Crossroads Care Rotherham
01709 360272
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Home
Care Support Worker Application
Care Support Worker Application
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Title
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Please Select
Mr
Mrs
Miss
Ms
Forename
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Surname
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Address 1
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Address 2
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Address 3
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Postcode
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Home phone
Mobile
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Email
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REHABILITATION OF OFFENDERS ACT 1974 and EXCEPTION ORDER 1975 Because of the nature of the work for which you are applying, you must provide information about any convictions. Our power to require this lies in the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975, which removes the normal operation of the Act in relation to specific occupations, including the provision of Home Care Services. In the event of being employed in connection with this application, any failure to disclose such convictions could result in dismissal or disciplinary action. Crossroads Care Rotherham follows a Code of Practice about the fair use of disclosure information, and a copy is available on request. If you do have any previous or outstanding convictions, details of the type of offence, date, sentence, fine etc. should be brought along with you to the interview, should you reach this stage. A criminal record will not necessarily be a bar to obtaining a position.
Do you have any criminal convictions, cautions, reprimands or final warnings?
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Please select
Yes
No
NB. The above section will be detached prior to shortlisting.
Do you have access to a vehicle?
*
Please select
Yes
No
Do you hold a full driving licence?
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Please select
Yes
No
Current Job Role
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Please tell us why you would like to work for Crossroads Care Rotherham
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How many hours per week are you looking to work?
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Are you available to work some evenings?
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Please select
Yes
No
Are you available to work alternate weekends?
*
Please select
Yes
No
If you have any further information, please provide this here:
I declare that the information on this application form is true and accurate, to the best of my knowledge. If untrue or inaccurate information is recorded, any employment contract may be invalidated and the employee subject to disciplinary action or dismissal.
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GDPR
Your details will be kept secure and we will never pass your details onto third parties. For full details, see our Privacy Policy below.
Please tick to consent to your data being stored in line with the guidelines set out in our Privacy Policy
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EQUALITY & DIVERSITY MONITORING NB. The following section will be detached prior to shortlisting
Crossroads Care Rotherham strives to operate a policy of equality and diversity and not discriminate against any person. The information you provide will be treated in the strictest confidence and is for monitoring purposes only and in no way forms any part of the selection process.
Where did you see the post advertised?
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Facebook
Jobsite
Indeed
Newspaper
Word of Mouth
Leaflet
VAR
Crossroads Website
Community Hub
How would you describe your cultural or ethnic origin?
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Asian or Asian British - Bangladesh
Asian or Asian British – Indian
Asian or Asian British – Pakistani
Asian or Asian British – Any Other Asian Background
Black or Black British – African
Black or Black British – Caribbean
Black or Black British – Any Other Black Background
Chinese
Mixed – White and Asian
Mixed – White and Black African
Mixed – White and Black Caribbean
Mixed – Any Other Mixed Background
White – British
White – Irish
White – Any Other White Background
Any Other
I do not wish to disclose
Gender
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Male
Female
Age Group
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0-15
16-24
25-64
65-79
80-99
100+
Sexual Orientation
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I Do Not Wish to Disclose
Lesbian
Gay
Bisexual
Heterosexual
Marital Status
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Married/Civil Partnership
Common Law
Divorced
Single
Widowed
I do not wish to disclose
Religious Belief
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Atheism
Buddhism
Christianity
Hinduism
Islam
Judaism
Jainism
Sikhism
Other
I Do No Wish to Disclose
Do you consider yourself to be disabled?
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Yes
No
DISABILITY DISCRIMINATION ACT 2005 A person has a disability under the Disability Discrimination Act if he/she has a physical or mental impairment which has a substantial and long term diverse effect on his/her ability to carry out normal day-to-day activities. Long term means has lasted, or is expected to last for 12 months.
