Recruitment Pack – Individual Applicant – Hierarchy Support Services

ONLINE APPLICATION FORM

The Application Form, Employment Continuity Check and Identity Check are for candidate use, and should be filled in and sent prior to interview. The recruitment process within this company has a minimum of two stages. The completion of this application form is part of stage one. This application will be reviewed and a decision made as to whether to proceed to stage two.

Minimum age legislation dictates that Care workers in general must be 16 years old or older. Please inform your interviewer immediately if you do not meet these specification.

Please enable JavaScript in your browser to complete this form.

Name

First

Last

Date of Birth

Current address

Post code

Date moved to this address

Previous address

Note: For Criminal Record check purposes, addresses covering the five years up to the application date must be supplied. Please add the date you moved to the address.

Post code

Home phone

Mobile phone

Phone number work

Your work phone number will be used with discretion.

Position applied for

Approx. no. of hours wanted

Full-time or part-time

Own Transport

Yes / No

How long has your license been held?

Driving license endorsements (if any)

Driving endorsements details

EDUCATION

School/College/University

Examinations Passed/Qualifications Gained

Please supply copies of certificates, to career@hss-uk.org.uk, with your name and contact number.

Date of Graduation/Qualification – Location/Details

Please supply copies of certificates/membership details to career@hss-uk.org.uk, with your name and contact number.

ADDITIONAL COURSES ATTENDED

You may need to email any extra information to career@hss-uk.org.uk with your name and contact number.

EMPLOYMENT HISTORY

Name and address of your most recent/last employer. Current/most recent first. Information must cover the whole of your working life to date. State the reasons for any breaks in employment. You may need to email any extra information to career@https://hss-uk.org.uk with your name and contact number.

Date employed

Nature of business

Position held and reason for leaving

Salary / Rate

Name and address of employer prior to the employer listed above

Date employed

Nature of business

Position held and reason for leaving

Salary / Rate

Name and address of employer prior to the employer listed above

Date employed

Nature of business

Position held and reason for leaving (copy)

Salary / Rate

Other roles

Please give details of relevant experience. This may be taken from the work situation, voluntary work, charity or your own home

ASSISTANCE WITH INTERVIEW AND ASSESSMENT

Yes / No

If yes, please give details

This information will not be used in reaching a decision on whether to offer employment. Any offer of employment may be made subject to a satisfactory medical report.

GP’s name

Your GP will never be contacted without your permission

phone number

Address

NEXT OF KIN

First

Last

Name

Relationship

phone number

Address

APPILICANT IDENTITY DETAILS

National Insurance Number

CAPACITY TO WORK IN THE UK

Yes / No

If yes, please provide details

If you are successful in the application, would you require a work permit prior to taking up employment?

Yes / No

REFEREES

You must provide references from your two most recent employers. Please provide an additional character referee. All will be contacted, therefore please inform the referees of the fact that you have used their name. If you are unable to provide the required references, please discuss the matter with us.

Current or most recent employer

Name

Address

Post code

phone number

Job title

Previous employer to the one above

Name

Address

Post code

phone number

Job title

CRIMINAL RECORD – Please declare all criminal convictions, whether spent or not, charges, whether proceeded with or not, and warnings and cautions in the space provided below.

Workers of The Agency are subject to the The Regulation of Care (Scotland) Act 2010, and will be subject to a Police Record Check through the PVG Check. Please declare all criminal convictions, whether spent or not, charges, whether proceeded with or not, and warnings and cautions.
Please note, you may not be eligible for work in a Care setting if you are on the PVG Check Register(s).

SIGNATURE and DECLARATION – IMPORTANT – READ BEFORE SIGNING

I declare that to the best of my knowledge and belief the information given by me in this application is true, and I understand that the above information forms the basis of my contract of employment. I understand that if any of the information supplied by me is found to be falsely declared, my contract may have been fundamentally breached and my employment may be terminated immediately.
I understand that I may not be offered a post until a satisfactory response has been received with respect to my PVG Check Register status, and that should I subsequently be offered a post, that offer will be subject to receipt of two satisfactory references, one of which must be from my previous employer, and that confirmation of the employment will be subject to a satisfactory criminal record check from the PVG Check.
I understand that until a satisfactory response is received from the PVG Check, and my employment is confirmed, I will be supervised at all times at work, and will not seek or have unsupervised access to vulnerable people. By my signature, I Hierarchy Business Solutions Limited to request a PVG Check Register check and a criminal records check from the PVG Check, on initial employment and at any time during my employment thereafter. I undertake to inform my employer immediately if my PVG Check Register status or criminal status changes at any time during my employment, such as by being charged with an offence (other than motoring offences), the administering of a warning, criminal conviction, referral to any register of barred Care workers, or withdrawal of any registration required by my employment status.

Date

EMPLOYMENT CONTINUITY CHECK TIME LINE

It is essential to check the continuity of employment, as stated in the application form, and to note and investigate any gaps in employment. Failure to carry through such checks has been identified as a significant factor in several recent abuse cases. Use the “timeline” above to place in order all stated instances of employment and other activities (such as training), and identify any gaps for discussion during the interview. Assess and record the results of the enquiries, which must be followed through if interview answers are unsatisfactory. The period considered must be the whole working life of the applicant, to date.

IDENTITY CHECK

Identity is established by sending a clear image of one item from sections 1 or 2, and one from section 3. Please email these to career@hss-uk.org.uk with your full name and contact number.

You will also need to bring the original documents provided in your images on the day of your interview.

1. Photographic
1.a. Passport
1.b Biometric Card: Issue date:

Expiry date:
1.b. New Style Driving License
OR
2. Birth Certificate
2.b. With the correct name
2.c. Or in another name, with evidence of change of name
AND
3. Proof of Address
3.a. Utility bill, correct name and address, and < 3 months old, and paid, or
3.b. Credit card statement, correct name and address, and < 3 months old, or
3.c. Bank statement, correct name and address, and < 3 months old, or
3.d. Council tax bill, correct name and address, and < 3 months old