Welcome to our online job application page. You will find a full job specification with each job, we would recommend reading these carefully before starting the online application process. For a full list of our current vacancies including job specifications please click here. If you are unsure of any of the information within this application form please contact us. Please complete and submit. Job Application Title Miss Mrs Mr Ms Forenames * Surname * Address * Postcode * Phone * Email * Position applied for Activity Therapist Catering Assistant Care Assistant Days Care Assistant Nights Home Care Worker Kitchen Assistant Kitchen Cook Staff Nurse Day Staff Nurse Night Which home are you applying for * Antrim Care Home Ballyclare Nursing Home Clareview Clonlee Drummaul Glenkeen Massereene Care at Home How did you find out about the role? * Facebook Job Centre Staff Referral - Pls provide name in relevant box Other If referral, please provide name of staff member Do you hold a full driving licence * Yes No Expiry date on licence Licence number Are there any restrictions on you taking employment in the U.K.?: * No Yes Please detail any other employment you would continue if you were successful in obtaining this position? Previous position 1 * Please list most recent employment first Previous employer 1 * Start date * End date * Previous position 2 Previous employer 2 Start date End date Evidence to Support Criteria in Personal Specification - please refer to the person specification in the job description and explain how you meet each criteria in full – failure to do this will result in your application not going any further. * Education, Relevant Qualifications & Dates * Reference 1 * Please note here the names and addresses of references from whom the company may obtain work experience references. One of these references must be from your most recent employer. Reference 2 * Please note here the names and addresses of references from whom the company may obtain work experience references. One of these references must be from your most recent employer. Criminal Record Hutchinson Care Homes Ltd at all times comply with the Access NI code of practice. A copy of which can be found on our website www.hutchinsoncarehomes.com. In compliance with Access NI code of practice Hutchinson Care Homes need to make you aware of our policy on the recruitment of exoffenders, a copy of which can be made available on request. 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 spent under the terms of the rehabilitation of offenders Act 1974 must be disclosed and will not necessarily be a bar to obtaining a position. Any information will be completely confidential and will be considered only in relation to this application. Is there any reason why you cannot be placed in a position working within Regulated Activity? * No Yes If YES, please give details Have you ever been convicted in a Court of Law and/or cautioned in respect of any offence? * No Yes If YES, please give details Health Details Do you have a physical or mental impairment which has a substantial and long term effect on your ability to carry out day to day activities? * No Yes Please specify any special arrangements for work associated with any impairment Please specify any special arrangements you will need to attend an interview Please list any diseases, disorders, allergies, muscular or musculoskeletal injuries from which you have suffered or do suffer Please detail any form of medicine, drugs or treatment you are currently and/or regularly receiving Please list all absences from work in the past 12 months and the reasons for such absences Consent & Declaration Because this position involves the care of children and/or vulnerable adults employment is dependent on the following consent: By signing this declaration you give written consent for us to: Obtain an enhanced disclosure certificate with/without barred list check from Access NI. Such disclosure being acceptable to us. Request proof of identity – e.g. birth or marriage certificate (where appropriate) and passport (if available). Request and receive two satisfactory written references. Request a photograph of yourself for retention in your records. Request evidence of physical or mental suitability for your work. Declaration Please read this carefully before signing this application. I confirm that the above information is complete and correct and that any untrue or misleading information will give my employer the right to terminate any employment contract offered. I agree that the organisation reserves the right to require me to undergo a medical examination. (Should we require further information and wish to contact your doctor with a view to obtaining a medical report, the law requires us to inform you of our intention and obtain your permission prior to contacting your doctor). I agree that this information will be retained in my personnel file during employment and for up to six years thereafter and understand that information will be processed in accordance with the Data Protection Act. I agree that should I be successful in this application, I will be required to submit an Access NI enhanced disclosure application. I understand that should I fail to do so, or should the disclosure not be to the satisfaction of the company any offer of employment may be withdrawn or my employment terminated. Signed * Date * Equal Opportunities Monitoring Form Private & Confidential This is optional but is a sign that the employer takes this topic seriously (employers in Northern Ireland are obliged to measure this kind of information). Forms are separated from applications before the selection process starts and are for monitoring purposes only. If you have a strong objection, you can choose not to fill it in. This information will be treated in the strictest confidence and will be used only for statistical monitoring. It is not part of the selection process and will be separated from the application prior to shortlisting. We are committed to equal opportunities for all, irrespective of race, colour, creed, ethnic or national origins, gender, marital status, sexuality, disability or age. So that we can monitor the implementation of our policy we are seeking your help. It would be of great assistance in pursuing our commitment to equal opportunities if you would complete this monitoring form. Please indicate your Ethnic Origin Asian / Asian British Yes No Black / Black British Yes No Middle / Near Eastern Yes No Mixed Ethnic Group Yes No White Yes No Black Other Yes No Other Disability Do you consider yourself to have a disability Yes No if yes, which of the following descriptions best describes your disability? Visual (NOT corrected by wearing glasses or contact lenses) Yes No Co-ordination, dexterity or mobility Yes No Mental health Yes No Speech Yes No Learning difficulties Yes No Hearing Yes No If you have a combination of above or other physical or medical conditions ~ please specify Religion Please indicate below your religion, or the religion to which you would be perceived to belong. (This information is required to enable us to fulfil the requirements of the Fair Employment (Northern Ireland) Act 1989.) I am a member of the Protestant community Yes No I am a member of the Roman Catholic community Yes No I am a member of neither the Protestant nor the Roman Catholic community Yes No Submit If you are human, leave this field blank.
