APPLICATION PACK.
WHEN COMPLETED PLEASE TAKE OR SEND TO;-
Abbots Care Ltd.
Unit 5 and 6
Phoenix House
63, Campfield Road
St. Albans HERTS
AL1 5FL
Phone; 01727891004
IF YOU RECIEVED THIS PACK BY E-MAIL PLEASE E-MAIL COMPLETED PACK AS AN
ATTACHMENT TO [email protected]
for more information; [email protected]
Co.no. 04312379
Author= S. Hyde- Checked by C. Leavold- Reviewed by Director/Mngrs 06/10-Review due 07/11-Written Nov.1995
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ABOUT OUR COMPANY, ABBOTS CARE LTD.
Dear Applicant,
We are a small and friendly family business established in 1995. The emphasis is on finding
you work at the times you want it, and making sure you have the information and skills
needed to work safely and well.
WHO WE CARE FOR AND WHAT WE DO
We care for the elderly, adults and children, people who are learning disabled and/or who
have physical disabilities, people who have been discharged from hospital and other frail or
vulnerable people who are in need of our service.
We provide personal care, such as help to eat, toileting, washing and dressing. We provide
stimulating activities and escort for outings. We help as far as possible towards achieving
independence.
WORK AND PAY ARRANGEMENTS
We work in people’s own homes, residential care homes and day care centres.
We have a wide variety of work local to our care workers in Herts and Bucks. Care Workers
tell us times and hours they want to work and we offer them the most suitable work we can
find. No one pressurises them, they choose their own work. Once work is agreed to they are
expected to honour the commitment.
We give good rates of pay, enhanced rates for unsocial hours and paid holidays. Grades are
determined by the responsibility of the job. We pay our staff four weekly and we deduct NI
and Tax at the appropriate rate. Pay rates are provided during interview. Please call us if you
wish to know the present rates before applying.
CARE WORKERS
We ensure the training of our staff, and the opportunity to achieve a qualification.
We need kind, honest and caring people for this work.
Many of our staff have been with us since we opened in 1995. We have many care workers
who are with us because we were recommended by others as an employer. We are well
known for our great care workers. We have many full time staff and part time too, for
example parents who want to work around their family’s needs, students who work only in
school holidays, day workers, evening and /or weekend workers, night workers.
Whatever hours you are able to work we would love to hear from you.
NEXT STEPS
If your application form is suitable the next steps are you will be invited for an interview.
If we suit you and you suit us, we will send for your references.
If refs are acceptable, we will arrange for an enhanced disclosure (which comes to you and
for which you pay) and for your Induction training (which is free of charge) Induction training
takes place on a Tuesday, Wednesday and Thursday over a two week period. Induction
training takes place prior to you signing a contract and is unpaid. We do not charge you for
Induction training.
Hope to hear from you!
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EQUAL OPPORTUNITIES POLICY.
Summary.
We strive to ensure that all Employees, Care Workers, Job Applicants and Service
Users (Clientele) are treated equally and not discriminated against irrespective of
their race, age, religion, gender, sexual orientation, marital status or disability.
APPLICATION PACK.
The information you disclose to us will only be accessible to the person processing
your application, and the Managers and Directors of Abbots Care Ltd. If you are
successful in your application it will also be accessible to the office staff who are
responsible for training you salary, providing you with wok and monitoring your
work. Following this a profile of your skills and care experience will be drawn up and
shown to employers with whom you are seeking work.
IF YOU ARE INVITED FOR INTERVIEW, YOU MUST BRING PROOF OF YOUR IDENTITY;

BIRTH CERTIFICATE,

PASSPORT

DRIVERS LICENCE (IF RELEVANT)
ALSO BRING ANY RELEVANT CERTIFICATES OF QUALIFICATION WITH YOU.
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ABBOTS CARE AGENCY APPLICATION FORM.
PLEASE USE CAPITAL LETTERS THROUGHOUT THIS FORM
Surname
First names
Address
Phone
Ms.Mr.Miss.Mrs
.
Mobile
e-mail
POST CODE
D.O.B.
Nationality
National Insurance
no.
Do you need
a work
permit ?
Do you hold a
current driving
licence?
Do you have
transport?
How many hours do
you wish to work
weekly?
Which days
and times?
Emergency
Contact
In which areas would
you be prepared to
work?
1. HERTS
Do you have Care
Work experience
with any of the
following groups?
(please tick)
Which of the
following
work are you
interested
in?
1.Learning disabled
adults and/ or
children.
1.Caring for
children
Name
2. BUCKS
Address…
Phone…
Any within reason
Or
Describe ideal
locations;-
2.Adults and /or
children with
physical disabilities
3.Challenging
behaviour.
4.Ordinary child
care.
5.Elderly Care.
6.Mental health
2.Caring for
adullts
3.
Domiciliary
home care
4.
Residential
home care
5. Day
Centres
6. Any
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EDUCATION AND TRAINING.
SECONDARY EDUCATION.
Please give the name and addresses of all senior schools attended with dates
started and finished.
Please give the name, grade, and date of any examinations passed at school.
If none write ‘none’
FURTHER EDUCATION. Please give the names and addresses of any further
education establishments attended with dates. If none write ‘none’
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TRAINING RECORD. (CONTINUE ON A SEPARATE SHEET IF NEEDED)
Name
Address
Phone nos.
E-mail address
Date
Do you have learning
disabilities experience?
Yes no
If yes , through work or
personal life?
Do you have experience
of; (tick if yes)
Challenging Behaviour?
Physical Disabilities?
Children?
Adults?
Epilepsy?
Do you have an NVQ 2, or
a higher NVQ, in Health
and Social Care?
Are you a qualified nurse,
or a nursing student?
Do you have a B Tech or
other qualification in
Health and Social Care?
How many years?
Do you hold a CACHE,
NNEB or other child care
qualification?
Do you have English as a
second language?
Do you need any help
with reading and writing?
(For example Dyslexia)
YES NO
YES
NO
YES
PLEASE LIST ANY OTHER CARE RELATED QUALIFICATIONS
NO
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Short training courses attended
Course title
Company
Date
Induction training section –office use.
SUBJECT
DAY 1 INDUCTION
DAY2 INDUCTION
DAY3 INDUCTION
DAY4 INDUCTION
DAY5 INDUCTION
DAY6 INDUCTION
DATE
NAME
OTHER QUALIFICATIONS
Please give the name, grade and date of any qualifications from further
education not directly relevant to care work. If none write ‘none’
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Intentionally blank
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EMPLOYMENT HISTORY.
Please give a full employment history from leaving school. Please do not leave any gaps in time
unaccounted for ~ if you were unemployed, a homemaker, in education, not working due to ill
health or taking time off please say so.
DATE FROM
MONTH AND YEAR
DATE TO
MONTH AND
YEAR
JOB
TITLE
NAME OF EMPLOYER AND
ADDRESS
REASON
FOR
LEAVING.
PLEASE CONTINUE ON A SEPARATE SHEET AS NECESSARY.
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REFERENCES.
Abbots Care Ltd. have very thorough vetting procedures in order to
protect our Service Users from potential abusers.
1. You must account for any breaks in employment.
2. One reference must be from your most recent employer.
3. Additionally, if you have worked with vulnerable adults previously, you must
provide a reference from your last employer, regardless of how long ago the
employment was, and he /she must state why you left.
4. Additionally, if you have worked with children,
you must provide a reference from your last employer in child care,
regardless of how long ago the employment was, and he /she must state why
you left.
5. The minimum number of references you can give are four.
If  you have not worked continuously for the last five years
 you have only worked for one employer,
 you have not worked with vulnerable adults or children previously,
We require a minimum of four references. These can be made up from some
personal references but they must be from reliable sources and not from
relations.
6. If you are aged 18 to 20 one of your references should be from a teacher or
headmaster.
7. If you have been, or are in further education, one can be from a tutor or
principal
8. We will send for your references- if you do not wish us to contact your
references prior to an interview you must write on the following form to say
so.
9. If you are successful at interview we will immediately send for your
references. Please ensure the people you describe have agreed to provide
them. If you do not wish us to approach your references at this stage you
must say so and your application will not be processed any further until you
are ready.
10. If any reference has not arrived after two weeks, we are prepared to ask the
referee a second time for a reference. Following this if we have not obtained
the reference, you will be expected to contact the person and ensure
provision if you wish to continue the application.
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DATE
FROM
DATE
TO
NAME
OF REFERENCE
ADDRESS
PHONE
CAN WE CONTACT
PRIOR TO INTERVIEW?
HAVE
THEY
AGREED TO
GIVE A
REFERENCE?
EMPLOYERS REFERENCES TO COVER LAST 5 YEARS OF EMPLOYMENT
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REFERENCES- HAVE YOU WORKED WITH VULNERABLE ADULTS?
YES NO
IF YES AND NOT YET GIVEN, PROVIDE A MOST RECENT EMPLOYERS REFERENCE REGARDING
VULNERABLE ADULTS
DATE
FROM
DATE
TO
EMPLOYERS
NAME
ADDRESS
PHONE
CAN WE
CONTACT
PRIOR TO
INTERVIEW
?
HAVE
THEY
AGREED TO
GIVE A
REFERENCE?
REFERENCES- HAVE YOU WORKED WITH CHILDREN? YES NO
IF YES AND NOT ALREADY GIVEN PROVIDE AN EMPLOYERS REFERENCE REGARDING MOST
RECENT CHILD WORK
DATE
FROM
DATE
TO
EMPLOYERS
NAME
ADDRESS
PHONE
CAN WE
CONTACT
PRIOR TO
INTERVIEW
?
HAVE
THEY
AGREED TO
GIVE A
REFERENCE?
What are your reasons for applying for care work?
Where did you hear about Abbots Care?
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CRIMINAL CONVICTIONS.
DO YOU HAVE ANY CRIMINAL
CONVICTIONS, past or pending? Do you
have any cautions, reprimands, final
warnings or convictions?
IF YOU HAVE HAD NONE YOU MUST
WRITE ‘NONE.’
Have you any reason to believe you
may be included on the ‘POCA’ or
‘SOVA’ lists? (PLACEMENT ON THESE
LISTS MEANS THAT YOU ARE NOT
ALLOWED TO WORK WITH CHILDREN
OR VULNERABLE ADULTS AND IT IS AN
OFFENCE TO SEEK WORK WITH THEM
PLEASE ANSWER HERE
PLEASE ANSWER HERE
As Abbots Care Ltd. meets the requirements in respect of exempted questions under
The Rehabilitation of Offenders Act 1974 all applicants who are offered employment
will be subject to a criminal records check from the Criminal Records Bureau
including POCA and SOVA lists, before the appointment is confirmed. This will
include details of cautions, reprimands or final warnings, as well as convictions.
People from overseas will be expected to provide proof from their own country.
If you have any convictions or anything else you wish to disclose you do not have to
detail them here but you must discuss them if you are invited for interview.
Protection of Children Act 1999 and the Criminal Justice and Court Services Act
2000.
It is a criminal offence for people to apply for work with children and young people if
they have been convicted of certain offences of a seriously violent or sexual nature.
Further details are available from the Department of Health and The Home Office.
It is also an offence for any organisation to offer work with children and vulnerable
young people to anyone who has been convicted of the above-mentioned offences,
or who has been included on any lists of people considered unsuitable for work with
children held by the Dept of Health, Education or Employment.
I have given the required information and believe it to be true to the best of my
knowledge.
Health
To the best of my knowledge there is no reason in respect of my physical or mental
health why I should not be able to carry out the tasks described in the job
description. Please note all successful applicants will be expected to complete a
health questionnaire.
SIGNED ……………………………… PRINT NAME………………………………Date………………
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APPLICANTS questionnaire reviewed Sept 2009.
Name
Date
We would be grateful if you will help us to monitor our equal opportunities;Where did
you hear
about Abbots
Care?
Age: please
18 – 25,
25 – 35,
35 – 50,
50+
tick
Gender
Male
female
transgender
Nationality:
Ethnicity
(please tick):
White:
British
Irish
Any other white background
Mixed:
White and Black Caribbean
White and Asian
White and Black African
Any other Mixed background
Asian or Asian British:
Indian
Pakistani
Bangladeshi
Any other Asian background
Black or Black British:
Caribbean
African
Any other Black background
Chinese or other ethnic group: Chinese
Any other
Religion
First language
spoken
Any learning
difficulties
Eg dyslexia, sight or hearing problems, concentration problem or
other problem with reading and writing, language difficulty, other
Do you
consider you
have a
disability?
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Were you
given enough
information
regarding the
post?
Did we uphold
our equal
opportunities
policy?
Yes
WERE THE
FORMS
FAIRLY EASY
TO USE?
Yes
No
If no please comment;Yes
No
If no please comment;-
No
If no please comment;-
Any other
comments
THANK YOU FOR COMPLETING THIS FORM.
THIS BOX OFFICE USE ONLY Human resources officer please
=use 2=yes 1=no to score page 2 of this form. Then place the whole form in the
questionnaires folder.
Director for quality. Please use page one to contribute to the charts which monitor our
equal opportunities and your report. Page two score to express as a satisfaction score
monthly shown over the number of forms completed.
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