ONLINE JOB APPLICATION

Online Job Application Form- Everliving Services Ltd

Please ensure that you complete all parts of the form declarations.

Step 1 of 8

Title

Mr
Mrs
Miss
Ms

Names *

First

Middle

Last

Please enter your names as they appear on your passport

Position Applied For:

Day Shift + Sleep in 07:00-20:00/ 08:00-23:00 + Sleep in
Recovery hours. 09:00-15:00 / 15:00- 21:00 (Driver)
Wake Night. 22:00 - 08:00
Day Shift 08:00 - 22:00 / 07:00 - 22:00
Care management Assistant/administrator.

Availability. Please specify days you are not available to work and hours in the week.

DOB *

Current Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

NI Number (UK)

Email *

Phone *

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Next Of Kin Name

Relationship

Address

Address Line 1

City

State / Province / Region

Postal Code

Country

Contact Number

Vehicle Licences Held

Current driving licence *

Do you own a car? *

Do you have any current endorsements? *

If yes, give details

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Emergency Contact Details

Relationship

Contact Number

Current Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

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Previous Employment.

Start with the most recent employer first. Please cover all jobs and minimum of 10 years employment history (all periods/gaps between jobs should be accounted for).

1. Name of Company *

Name & address of employer and nature of business

Position Held *

Start Date *//

End Date *//

Brief description of job and salary. Reason for leaving *

2. Name of Company *

Name & address of employer and nature of business

Position Held *

Start Date *//

End Date *//

Brief description of job and salary. Reason for leaving *

3. Name of Company *

Name & address of employer and nature of business

Position Held *

Start Date *//

End Date *//

Brief description of job and salary. Reason for leaving *

References

Reference from your current or most recent post. You must provide the names and contact details for at least 2 professional references who can comment on your professional abilities. Please note that one of these must be from your current or most recent post

1. Organisation and address *

Organisation name, address

Referee Name and Professional Title *

Work Email and Telephone number *

Do you give consent for Everliving Services LTD to request an Employment and Professional reference from the organization above: *

Signature

2. Organisation and address *

Organisation name, address

Referee Name and Professional Title *

Work Email and Telephone number *

Do you give consent for Everliving Services LTD to request an Employment and Professional reference from the organization above: *

Signature *

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Upload your resume

Click or drag files to this area to upload. You can upload up to 5 files.

Upload a cover letter

Click or drag a file to this area to upload.

Additional Information

If other

Working Time Directive.

Regulation 4 of the Working Time Directive requires that a worker’s average time spent at work does not exceed 48 hours within 1 rolling week unless the worker hereby agrees to exceed this limit. Please note should you choose to not opt out of the Working Time Directive that it is your responsibility to ensure that you do not work in excess of 48 hours per week. I hereby confirm that I am willing to opt out of the Working Time Directive. I understand that I can opt out of this agreement at any time providing Everliving Services Ltd with one week’s notice

Signature

Declaration

1. I declare that all the information provided by me to Everliving Services Ltd and its subsidiaries is true and accurate and has not been presented in a way as to mislead or misinform. I agree that if I have given false or misleading information, if I have omitted or subsequently omit, information which may affect my ability to work in my chosen profession that Everliving Services Ltd may cease to offer me further placements with immediate effect. 2. I am not aware of any condition, medical or otherwise, which would affect or limit my performance in employment other than those already provided, including information provided in the Occupational Health Questionnaire. 3. I hereby give permission for Everliving Services Ltd and its subsidiaries to apply for an Enhanced DBS Check and I declare that I have not withheld any information which may be later disclosed by the DBS. 4. I hereby give permission for Everliving Services Ltd and its subsidiaries to obtain all my occupational health results and reports, qualifications, and training information where necessary. 5. I hereby give permission for Everliving Services Ltd and its subsidiaries to contact the UKBA to perform a check on my Biometric Residence Permit. 6. I acknowledge that my personal details will be stored and used by Everliving Services Ltd and its subsidiaries in strict accordance with the Data Protection Act 1998. I agree that all information provided to Everliving Services Ltd can be made available for audit/review by relevant third parties. 7. I hereby agree to immediately notify Everliving Services Ltd and its subsidiaries of any changes to my circumstances or personal information including but not restricted to changes in my health; charges or investigations at work; changes to my DBS record or suspensions by my regulatory body. 8. I hereby agree that I will always act in a professional manner when representing Everliving Services Ltd and its subsidiaries and that I will fully co-operate with the instructions and duties allocated to me during each and every placement. 9. I will immediately inform Everliving Services Ltd and its subsidiaries if any complaint is made against me whilst on assignment for Everliving Services Ltd or any other body. 10. I acknowledge that it is my responsibility to ensure that my skills and knowledge are continuously updated and that I will always endeavor to carry out my duties and responsibilities to the best of my ability. 11. I can confirm that I have been given a copy of the Terms and Conditions of Service issues by Everliving Services Ltd, that I have read those Terms and agree to abide by them at all times. 12. I agree to abide by the Data Protection Act 1998 with regard to all information about Everliving Services Ltd and its subsidiaries, clients, candidates, patients and any other third party who I interact with during my employment with Everliving Services Ltd. I will not attempt to deliberately procure any information pertaining to Everliving Services Ltd, clients, candidates, patients or any third parties that would be deemed to be outside of my job description. I will not discuss information either verbally or in writing and if I am unsure about how to treat any information, I shall immediately contact Everliving Services Ltd Senior Management for clarification. 13. I can confirm that I have received the Everliving Services Ltd handbook and that I will abide by the code of conduct thereby set out. This code incorporates the code of conduct as set out by the regulatory bodies the NMC, GMC and Social Work England. I therefore agree that I will: • Respect the patient of client as an individual • Obtain consent before I give any treatment or care. • Protect confidential information. • Co-operate with others in my team. • Maintain my professional knowledge and competence. • Be trustworthy. • Act to identify and minimise risk to patients and clients. • Abide by the rules and regulations of the departments in which I work

Signature

Date *

Name

ONLINE JOB APPLICATION

Vehicle Licences Held

Previous Employment.

References

Disclosure and Barring Service Checks

Qualifications and Educational Information

Equal Opportunities Form

Working Time Directive.

Declaration

Head Office

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