Application Form | Link Community Care

Personal Information

Title

Full Name *

First

Last

Current Address *

Address Line 1 *

Address Line 2

City *

County *

Post Code *

Email Address *

Phone Number

National Insurance Number

Do you have

A full driving licence that allows you to drive in the UK?

Yes No

Use of a car for work?

Yes No

Additional Info

Are you able to work flexible hours?

Yes No

Do you have a disability?

Yes No

Do you need any special arrangements to help attend interview?

Yes No

Please tell us what you need

Give dates of any planned holidays

From

Where did you hear about this job?

Newspaper Job Market Other

To help us monitor advertising, please provide the name of the newspaper

Job References

Referee 1

Job Title

Name & Address

Phone Number

Referee 2

Job Title

Name & Address

Phone Number

Referees will only be contacted if we are considering offering the post.

Employment Records

Current Job

Type of contract

Permanent Fixed Temporary Relief

Name of employer

First

Last

Job Title

Employer address

Address Line 1 *

Address Line 2

City *

County *

Post Code *

Date Started

Salary

Brief description & responsibilities relevant to this post;

Notice Period

Reason for leaving

Previous Employment history, including voluntary work/Career Breaks. Periods of unemployment. Give details started with previous employment.

Repeat Field

Name & Address	Dates Employed from and to	Position held, main duties	Actions

Qualifications

Education and Qualification

Title of Qualification	Level	Grade Achieved	Date Passed	Actions

Professional Qualifications (Write None if None)

Professional Body	Qualification/Class held	Date Passed	Actions

Experience and Skills

Applicants should detail their skills, experience and knowledge needed for the post applied for and show how your past experience has given you these skills and experience.

Whether you have been employed or unemployed, how many days you have been unfit for work over the past 3 years?

Number of days sick	Number of occasions	Reasons	Actions

Further Information

Place of Birth

Please give all addresses within the last 5 years

Have you ever lived elsewhere in the UK or ROI

Yes No

Where else did you live?

Please give any other surnames by which you have been known.

Criminal Convictions/Offences

Do you know of any reason or conviction that would render you unfit to work with Children or Vulnerable Adults?

Yes No

Please list below details of all charges, prosecutions, convictions, cautions, bind-over even if they happened a long time ago. You must include any that may be pending minor matters and any road traffic or motoring offences if none then please write none.

Convictions/Offences

Personal Declaration

1. I DECLARE THAT ALL THE INFORMATION ON THIS FORM IS TRUE, COMPLETE AND ACCURATE.
2. I UNDERSTAND THAT ACCESS NI CHECKS WILL BE CARRIED OUT BEFORE I AM OFFERED A JOB AND I CONSENT TO THE CHECKS BEING MADE.
3. I UNDERSTAND THAT IF I GIVE WRONG INFORMATION OR LEAVE OUT IMPORTANT INFORMATION I COULD BE DISMISSED IF I TAKE UP THIS JOB.
4. I UNDERSTAND THAT I WILL BE ASKED TO SHOW EVIDENCE OF MY IDENTITY AND EVIDENCE OF ANY QUALIFICATIONS THAT ARE NEEDED BEFORE I CAN BE OFFERED THE JOB.
5. I CONFIRM THAT AS FAR AS I KNOW THERE are NO MEDICAL REASONS WHICH WOULD STOP ME FROM CARRYING OUT THE DUTIES OF THIS JOB.
6. I AGREE TO LINK COMMUNITY CARE AGENCY MAKING NECESSARY ENQUIRIES DURING THE RECRUITMENT AND SELECTION PROCESS.
7. I UNDERSTAND THAT CANVASSING WILL DISQUALIFY ME FROM THE SELECTION PROCESS FOR THIS JOB.

I have read and agree to the Terms and Conditions

Sign Here *

Clear

Link Community Care provides a service promoting dignity and self-esteem of service users through ‘empowerment’ and ‘advocacy’. If you have any questions, just contact us

Link Community Care is a private agency operational since January 2008. This agency is a professionally led organisation and currently accepts referrals from the South Eastern Trust.
The Organisation is registered with the Regulation & Quality Improvement Authority (RQIA) which oversees the implementation of the ‘Minimum Standards’ developed by DHSSPS for a range of regulated services including ‘Domiciliary Care Agencies’.
Our organisation aims to provide service users with a service enabling them to remain in their own home. Daily support in personal care and meal provision coupled with respite services to support the main carer who may require ‘time for themselves’ or with practical tasks in light housework duties.
Our services will be delivered in a friendly and helpful manner from staff who will receive training to help them deal with most situations in an efficient and effective manner.

We welcome any suggestions from clients, which will be treated confidentially and used to help us build an agency which includes the view of our service user’s.
The philosophy and practices of a domiciliary care agency should lead to a friendly and caring service where service users are listened to and feel valued, their rights are upheld, their cultural and religious beliefs are respected and receiving a service is a positive and beneficial experience. In order to achieve this, managers and staff must at all times have the following values firmly embedded in their practice.
Each service user will be respected as individuals and will be valued in all situations. Staff will work in a non-judgemental manner and carry out all tasks with agreement and consent.
Our service users will be treated with respect and dignity and as equals to self and others whilst valuing all cultural differences.

Link Community Care – Application Care

Do you have

Give dates of any planned holidays

Referee 1

Referee 2

Current Job

Previous Employment history, including voluntary work/Career Breaks. Periods of unemployment. Give details started with previous employment.

Experience and Skills