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Recruitment Application Form

Personal Information

First name

Last name

Phone number

Address inc. postcode

Date of Birth

Do you smoke / vape?

Yes

Are you happy not to smoke / vape at work?

Yes

Are you able to assist with personal care?

Yes

e.g. washing, dressing and helping with using the toilet?

Do you have a full British drivers license?

Yes

Do you have any medical or disabilities we must be aware of? If so, please specify below.

Work History

Are you currently in employment?

Yes

Name of current employer

Please rest assured that this will remain confidential unless you approve and are happy for me to contact them.

Related skills & expertise

e.g. experience working with dementia people, Alzheimer's, challenging behaviours etc.

Qualifications and training

e.g. NVQs, manual handling, medications, etc.

References

Reference 1 name

Phone Number

Reference 2 name

Phone Number

Feedback

How did you hear about Gould Care?

e.g. Facebook, Google, Job Centre

Do you know anyone who had worked for Gould Care?

Yes

Documentation

Attach Cover Letter & CV

Attach Training Certificates & DBS

Attach Vaild ID

e.g. passport, driving license

Upon submitting this form, you sign and consent that the above details are correct.

Useful Links

Carers allowance:

www.gov.uk/carers-allowance/eligibility

Care and support plans:

www.nhs.uk/conditions/social-care-and-support-guide/help-from-social-services-and-charities/care-and-support-plans/

Safeguarding policy - Protecting vulnerable adults:

www.gov.uk/government/publications/safeguarding-policy-protecting-vulnerable-adults

https://www.gouldcare.co.uk/application-form

https://www.gouldcare.co.uk/reference-form

https://www.gouldcare.co.uk/hcpa

E: gcmc@gouldcare.co.uk
T: 0749 543 0801
Petersfield, Hampshire, GU32 3BQ

Office hours 8am-5pm

(Monday-Friday)

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