Join the Team

Job you wish to apply for*

If you are unsure on which job you wish to apply for, please go back to the Join our team for more information.

Personal applicant details

Title MrMrsMissDrOther
First name*
Second name*
Home Address*
Postcode*
Home number
Work number
Mobile number*
Email*
National insurance number*
Do you have the right to work in the UK .i.e. under EU citizenship or under the restrictions of a work permit.*—Please choose an option—YesNo
Current drivers license

How much notice do you need to give to your current employer

Education

Please tell us about your education and any qualifications which you feel are relevant to the post. Include relevant courses which you are currently undertaking. Please start with the most recent.

Name of School/College/University or training establishment*
Subject(s) studied*
Qualification/Level attained*
Date(s)* e.g."1/1/96 - 1/1/01"*

Name of School/College/University or training establishment
Subject(s) studied
Qualification/Level attained
Date(s) e.g."1/1/96 - 1/1/01"

Name of School/College/University or training establishment
Subject(s) studied
Qualification/Level attained
Date(s) e.g."1/1/96 - 1/1/01"

Training

Please list any training you have received or courses which did not lead to a qualification but which you feel
are relevant to the advertised post.

Training course
Date completed e.g."1/1/96"

Training course
Date completed e.g."1/1/96"

Training course
Date completed e.g."1/1/96"

Training course
Date completed e.g."1/1/96"

Professional Associations

Please state whether you are a member of any technical or professional association, and if so it the details:

Professional Associations
Registration Number
Date

Professional Associations
Registration Number
Date

Professional Associations
Registration Number
Date

Foreign Languages

Please list any foreign languages you speak & your level of competence either oral &/or written

Foreign language
Competence OralWrittenBoth

Foreign language
Competence OralWrittenBoth

Foreign language
Competence OralWrittenBoth

Hobbies & Interests

Please list any hobbies and/or interests you have. This is strictly voluntarily but as an organisation which seeks to include our service users in as much activities as possible.

Hobbies & Interests

Employment Record

Please start with your most recent employment. Briefly describe the main duties and responsibilities of your
post. If you wish to expand on specific areas of responsibility, please do so in the Experience /skills section.

Job title*
Start Date*
End Date
Address*
Brief description of duties*
Reason for leaving

Job title
Start Date
End Date
Address
Brief description of duties
Reason for leaving

Job title
Start Date
End Date
Address
Brief description of duties
Reason for leaving

Experience/Skills

This section is for you to give specific information in support of your application.

After reading the Job Description and Person Specification carefully, consider to what extent you have gained the skills and experience necessary for the post. Your experience need not have been gained in paid employment and may include special interests relevant to the post. It is important that you provide evidence of your achievements by giving examples to support your application. You may wish to use the headings in the person specification in order to set the information out clearly.

Relevant experience/skills*

References

Please give name, address and position/occupation of two referees. One must be your present or most recent employer. References will only be taken up for the successful candidate. Testimonials or references

from friends and relatives are not acceptable.
Name*
Organisation*
Email address*

Name
Organisation
Email address

Name
Organisation
Email address

Criminal Convictions

Because of the nature of the work for which you are applying, this post is exempt from the provisions of Section 4(2) of the above Act by virtue of the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975. Applicants are therefore, not entitled to with hold information about convictions which for other purposes are “spent” under the provisions of the Act and, in the event of employment, any failure to disclose such convictions could result in dismissal or disciplinary action. Any information given will be completely confidential and will be considered only in relation to an application for positions to which the Order applies. The post you are applying for involves working with vulnerable adults and as such you will be required to consent to the disclosure of any criminal record you may have by the CRB. If you are offered the post, you will be required to complete an application for disclosure and will not be able to start work until the disclosure is received and approved.

Do you have any criminal convictions?* —Please choose an option—YesNo

If yes, please contact us directly via our email, info@greenshootscs.com, and include any spent convictions under Section 4(2) of the Rehabilitation of Offenders Act 1974.

Covid 19 vaccination

The new legislation means from October 2021– subject to Parliamentary approval and a subsequent 16-week grace period – anyone working in a CQC-registered care home in England for residents requiring nursing or personal care must have 2 doses of a COVID-19 vaccine unless they have a medical exemption. More information can be found here.

Have you been fully vaccinated?* —Please choose an option—YesNo

Declaration

By signing and returning this application form you consent to Surge Care using and keeping information about you provided by you – or third parties such as referees – relating to your application or future

Surge Care Care employment. This information will be used solely in the recruitment process and will be retained for six months from the date on which you are informed whether you have been invited to interview, or six months from the date of interview. Such information may include details relating to ethnic monitoring and disability: these will be used solely for internal monitoring and will not be disclosed to any third party.

By submitting your application form, you consent to Surge Care keeping aspects of you application form as required by law?* —Please choose an option—YesNo