HCA CARE DYNAMICS LTD APPLICATION FORM

CARE DYNAMICS LTD APPLICATION FORM - 2021

PLEASE SELECT JOB ROLE YOU ARE APPLYING FOR *
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TYPE OF CONTRACT YOU WANT
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NAME OF APPLICANT
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Required FIRST NAME Required SURNAME
PRIVACY SUMMARY

Your personal information will be held by Care Dynamics Ltd.

Our commitment below explains our key obligations to you in respect of our collection and use of your personal information. We refer you to our full privacy notice at www.care-dynamics.com for more detailed information on how we use your personal information, your rights, and your right to opt out of future marketing communications.

OUR COMMITMENT

We will:
- Only ask for and keep personal information about you which we feel is necessary to deliver the best recruitment service we can; which is in your interests, and the business interests of potential future employers.
- Only use your personal information in connection with the provision of our recruitment services both now and in the fututre (including administering contract assignments that you agree to).
- Only share your personal information with prospective employers and those persons we have confirmed to you in our privacy notice. We will never sell your information to any person.
- We may store and process your personal information outside of Europe where it is necessary for us to do so or where our IT systems are cloud-based services provided by third party service providers. We will only process your personal information outside of Europe where we have adequate safeguards in place with our clients and third-party service providers or we have obtained your explicit consent to handle your information in this way.
- Only retain your personal information for as long as we consider it necessary in order that we can continue to provide the best recruitment service to you now and in the future or for as long as required to comply with our legal obligations.
- Ensure that your personal information is held securely.
- Not make any decision about your application for a vacancy based solely on automated decision-making. Your application will be considered, and any decision taken, by our recruitment consultants.
- Comply with all applicable laws in the provision of our recruitment services to you and our processing of your personal information.
- Only contact you about relevant temporary, contract and permanent vacancies we have now and in the future by post, phone, e-mail or by other means of electronic communication.
- Only send your marketing communications by post, e-mail or by means of electronic mail which relate to our recruitment services or other similar services which we believe will be of interest to you.
HAVE YOU EVER WORKED IN THE CARE SECTOR? *
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If you tick "NO", please click NEXT and continue to PART 3
PLEASE LIST ANY OTHER AGENCIES/COMPANIES YOU ARE WORKING FOR
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DATE OF APPLICATION
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dd-MM-yyyy
YOUR E-MAIL ADDRESS *
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PART 1 - PERSONAL INFORMATION
MAIDEN NAME IF MARRIED
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ADDRESS
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Required STREET NAME AND NUMBER / FLAT NAME AND NUMBER Required STREET NAME AND NUMBER Required TOWN / CITY Required COUNTY Required POSTCODE

Required
COUNTRY
MOBILE NUMBER *
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HOME PHONE NUMBER
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DATE OF BIRTH
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dd-MM-yyyy
NATIONALITY *
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DO YOU HAVE A DRIVING LICENCE? *
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DO YOU HAVE A CAR?
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PART 3 - WORK EXPERIENCE

PLEASE PROVIDE DETAILS OF YOUR COMPLETE EMPLOYMENT HISTORY SINCE LEAVING FULL TIME EDUCATION. PLEASE INCLUDE REASONS FOR ANY GAPS (UNEMPLOYMENT, RAISING CHILDREN, etc.)
PLEASE UPLOAD YOUR COMPLETE DETAILED CV
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Upload file Capture image using webcam

PART 4 - EDUCATION
NAME OF LAST SCHOOL ATTENDED
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QUALIFICATION LEVEL OBTAINED
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DATE FINISHED
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dd-MM-yyyy
PLEASE PROVIDE DETAILS OF YOUR FURTHER EDUCATION & TRAINING
NAME OF ESTABLISHMENT
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QUALIFICATION OBTAINED
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DATE FINISHED
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dd-MM-yyyy

PART 6 - NIGHT SHIFT WORKERS ONLY
Would you like to work night shifts?
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PART 7 - DBS AND REHABILITATION OF OFFENDERS ACT 1974
DO YOU HAVE A TRANSFERABLE DBS? *
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IF "YES", WHAT IS YOUR DBS CERTIFICATE NUMBER?
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The amendments to the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (2013 and 2020) provide that when applying for certain jobs and activities, certain convictions and cautions are considered ‘protected’. This means that they do not need to be disclosed to employers, and if they are disclosed, employers cannot take them into account. Guidance about whether a conviction or caution should be disclosed can be found on the Ministry of Justice website. 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 Rehabilitation of Offenders Act 1974, by virtue of the Exceptions Order 1975 as amended by the Exceptions (Amendment) Order 1986, which means that convictions that are spent under the terms of the Rehabilitation of Offenders Act 1974 must be disclosed, and will be taken into account in deciding whether to make an appointment. Any information will be completely confidential and will be considered only in relation to this application. In addition you are required to submit to a Disclosure and Barring check. Any disclosure made by the Disclosure and Barring Service will remain strictly confidential.
Have you ever been convicted in a Court of Law and/or cautioned in respect of any offence? *
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If YES, please give details.
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HAVE YOU EVER BEEN CAUTIONED OR ISSUED WITH A FORMAL WARNING FOR ANY CRIMINAL OFFENCE? *
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If YES, please give details.
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(If have answered “Yes” )

The DBS, Disclosure and Barring Service, is the executive agency of the Home Office responsible for conducting checks on criminal records. It is a condition of proceeding with your application that you apply for a DBS check with Care Dynamics Ltd. The Disclosure will be compared with the information given above in Part 8 and any inconsistencies could invalidate your application or lead to the cancellation of your registration with us.
HAVE YOU EVER BEEN OR ARE YOU CURRENTLY BEING INVESTIGATED UNDER ADULT/SAFEGUARDING PROCEDURES? *
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If YES, please give details.
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PART 8 - PASSPORT & WORK PERMITS

IF YOU ARE A CITIZEN OF THE UK OR EUROPEAN UNION, MOVE TO PART 11
DO YOU NEED A VISA TO WORK IN THE UK? *
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DO YOU HOLD A STUDENT VISA?
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ARE YOU IN THE UK ON ANY TYPE OF VISA?
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PASSPORT NATIONALITY *
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PART 9 - WORKING TIME DIRECTIVES
There are guidelines for all workers governing the length of the maximum working week that it is safe to work. The current limit is 48 hours per week. You will never be compelled to work more than 48 hours per week, but you may choose to do so.

Please would you indicate below to confirm that you have read and understood this information by ticking the most appropriate box.
I WISH TO WORK MORE THAN 48 HOURS PER WEEK
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PART 10 - DATA PROTECTION AND INSPECTIONS
We are required to hold personal information on staff e.g. National Insurance number, address, qualifications, training, etc., as requested in this application form. From time to time we may be required to release elements of this information in placing you in assignments; please be assured we will only release information that is necessary. Regulatory bodies such as Social Services, Home Office, Immigration, Care Quality Commission and the NHS have the right to access personal files for inspection purposes in order to verify compliance with legislation and CQC Regulations.
I CONSENT TO THE DISCLOSURE OF INFORMATION ABOUT ME REQUIRED TO PLACE ME ON ASSIGNMENTS
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PART 11 - DISCLOSURE & BARRING SERVICE
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I CONSENT TO AN ELECTRONIC/PAPER COPY OF MY DBS CERTIFICATE BEING HELD BY CARE DYNAMICS LTD * I CONSENT TO AN ELECTRONIC/PAPER COPY OF MY DBS CERTIFICATE BEING HELD BY CARE DYNAMICS LTD Required
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I GIVE MY CONSENT FOR MY INFORMATION TO BE USED TO SUBMIT A DISCLOSURE APPLICATION. I UNDERSTAND THAT UCHECK WILL SHARE THIS WITH THE DBS SERVICE * I GIVE MY CONSENT FOR MY INFORMATION TO BE USED TO SUBMIT A DISCLOSURE APPLICATION. I UNDERSTAND THAT UCHECK WILL SHARE THIS WITH THE DBS SERVICE Required
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I UNDERSTAND HOW THE DBS SERVICE WILL PROCESS MY PERSONAL DATA AND THE OPTIONS AVAILABLE TO ME FOR SUBMITTING AND APPLICATION * I UNDERSTAND HOW THE DBS SERVICE WILL PROCESS MY PERSONAL DATA AND THE OPTIONS AVAILABLE TO ME FOR SUBMITTING AND APPLICATION Required
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I CONSENT TO THE DBS PROVIDING AN ELECTRONIC RESULT TO THE REGISTERED BODY THAT SUBMITTED MY APPLICATION. I UNDERSTAND THAT AN ELECTRONIC RESULT CONTAINS A MESSAGE THAT INDICATES EITHER THE CERTIFICATE IS BLANK OR TO AWAIT CERTIFICATE * I CONSENT TO THE DBS PROVIDING AN ELECTRONIC RESULT TO THE REGISTERED BODY THAT SUBMITTED MY APPLICATION. I UNDERSTAND THAT AN ELECTRONIC RESULT CONTAINS A MESSAGE THAT INDICATES EITHER THE CERTIFICATE IS BLANK OR TO AWAIT CERTIFICATE Required
Ucheck is the "Data Controller" with regard to data processed using this service and as such is responsible for any personal data entered using this service. DBS Applications are processed on behalf of it's clients by Ucheck, in accordance with the data protection legislation and the DBS Code of Practice.

PART 12 - DECLARATION
CONFIDENTIALITY AGREEMENT

You undertake to treat as secret and confidential and not at any time for any reason to disclose, directly or indirectly, to any person (or otherwise make use of, or permit to be made use of, for any purpose whatsoever:
a) any unpublished information relating to Care Dynamics Limited bids or contracts, or to any of Care Dynamics’ activities or business or affairs; or
b) any technology, software code, brands, images, products or designs of Care Dynamics; or
c) any similar information relating to or property of, any subsidiary, supplier, customer or client of Care Dynamics.

You agree not to make copies, captured images, abstract, summary or précis of the whole or any part of any document, computer program, or other material belonging to Care Dynamics except when required to do so in the course of the performance of your duties as an employee of Care Dynamics, in which event you acknowledge an agree that any such item, and any intellectual property rights subsisting in such item, shall belong absolutely to Care Dynamics Limited.

You acknowledge and agree that Care Dynamics shall be entitled to obtain injunctive relief against a threatened or actual breach of the clauses in this Variation (or the continuation of any such breach) without the necessity of proving actual damages. In addition, Care Dynamics Limited shall be entitled to any other remedies that may be available in law, in equity or otherwise.

Upon the expiry or termination of your contract of employment for whatever reason, or at any other time when requested to do so by Care Dynamics Limited, you agree to deliver up to Care Dynamics Limited all documents, working papers, computer disks, tapes and any other materials (and all copies thereof) in your possession which have been provided to you in connection with, or prepared by you during the course of work for Care Dynamics Limited.
SPECIAL REQUIREMENTS (CARE SECTOR)

Because this position involves the care of children and/or vulnerable adults employment is dependent on
the following:
1.        Provision of a Disclosure and Barring certificate from the Disclosure and Barring Service.
2.        Such disclosure being acceptable to us.
3.        Proof of identity – birth or marriage certificate (where appropriate) and passport (if available).
4.        Two satisfactory written references including one from your most recent employer (this is a Legal Requirement).
5.        That you will supply a recent photograph of yourself for retention in your records (this is a Legal Requirement).
6.        Evidence of physical or mental suitability for your work.
7.        Documentary evidence of any qualifications relevant for the position (this is a Legal Requirement).
PART 13 - EMPLOYMENT HISTORY
LAST/CURRENT EMPLOYER - NAME OF EMPLOYER
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ADDRESS
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DATES OF EMPLOYMENT
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JOB TITLE
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DUTIES
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REASON FOR LEAVING
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Please explain any gaps in employment if this employment did not immediately follow your previous employment.
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PREVIOUS EMPLOYER # 2 - NAME OF EMPLOYER
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ADDRESS
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DATES OF EMPLOYMENT
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JOB TITLE
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DUTIES
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REASON FOR LEAVING
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Please explain any gaps in employment if this employment did not immediately follow your previous employment.
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PREVIOUS EMPLOYER # 3 - NAME OF EMPLOYER
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ADDRESS
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DATES OF EMPLOYMENT
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JOB TITLE
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DUTIES
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REASON FOR LEAVING
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Please explain any gaps in employment if this employment did not immediately follow your previous employment.
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PART 14 - REFERENCES (please note here two persons from whom we may obtain both character and work references)(please note here two persons from whom we may obtain both character and work references)
REFERENCE 1 - NAME OF EMPLOYER
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REFERENCE #1
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Title First Name Last Name
Address
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Street Address Address Line 2 City County Postal / Zip Code
Email
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Phone
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REFERENCE 2 - NAME OF EMPLOYER
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REFERENCE #2
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Title First Name Last Name
Address
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Street Address Address Line 2 City County Postal / Zip Code
Email
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Phone
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THE INFORMATION THAT I HAVE GIVEN IN THIS REGISTRATION FORM IS, TO THE BEST OF MY KNOWLEDGE, COMPLETE AND ACCURATE IN ALL RESPECTS. I UNDERSTAND THAT KNOWINGLY GIVING FALSE INFORMATION WILL DISQUALIFY ME FROM REGISTRATION WITH CARE DYNAMICS LTD. I ALSO AGREE TO KEEP CARE DYNAMICS LTD ADVISED OF ANY CHANGES TO ANY OF THE INFORMATION SUPPLIED.

THIS APPLICATION FORM HAS BEEN COMPLETED AS PART OF THE ‘FACE TO FACE’ INTERVIEW PROCESS WITH AUTHORISED STAFF FROM CARE DYNAMICS LTD.

To be signed AGAIN at your Face-to-Face Interview only.

I CONFIRM THE ABOVE STATEMENTS
SIGNATURE *
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E-Signature Field
Clear
DATE SIGNED *
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dd-MM-yyyy
NEXT OF KIN
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First Name Last Name
ADDRESS OF NEXT OF KIN
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Street Address Address Line 2 City State/Region/Province Postal / Zip Code

Country
PHONE OF NEXT OF KIN
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EMAIL OF NEXT OF KIN
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	NONE	INTERMEDIATE	ADVANCED
CARE HOME *
DOM CARE *
EXPERIENCE OF WORKING WITH PEOPLE WITH LEARNING DISABILITIES *
EXPERIENCE OF WORKING WITH PEOPLE WITH MENTAL HEALTH NEEDS *

CARE DYNAMICS LTD APPLICATION FORM - 2021

PART 1 - PERSONAL INFORMATION

PART 2 - EXPERIENCE

PART 3 - WORK EXPERIENCE

PART 4 - EDUCATION

PLEASE PROVIDE DETAILS OF YOUR FURTHER EDUCATION & TRAINING

PART 5 - DECLARATION OF HEALTH

PART 6 - NIGHT SHIFT WORKERS ONLY

PART 7 - DBS AND REHABILITATION OF OFFENDERS ACT 1974

PART 8 - PASSPORT & WORK PERMITS

PART 9 - WORKING TIME DIRECTIVES

PART 10 - DATA PROTECTION AND INSPECTIONS

PART 11 - DISCLOSURE & BARRING SERVICE

PART 12 - DECLARATION

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