Priory Homecare Limited. Careers in Social Care Work in the Wyre & Fylde boroughs with an Investors In People company dedicated to staff development.

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Application for Employment - Confidential

To apply for a job with us, please complete the form below and click send. Alternatively, you may with to e-mail us your CV and covering letter.

General Information

Position applied for

How did you hear of this vacancy?

Personal Details

Title

Fornames

Surname

Address

Postcode

Telephone

Date of Birth

If successful, will this be your only job?

P45 Available?

Car owner/driver?

Date driving test passed

Clean Licence?

If no, please give details

Education

School/College

From To

Qualifications Gained

School/College

From To

Qualifications Gained

School/College

From To

Qualifications Gained

School/College

From To

Qualifications Gained

Employment HistoryPlease state last 5 years - please explain any gaps.

Dates

Employer's Name & Address

Position/Duties

Salary

Reason for leaving

Dates

Employer's Name & Address

Position/Duties

Salary

Reason for leaving

Dates

Employer's Name & Address

Position/Duties

Salary

Reason for leaving

Dates

Employer's Name & Address

Position/Duties

Salary

Reason for leaving

Have you ever been disciplined or dismissed?

If yes, please give details

Relevant ExperienceHave you had training and/or experience in any of the following?

Dressing ClientsYes No When Where

Denture/mouth careYes No When Where

Care of fingernailsYes No When Where

Care of eyesYes No When Where

Hair careYes No When Where

ShavingYes No When Where

HouseworkYes No When Where

CookingYes No When Where

FeedingYes No When Where

LaundryYes No When Where

Bed making with client inYes No When Where

Use of bed pans/commodesYes No When Where

Bathing clientsYes No When Where

Use of bath aidsYes No When Where

Catheter careYes No When Where

Colostomy careYes No When Where

ConveensYes No When Where

Incontinence careYes No When Where

Use of hoistsYes No When Where

Walking aidsYes No When Where

Pressure area careYes No When Where

Food Hygiene CourseYes No When Where

Health & Safety CourseYes No When Where

Hobbies

Please state any hobbies and interests you have

Availability for work Priory Homecare offers a 24 hour service, seven days a week. Due to the nature of the work, the hours and times of work will vary from week to week. Please state your availability for work.

MondayStart Finish

TuesdayStart Finish

WednesdayStart Finish

ThursdayStart Finish

FridayStart Finish

SaturdayStart Finish

SundayStart Finish

References Please give the names and addresses of two referees. Both should be employers and not related in any way. Please state in what capacity you know the referee, they should be able to comment on your skills and aptitude for this position and preferably relevant to your employment history.

Reference 1.

Name

Telephone

Address

In what capacity known?

Reference 2.

Name

Telephone

Address

In what capacity known?

Health Declaration

The work may involve tasks which are demanding both physically and emotionally. Do you have any condition which may affect your ability to carry out such tasks?Yes No

Do you, or have you suffered from any physical or mental illness?Yes No

Do you consider yourself to be disabled?Yes No

How many days have you been absent from work due to illness in the last 2 years?

State reasons for absence

GP name and address

May we contact your GP for health check?Yes No

Send Details Thank you for taking the time to complete this form. Please click the 'Send' button below to submit your details to us.