SECTION ONE JOB APPLICATION FORM SECTION TWO YOUR PERSONAL DETAILS SUNSHINE CARE EMPLOYMENT DETAILS ABOUT YOU NEXT OF KIN

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1 01 SECTION ONE YOUR PERSONAL DETAILS JOB APPLICATION FORM SUNSHINE CARE Sunshine CARE ABOUT YOU Title Forename(s) I certify that I m over the age of 17 years old Surname N.I. Number Your current Address NEXT OF KIN Forname & Surname Relationship Address Day Phone Evening Phone Mobile phone Telephone OWN TRANSPORT & DRIVING LICENCE What type of driving licence do you have? Do you have your own transport? Full UK Other International Provisional UK ne Have you had any motor convictions or any penalties? Full EEC, I have points on my licence 02 SECTION TWO EMPLOYMENT DETAILS POSITION APPLIED FOR AVAILABILITY Agency Care Worker Registered Mental Nurse If offered this position, will you work in any other capacity? Live In Care Worker Domiciliary Care Worker Registered Nurse Administration Post What date will you be available to start work? other Have you ever worked for this Company before? (If yes, please give us more details) Position Dates -

2 03 SECTION THREE CRIMINAL RECORDS AND WORK PERMITS It is a condition of proceeding with your application that you apply for a DBS (former CRB) disclosure. This disclosure will be compared with the information given above and any inconsistencies could invalidate your application or lead to termination of your employment with us. POLICE WARNINGS, CAUTIONS, REHABILITATION AND CRIMINAL RECORDS Have you ever been convicted, or otherwise, in a Court of Law in respect of any offence? * Are you currently subject of any criminal investigation, proceedings or convictions? * * If, please submit written details and dates of convictions, cautions, reprimands, final warnings, pending prosecutions, police enquiries, etc, using a sealed envelope, marked PRIVATE and CONFIDENTIAL, to the Recruitment Consultant. DISCLOSURE AND BARRING SERVICES Inclusion on the DBS s barred lists has the same effect as inclusion on the previous lists; List 99, PoCA, PoVA, POCVA or the Unsuitable Person s Lists. Are you on these lists? RIGHT TO WORK IN THE UK Do you need permission to work in the UK? (If, please continue on Section 4) People with an automatic right to work are citizens of the UK, European Union and EEA and certain commonwealth citizens. Are you visiting Britain on a working holiday? Do you hold a Student Visa? Do you require a work permit? On entering Britain what entry was put on your passport by immigration? Visa reference Residency permit number Work permit number Visa issued date Residency permit issued date Work permit issued date Visa expiry date Residency permit expiry date Work permit expiry date Because this position involves the care of children and/or vulnerable adults, employment is dependent upon the following: Your written consent to obtaining a standard/enhanced disclosure certificate from the Disclosure and Barring Services or an approved umbrella body. Such disclosure being acceptable to the company. Sufficient proof of identity and current address. Two satisfactory written references. Photographs of yourself for retention in our records and for an identification badge. Evidence of physical or mental suitability for your work.

3 04 SECTION FOUR WORK HISTORY (must be from leaving school) YOUR CURRENT OR MOST RECENT EMPLOYER Are you still working for this company? * *In Point 8, please explain your current situation YOUR MOST RECENT EMPLOYER 3 4

4 04 SECTION FOUR WORK HISTORY (continued) Please identify and explain any gaps in your employment If required, you may add additional information using A4 white paper and black ink.

5 05 SECTION FIVE EDUCATION & QUALIFICATIONS WHAT HAVE YOU BEEN STUDYING? Name of school attended Achieved qualifications or Area of study Name of school/college attended Achieved qualifications or Area of study Name of school/college/university attended Achieved qualifications or Area of study ANY OTHER TRAININGS OR QUALIFICATIONS RELEVANT TO APPLIED POSITION Title / Membership Registration number Date of issue Date of expiration DO YOU SPEAK OR READ OTHER LANGUAGE OR DIALECT? Scots Welsh Cornish Irish other Spanish French Italian German Slovakian Polish SUPPORTING INFORMATION Important Please include any skills or experience you have acquired that can support this application.

6 06 SECTION SIX REFERENCES 1 Please give at least THREE work references and ONE being the last position in care. Name of referee Address I give Referee s Position in company Day phone number Length of time known I don t give permission to contact this referee prior to an interview 2 Name of referee Address I give Referee s Position in company Day phone number Length of time known I don t give permission to contact this referee prior to an interview 3 Name of referee Address I give Referee s Position in company Day phone number Length of time known I don t give permission to contact this referee prior to an interview 4 Name of referee Address I give 07 Referee s Position in company Day phone number Length of time known SECTION SEVEN ADVERTISING I don t give permission to contact this referee prior to an interview PLEASE TELL US HOW DID YOU FOUND OUT ABOUT US Sunshinecare website Google Radio adverts Flyers Advert on buses Magazine Newspapers Friend Member of our staff* other *Please state the name of person who recommended us

7 08 SECTION EIGHT HEALTH & WORKING TIME The candidates must be medically fit to carry out the duties connected with post for which they are applying. The successful candidate may be asked to fill in a medical health questionnaire to determine whether any medical conditions are relevant to applied position. I am not aware of any health conditions which may affect my ability to undertake the duties of the position or place me at any risk in the workplace. I am aware that some of my health conditions may affect my work and may require some special adjustments in the workplace. The EU has laid down guidelines for all workers, governing the length of maximum working week that it is safe to work. The current limit is 48 hours per week. Because you are under no obligation to accept work offered, you will never be compelled to work more than 48 hours per week but you may choose to do so. Please tick appropriate box and sign. I DO NOT WISH to work more than 48 hours per week Your signature I DO WISH to work more than 48 hours per week 09 SECTION NINE DECLARATION I declare that the information given in this application is true and correct to the best of my knowledge and belief. It is understood and agreed that any misrepresentation by me on this application form will be sufficient cause for cancellation of this application and/or termination from the employer s service if I am employed. I give the employer the right to investigate all of the references and to secure additional information about me, if job related. I hereby release from liability the employer and its representatives for seeking such information and all other persons, corporations or organisations for furnishing such information. Date Your signature

8 i APPLICATION FORM GUIDANCE NOTES Please send this application form by or using sealed envelope to our recruitment team Sunshine Care Recruitment Team Building 5, Derriford Business Park Brest Road, Derriford Plymouth, PL6 5QZ Employment Details The full job title should be completed, and indicate the earliest date on which you could start work for us if the job is offered to you. Employment Details Chose desired position and mark appropriate box if you happy to be transfered to another post during your time with us. CRB Check Employers are required to check the criminal background of those employees whose jobs give them access to children or other vulnerable members of society. Decisions to appoint will be subject to consideration of a disclosure from the Criminal Records Bureau. If the post for which you are applying requires a Criminal Records Bureau check, you must provide information about ALL convictions, as the post is automatically exempt from the Rehabilitation of Offenders Act 1974 and rules relating to spent convictions do not apply. If the post for which you are applying does not require a Criminal Records Bureau check, you are still required to answer this question but you do NOT need to disclose convictions which under the Rehabilitation of Offenders Act 1974 are considered as spent. 04 Working History Starting with your last employer, list all employers you have worked for, providing the job title, starting / leaving dates, salary and the reason you left. If relevant include any voluntary work. 05 Education & Qualification This information may be used to assess whether you meet the experience requirement for the vacancy. List your formal qualifications, including grades where appropriate, where they were obtained and when awarded. Please detail the organising body and the details of any training you have attended. Please make sure nothing has been omitted. Supporting Information This section is probably the most important part of your application, as you have to make your case here for selection. Make sure you complete this in a concise, well organised and positive way. Do not repeat your career history; refer only to the relevant parts. 06 References Please give details of two referees including your current or most recent care employer. te references will be taken up prior to interview unless otherwise requested.

9 10 SECTION TEN EQUAL OPPORTUNITY MONITORING We will separate this section of the form from the application form and we would like to ensure you that this page will not form part of the selection procedure. We, in Sunhsine Care believe people are the most important part of our business and we believe in equal opportunities. The aim of our policy is to ensure that no job applicant or employee receives less favourable treatment on the grounds of sex, race, ethnic or national origin, political opinion, religious belief, sexual orientation, age or disability. All employees are given equal opportunity and are encouraged to progress within organisation. PERSONAL DETAILS Title Full name Position applied for ETHNIC ORIGIN White English Welsh / Scottish rthern Irish Irish Irish Traveller White EU Any other White background (please specify) MARITAL STATUS Married Divorced Single Separated Widowed Mixed background White & Black Carribean White & Black African White Asian Other background* GENDER *please specify Male Female SEXUAL ORIENTATION Asian, Asian British Indian Pakistani Heterosexual Lesbian or Gay Bangladeshi Persian Bisexual RELIGIOUS BELIEF Christian Jewish Muslim Buddhist Sikh Other FAMILY CIRCUMSTANCES religion Hindu Chinese Philipine Any other Asian background (please specify) Black, African, Caribbean, Black British Carribean African Any other Black background (please specify) Parent or carer with dependent children Carer for other dependents Single parent Any other Ethnic background Please specify t applicable

10 10 SECTION TEN EQUAL OPPORTUNITY MONITORING Equality Act 2010 The Equality Act 2010 came into force on 1 October In particular, the Act is protecting disabled people, people with long term health conditions and various forms hidden disabilities. The Equality Act 2010 defines as disabled Person with physical or mental impairment Person with substantial or long-term impairment, which effect their day-to-day activities Please tell us about your disability so we can make any reasonable adjustments for you. We would like to make sure that our selection process such as interview is equitable and fair for everyone. Do you consider yourself to have disability under the Equality Act 2010? Do you have any other disabilities? Co-ordination, mobility impairments or back problems Learning, speakig or communication difficulties Hearing or visual difficulties Any form of Mental health conditions Any other physical or medical conditions If you consider yourself to have disability, please let us know what adjustments would you like us to make.