MNS CARE PLC / ANGEL CARE PLS
APPLICATION OF EMPLOYMENT

POSITION APPLIED FOR:____________________________   DATE AVAILABLE FROM_________________ 

PHOTOGRAPH

PREFERED TITLE____________	SURNAME_______________________________

PREVIOUS  SURNAME ____________________     

FORENAMES_____________________________

ADDRESS	___________________________________				
	   	___________________________________
	   	___________________________________
	   	___________________________________
		
              POSTCODE: ________________________      

TELEPHONE_________________________MOBILE_________________________

Email Address:----------------------------------------

DATE OF BIRTH ________________________		NI NUMBER________________________________

MARITAL STATUS _____________________		DEPENDANTS______________________________

NATIONALITY_________________________		DO YOU HOLD A PASSPORT?     YES/NO

DO YOU HOLD A WORK PERMIT?    YES/NO		EXPIRY DATE OF WORK PERMIT_____________

PIN NUMBER___________________________		EXPIRY DATE OF PIN NUMBER_______________

NEXT OF KIN___________________________		RELATIONSHIP______________________________

ADDRESS______________________________________________________________________________________

TEL NO:_______________________________ MOBILE____________________________________________

DO YOU OWN A CAR?     YES/NO   	IS IT AVAILABLE FOR USE AT WORK?        YES/NO 

General Information:	       Hours Prepared to Work: ______________________________________
                         Will this be your only employment YES/NO

Please indicate shift times available to work on a regular basis:

Mornings    Yes/No		Afternoons       Yes/No			Evenings  	Yes/No
Evenings      Yes/No		Nights 	             Yes/No			Weekends	Yes/No      

Office Use only:
		START DATE OF EMPLOYMENT:__________________Reference No:______
              
 P45:      YES/NO     TAX CODE_________________   If no has she completed P46      YES/NO	
		
		Rate of Pay:	Basic		_____________________
				Weekend	_____________________	
				Holiday		_____________________		

EDUCATION

Secondary
Name & Full Address	Attendance	Examinations taken		Pass/Fail	Date Exam       
of School attended	Date								Taken
______________________________________________________________________________________________

Further Education
Name & Full Address	Attendance	Examinations taken		Pass/Fail	Date Exam       
of College attended	Date								Taken
______________________________________________________________________________________________

Professional/other Training
Name & Full Address	Attendance	Examinations taken		Pass/Fail	Date Exam       
of Training Centre	Date								Taken
______________________________________________________________________________________________

CAREER DEVELOPMENT

Current Employment
Name & Full 		Date started	Date 		Position Held and	Salary		Reason for 
Address of Employer	Work		Left work	Description of duties			Leaving
_______________________________________________________________________________________________

Past Employment
Name & Full 		Date started	Date 		Position Held and	Salary		Reason for 
Address of Employer	Work		Left work	Description of duties			Leaving _______________________________________________________________________________________________

_______________________________________________________________________________________________

_______________________________________________________________________________________________

How may days sick have you had in the past two years? ___________________________________________________

Please give details of any long term illness  ___________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________

Doctors Name	__________________________________________

Address           	__________________________________________
		__________________________________________
		__________________________________________
		________________Post Code__________________

Should we need to contact your doctor regarding the above, do we give your permission for us to contact them?
																							YES/NO_________

REFERENCES
You will need to give three references, one of which must be your last employer
Name of  Referee			Name of  Referee		Name of  Referee
_____________________			______________________		______________________
Position					Position					Position
_____________________			______________________		______________________
Dates of Employment			Dates of Employment			Dates of Employment
_____________________			______________________		______________________
Name & full address of			Name & full address of			Name & full address of
Company:				Company:				Company:
_____________________			______________________		______________________
_____________________			______________________		______________________
_____________________			______________________		______________________
_____________________			______________________		______________________
Post code:_____________		Post code:______________		Post code:______________
Tel:__________________		Tel:___________________		Tel: ___________________

Please complete reference details clearly including full address and postcode, as employment is subject to clear references.

REHABILITATION OF OFFENDERS ACT 1974 (EXCEPTIONS) ORDER 1975

The provisions relating to the non-disclosure of criminal convictions do not apply to certain occupations.  The position that you are applying for however does require you to disclose any past criminal convictions and those currently awaiting legal proceedings or judgement. Failing to disclose such convictions could result in dismissal.

Have you at any time been convicted of any criminal offence?			YES /NO  __________________

If yes please give details  ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Are you currently awaiting legal proceedings or judgement against you?		YES/NO  ___________________

if yes please give details
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

A criminal conviction will not necessarily debar you from applying from this post or lead to a refusal of employment, however failure to disclose information could result in rejection of your application or, if appointed, to your dismissal.

Signature ___________________________________	Date ____________________________________

SPECIAL REUIREMENTS (CARE SECTOR)
Because this position involves the care of vulnerable adults employment is dependent on the following:

1)  Your written consent to obtaining a standard/enhanced disclosure certificate form the Criminal Records 
      Bureau or an approved umbrella body.

2)  Such disclosure being acceptable to the company.
 
3)  Proof of identity – birth or marriage certificate (where appropriate) and passport (if available)
 
4)  Two Satisfactory written references.

5)  That you will supply a photograph of yourself for retention in your records.

6)  Evidence of physical and mental suitability for your work

DECLARATION

ALL THE ABOVE INFORMATION CONTAINED WITHIN THIS APPLICATION FORM IS TO THE BEST OF MY KNOWLEDGE. 

SIGNATURE _________________________________________	DATE ____________________________

In support of you application you are invited to add any further information, particularly in areas of experience, skills and training not covered in the application form and give you reasons why you are applying for the post, and why you are best suited for it.

EQUAL OPPORTUNITIES

MNS Care Plc endeavours to work towards and maintain a policy of Equal Opportunities and as such is committed to the equal rights and needs of the individual regardless of age, gender, sexual orientation, race, colour, creed and disability.  This applies to our residents and staff.  This will promote the highest standards of interactive and interdependent service provision.

CONFIDENTIALITY

Because of the nature of this post, information may become known to you, which could be personal, private, and of a sensitive nature, either from or concerning clients, employer and colleagues.  This shall be regarded as privileged information and as such may not be discussed outside the premises or out of context within.  Failure to take responsibility could lead to disciplinary action and/or dismissal.

BANK DETAILS

BANK NAME:			________________________________________________

ADDRESS:			________________________________________________
				
				________________________________________________
		
				________________________________________________

				________________________________________________

ACCOUNT NAME:		________________________________________________

ACCOUNT SORT CODE:	________________________________________________

ACCOUNT NUMBER		________________________________________________

IF BUILDING SOCIETY ACCOUNT PLEASE QUOTE REFERENCE NUMBER:

				________________________________________________

PRE EMPLOYMENT QUESTIONNAIRE
Name:		
Position Applied:		
Doctors Name & Address:		
Physical description:		
Height	                              ft                                inches                                   metric	
Weight	                              stones                        lbs                                         metric	

 POST EMPLOYMENT QUESTIONNAIRE

Please note that the following information is strictly Private and Confidential and will stored appropriately.

Please tick boxes that apply:

GENDER

Male		Female		
Non specified				
ETHNICITY

White 	
British		Irish		
Other				
Mixed	
White/Black Caribbean		White/Black African		
White Asian		Other Mixed Background		
Asian	
Indian		Pakistani		
Bangladeshi		Other Asian Background		
Black or Black British	
Caribbean		African		
Other				
Chinese		
Other 	
Other		Unknown		

DISABILITY

Physical		Learning		
Sensory				

MENTAL HEALTH DIFFICULTIES

Please tick here if you have any mental health problems.		

RELIGION/BELIEF

Baha’i		Buddhist		
Christian		Hindu		
Jain		Jewish		
Muslim		None		
Pagan		Sikh		
Zoroastrian		Unknown		
Other (name)		

SEXUAL IDENTITY

Heterosexual/Straight		Gay or Lesbian		
Bisexual		Other		
Unknown