Local Care Force is committed to a policy of equal opportunities for all employees, workers and work seekers and shall adhere to such a policy at all times and will keep under review on an on-going basis all aspects of recruitment to avoid unlawful discrimination. We will treat everyone equally irrespective of sex, sexual orientation, gender reassignment, marital or civil partnership status, age, disability, colour, race, nationality, ethnic or national origin, religion or belief, political beliefs or membership or non-membership of a Trade Union and we place an obligation upon all staff to respect and act in accordance with the policy. Local Care Force shall not discriminate unlawfully when deciding which candidate/temporary worker is submitted for a vacancy or assignment, or in any terms of engagement for temporary workers. Local Care Force will ensure that each candidate is assessed only in accordance with the candidate’s merits, qualifications and ability to perform the relevant duties required by the particular vacancy.

Please specify the branch you are closest to.

Please specify the department(s) you are applying to.

About You

Next of Kin

Most recent first (including any gaps, e.g. study, unemployment or any time not working). Enter all the required information and then click the blue 'Add' button below.

Please ensure you provide your employment history from secondary school.

Please start with your most recent education. Enter all the required information and then click the blue 'Add' button below.

Names given should cover your last 3 years of employment; Nurses need to cover 5 years of employment. At least one reference must be from your most recent / current employer. All references will request a range of information we deem necessary to assess your suitability for work and will be requested immediately after interview unless otherwise stated.

• False references may result in refusal of your application • We are unable to accept references from family members or friends and all references must be from a place of work or education. • In providing this information, you are giving us permission to contact your referees.

**Note if you don't have these details please type 'n/a'. Please press the blue 'Add' button after entering all your reference details.

Please select which of the following training you have and provide the date you acquired the training.

Care Certificate - 3 Day Induction Course

Manual Handling

People Handling

Buccal Midazolam (Epilepsy meds)

Basic First Aid / Basic Life Support

Health and Safety (Including Fire Safety)

Restraint Training / MAV / Physical Interventions

Safeguarding Adults

Equality, Diversity & Inclusion

Diploma/NVQ Please specify level 2/3/4/5

Epilepsy

Autism Awareness

EpiPen

Infection Control

Medication (specify type)

Food Hygiene

Breakaway

Other Training

Other Training

Other Training

We, Local Care Force, will process your personal data in accordance with our obligations under the Data Protection Act 2018. Please refer to our Data policy for further information. This is available at: Data Policy or you can request a hard copy from reception while you complete this application.

On application, you will be requested to complete a DBS Disclosure (formally known as a CRB check). Should any applicant have a criminal record this may not obstruct your registration, although certain types of employment and professions are exempt from the Rehabilitation of Offenders Act 1974. You will be asked to pay for this DBS check in advance. Please advise us immediately if you do not wish to pay for this and do not wish to proceed with your application.

Please answer the following questions. Tick Yes or No where applicable.

Do you give consent for the contents of your DBS Disclosure to be shared with potential clients on the behalf of Local Care Force?

Do you give consent for a third party to view your file for compliance or inspection purposes? (e.g. CQC inspection, Home Office or 3rd party client of Local Care Force)

Do you agree to submit fees of £50.00, in advance, for the DBS Disclosure?

Do you have immigration permission to work in the UK?

*In line with Home Office guidance on the prevention of illegal working we will need to verify and take a copy of your original ID documentation as evidence of your right to work in the UK if you are to be engaged by Local Care Force for temporary work. Documents submitted for identification purposes may be forwarded to the Home Office for verification. By completing and returning this application to Local Care Force, you are confirming your agreement and acceptance of this.

Certain types of employment and professions are exempt from the Rehabilitation of Offenders Act 1974 and in those cases particularly where work is sought in relation to positions which involve working with children or vulnerable adults, details for all criminal convictions must be given. The information given by you on this form will be treated in the strictest of confidence and only taken into account where, in the reasonable opinion of Local Care Force, the offence is relevant to the post to which you are applying, or where we are obliged to do so by law. Failure to declare a conviction may require us to exclude you from our register or terminate an assignment if the offence is not declared but later comes to light. Filtering rules: As of 29 May 2013 you are no longer required to disclose information about any ‘filtered’ offences. You are not required to disclose on any part of this form any convictions or cautions that have been filtered. Guidance and criteria on the filtering of these cautions and convictions can be found on the Disclosure and Barring Service website. Note that: convictions and cautions that relate to certain offences under the Safeguarding of Vulnerable Groups Act 2006 and certain other offences will never be removed from a person’s criminal records certificate.

Have you ever been convicted or cautioned of a criminal offence?

If YES please detail the offence dates, the conviction/caution, the offence types and sentences below

Have you ever had disciplinary action / dismissal taken against you by an employer?

If yes please summarise below and we can discuss at registration

I hereby confirm that the information I have given is true and correct. I agree to inform Local Care Force of any changes to the information given and understand that if false statements are made, it may result in termination of my assignment and my registration with the agency terminated.

I authorise Local Care Force to contact my referees, as set out in my application form, in order to obtain work references from my previous employment and/or education.