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CAPRICORN CARE

committed. reliable. caring

Due to current popular demand of our services, Capricorn Care is vastly expanding its current team. We offer competitive pay rates, flexible working conditions & dedicated support to enhance professional development. Experienced or not, you will be offered the right support and training to prepare you for chosen role. For a fresh start or life changing work experience, why not apply to join the exceptional Capricorn Care team.

We offer support with your NMC revalidation and Care Certificate training to enhance continued professional development.

Our registration process is straightforward and would just require the following documents to get started:

a. Proof of ID

b. Right to work

c. DBS check

d. NI Number

c. Proof of Address

d. References.

GENERAL ENQUIRIES

*Required

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Name*:

Email*:

Phone*:

Message*:

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CAPRICORN CARE

APPLICATION FORM

*Required

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1. PERSONAL INFORMATION

Title*:

Name*:

Surname*:

Current Address*:

Contact Number*:

Email*:

SPACER

Gender*:

Date of Birth*:

Nationality*:

Role applied for:

NI No.:

Car & License*:

SPACER

NOK Name*:

Relationship*:

Contact Details*:

SPACER

2. TRAINING & DEVELOPMENT

Please give details of any training and development courses which support your application.

Course:

Training Provider*:

Date Completed*:

Course*:

Training Provider*:

Date Completed*:

Course:

Training Provider*:

Date Completed:

SPACER

3. EMPLOYMENT HISTORY

Name of Employer*:

Position Held*:

Address*:

Start Date*:

Leaving Date*:

SPACER

Name of Employer*:

Position Held*:

Address*:

Start Date*:

Leaving Date*:

SPACER

4. PAYROLL DETAILS

Bank Name*:

Account Name*:

Account Number*:

Sort Code*:

SPACER

5. CRIMINAL RECORD BACKGROUND CHECK

Applicants for Healthcare positions are exempt from the Rehabilitation of Offenders Act 1974. You are required to declare prosecutions or convictions, including those considered ‘spent’ under this Act.

Please Answer the below with Yes or No.

Do you have any convictions, cautions, reprimands or final warnings that are not “protected” as defined by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (as amended in 2013) by SI 2013 1198? *

Yes

Do you have any convictions, cautions, reprimands or final warnings which would not be filtered in line with current guidance? *

Yes

Have you had a Police check in another country within the last 6 months? If so, please provide details below and enclose a copy if held. *

Yes

Have you ever been suspended or are you currently under investigation by an NHS Trust, professional body or any other organisation? *

Yes

If you have answered yes to any of the above questions, please provide more information below:

Capricorn Care will undertake an Enhanced DBS check on your behalf.

SPACER

6. REREFENCES

Name*:

Position*:

Job Title*:

Work relationship*:

Organisation*:

Address*:

Email*:

SPACER

Name*:

Position*:

Job Title*:

Work relationship*:

Organisation*:

Address*:

Email*:

SPACER

7. MEDICAL DECLARATION

The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3) say that persons employed must ‘be able by reason of their health, after reasonable adjustments are made, of properly performing tasks which are intrinsic to the work for which they are employed.’

Do you suffer from any conditions that may prevent or limit you from carrying out your employment duties? *

Yes

If you have answered YES to the above question, please provide details below. Please note: We may need to ask you to provide a letter from your GP confirming you are fit to work. *

SPACER

8. Confidentiality Agreement for Care Workers

I understand that all the information regarding the client is confidential. In consideration of the information being made available to me by the client or by Capricorn Care, I undertake for myself and the organisation.

I represent that:

a.  I will use the information solely for the purpose of the contract of my dealing with the client and Capricorn Care. 

b.  I will not at any time without the client’s prior consent, disclose or reveal any information to any person other than to other employees of my organisation who are directly concerned with the purpose on a “need to know” basis.

SPACER

9. PERSONAL DECLARATION

I hereby confirm that the information provided on my application is correct and true to the best of my knowledge and that I have not withheld any information that should be taken into account when offering me work.

I understand that providing false/inaccurate information may result in the termination of employment.

I agree that I will endeavour to make myself aware of the Health & Safety procedures for each client I am assigned to.

I also agree to inform Capricorn Care of any changes to my health or circumstances.

Print Full Name*:

Date

Signed*:

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We will get back to you as soon as possible.

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admin@capricorncare.co.uk

www.capricorncare.co.uk