General job Application Form - www.xtrahealthcare.com

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APPLICANT GENERAL DETAILS
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MaleFemeleBetter not say
Job Details


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 Part-Time  Full-Time
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day(s) vailability:

 Days Afternoons
 Nights Evenings
 Mornings Weekends only
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Time availability:

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Previous Address
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Transport & traveling Options

 Own Car Bicycle  Moto Bike / scooter Public Transport

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Education


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TRAINING HISTORY
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EMPLOYMENT HISTORY
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References

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ASSISTANCE WITH INTERVIEW AND ASSESSMENT

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Medical Registration

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NEXT OF KIN
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IDENTITY DETAILS

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National Insurance Number:
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CAPACITY TO WORK IN THE UK

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CRIMINAL RECORD
Workers of The Agency are subject to the Health and Social Care Act 2008, and will be subject to a Police Record Check through the DBS. Please declare all criminal convictions, whether spent or not, charges, whether proceeded with or not, and warnings and cautions. You will not be eligible for work in a Care setting if you are on the DBS Register(s).




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EQUAL OPPORTUNITIES MONITORING FORM



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RELIGON/BELIEF

ETHNIC ORIGIN


DISABILITY
The Disability Discrimination Act 1995 (DDA) defines a disability as “A physical or mental impairment which has substantial and long-term adverse effect on a person’s ability to carry out normal day to day activities”. (In such cases long term is regarded as more than 12 months). Anyone who is diagnosed with HIV, cancer or Multiple Sclerosis is immediately treated as disabled under the DDA. We do not discriminate based on the grounds of a person’s disability and we are strongly committed to providing appropriate support for staff/students with disabilities.

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Without knowledge of your disability, it may be difficult to fully provide support for your needs and make the necessary adjustments. Information disclosed by the applicant regarding your disability and/or additional needs will be handled with the strictest confidentiality. For any further support please contact Office Manager .
HEALTH DECLARATION

 Cardiovascular disease  Kidney disease
 Respiratory disease  Diabetes
 Liver/Gallbladder disease  Rheumatoid Arthritis
 Gastrointestinal disease  Mental illness
 Contagious blood disease  Allergies

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WORKING TIME DIRECTIVE CONSENT






Contact Details
XTRA HEALTHCARE LIMITED
Main
17 Rushton Mews,
Corby,
Northamptonshire,
NN17 5EQ
01536 233157

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Xtra Healthcare and "Complex Care & Support " are service marks or registered service marks of Xtra Healthcare Limited.
© 2019 Xtra Healthcare All rights reserved .Created by Bigcross
Head Office
Office 2, Corby Business Centre
Eismann Way,
Corby,
Northamptonshire,NN175ZB
01536265377


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