime 12 - 2.00pm Tea 4-6.00pm Bedtime 7.10.00pm Friday Morning 7 -10am Lunchtime 12 - 2.00pm Tea 4-6.00pm Bedtime 7.10.00pm Section 8 : Your Training and DevelopmentPlease list below all your qualifications and any relevant training you have completed. You will be required to produce the applicable original documents and certificates for examination and verification.Name of the education training providerAddress* Street Address Address Line 2 City County Postcode Qualification or training receivedDate Completed Name of the education training providerAddress* Street Address Address Line 2 City County Postcode Qualification or training receivedDate Completed Name of the education training providerAddress* Street Address Address Line 2 City County Postcode Qualification or training receivedDate Completed Name of the education training providerAddress* Street Address Address Line 2 City County Postcode Qualification or training receivedDate Completed Section 9 : Your Health AssessmentWorking as a carer requires physical effort (for example, cleaning, moving and handling people), and emotional/psychological effort (for example, challenging behaviour, rapid changes to plans and emotional distress).Do you have any medical condition which could limit or affect your employment as a carer for which MSC Home Care might need to make reasonable adjustments?YesNoPlease provide details of your medical condition Section 10 : Your Transport DetailsYou will need to be able to travel to and from the location of care calls, how would you do this?*Do you hold a valid and current full driving licence?*YesNoDo you have access to your own transport for use at work?*YesNoDo you have valid and current insurance for a vehicle for business use?*YesNoAny further commentsIf you have any further comments, please enter them in the boxSection 11 : Your DeclarationBy making this application for employment, I confirm and agree to the following. (please tick indicating you have read each statement)* MSC Home Care can use and check this information to verify my suitability for employment. * Providing misleading or false information during the application process may prevent me being offered employment or my employment terminated after commencing employment. * All personal information provided for my application for employment is confidential and should be treated as required by the Data Protection Act 1998. Specifically, it should only be kept and used in connection with my application and employment as a care worker. * An offer of employment will depend on receipt of satisfactory references and an enhanced DBS check. * I will be required to satisfactorily complete a pre-employment induction training programme. Section 12 : Equality and Diversity MonitoringMSC Home Care works to ensure it promotes equality and diversity including in its employment arrangements. To check how effective we are please complete this section of your application form separately, this information is not used to assess your suitability for employment.Age*younger than 1818 - 2425 - 3031 - 4041 - 5051 - 6061 - 70Older than 70Gender*MaleFemaleTransgenderOtherOther gender detailsSexual Orientation*GayLesbianBisexualHetrosexualWhiteBritishIrishOtherAsianBangladeshiIndianPakistaniBlackAfricanCaribbeanMixedWhite and Black CaribbeanWhite and Black AfricanWhite and AsianOtherChineseOther ethnic groupPrefer not to sayOther*No religionBuddhistChristianHinduJewishMuslimSikhThe Final stage - An interviewWhen you have completed this application form, please contact us directly to return the completed form and arrange an interview. Please inform us before your interview if you need any reasonable adjustments for the interview, this might include equipment or assistance to ensure effective communications at the interview. At the interview we will ask you some questions about your motivation and experience to complete the role of a Care Worker? how you value other people? and your attention to detail and ability to follow instructions. Confirmation* I confirm all of the data I have supplied is correct and my own and by clicking this checkbox I acknowlege that this acts as the equivalent of a signature.