Job Application Form Step 1 of 12 8% Wyville Home Care Application FormPlease ensure that you complete form in full as we can not accept CVs. This form will be kept in confidential. Please note that no application will be unfairly discriminated against. This includes discrimination on account of age, culture/religious/political beliefs, disability, ethnicity, gender, race, relationship status, sexual orientation and/or Trade Union membership or stewardship. If you have any special requirement to support, you to complete this form (e.g. the need for large print or additional time) please contact recruitment team on 0116 3090 999Position AppliedPositionHealth Care AssistantPreferred Employment TypePart TimeFull TimeLocation you are applying for?Leicester Personal InformationCandidate Name* PrefixDr.MissMr.Mrs.Ms.Prof.Rev. Prefix First Last Address* Street Address Post Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÃ…land Islands Country Email* Mobile No*Telephone No (Home)Date of Birth* DD slash MM slash YYYY Emergency Contact DetailsName* First Last Emergency Mobile No*Emergency Contact Relation* Work EligibilityAre you eligible to work in uk?* Yes No Nation Insurance Number* Please enter your National Insurance Number. if you don’t have the National Insurance Number and only you have the reference number, kindly provide that. Sorry we can’t proceed for the application. Driving License DetailsDo you have full UK Driving License?* Yes No Upload a Photo of Driving License Drop files here or Select files Accepted file types: jpg, png, pdf, Max. file size: 10 MB, Max. files: 2. If your Driving License is not in a proper readable format, then your application may rejected. Equality Act 2010Under the Equality Act 2010 the definition of disability is if you have a physical or mental impairment that has a "substantial" and "long term adverse effect" on your ability to carry out normal day-to-day activities. Further information regarding the definition of disability can be found at: https://www.gov.uk/definition-of-disability-under-equality-act-2010/ For the purpose of this application and the interview stage only, is there anything you would like us to be aware of so that we can make reasonable adjustments during the process?* Yes No Prefer not to be discuss Education DetailsWe would require your last two qualification details you obtain.Are you currently studying?* Yes No Date of Completion (Expected Date)*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Current Education School / College / University Current Education Qualification you Enrolled in Please give your previous education detailsDate of CompletionDay12345678910111213141516171819202122232425262728293031Month123456789101112Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Education School / College / University Education Qualification you achieved Date of CompletionDay12345678910111213141516171819202122232425262728293031Month123456789101112Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Education School / College / University Education Qualification you achieved Date of CompletionDay12345678910111213141516171819202122232425262728293031Month123456789101112Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Education School / College / University Education Qualification you achieved Training Course DetailsHave you attended any training courses? Yes No Please give details of your training courseWe would require your last two qualification details you obtain.Date of CompletionDay12345678910111213141516171819202122232425262728293031Month123456789101112Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Training Subject Training Location / Details Date of CompletionDay12345678910111213141516171819202122232425262728293031Month123456789101112Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Training Subject Training Location / Details Date of CompletionDay12345678910111213141516171819202122232425262728293031Month123456789101112Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Training Subject Training Location / Details Date of CompletionDay12345678910111213141516171819202122232425262728293031Month123456789101112Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Training Subject Training Location / Details Date of CompletionDay12345678910111213141516171819202122232425262728293031Month123456789101112Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Training Subject Training Location / Details Employment HistoryAre you currently employed? Yes No Do you have any previous employers? Yes No Current Employment DetailsName of Company Address of Current Employer Employer Email Address Employer PhoneJoining Date DD slash MM slash YYYY Nature of Business Position You Held Reason for LeavingPrevious Employer DetailsName of Company Address of Company Employer Email Address PhoneJoining Date DD slash MM slash YYYY Relieving Date DD slash MM slash YYYY Nature of Business Reason for Leaving Other EmploymentDo you have any other employer? Yes No Other Employer DetailsName of Company Address of Company Employer Email Address PhoneJoining Date DD slash MM slash YYYY Relieving Date DD slash MM slash YYYY Nature of Business Reason for Leaving Last 10 Years HistoryKindly write the history of your last 10 years. Education, Housewife, Health Issue, Look after family members, Unemployed, etc. (Please include month and year are mandatory. If you can include the date as well, it will be really great) – Not writing appropriate 10 year history, it might delayed your joining process time. Details of last 10 yearsFrom Date – To DateDescription Please click on the + button, to add more previous years’ details. Supporting StatementPlease add here your reason for applying. You should refer to the job description and person specification to guide you. It would also be of value to describe particular strength and talents that set you apart from others as well as including skills gained from work, home and other activities. : Description* RefereesIn accordance with CQC guidelines, we require two high-quality references before you can start work. If you have been previously employed, these should be professional references within which your former employer/ manager/ supervisor /director of human resources vouches for your suitability to this role. If you are unable to provide two professional references, however, (e.g., if you have not previously been employed) we require character references from individuals of professional background (Teachers, Doctors, Nurses, Solicitors, Accountants, Managers of Limited companies, etc.) Please note: it is a common courtesy to contact your referees before providing their contact details for reference. Failure to do so may result in refusal to provide a referenceFirst. ReferenceType of Reference* Current Employment Previous Employment Character Reference Reference Name Place of Work Job Title Telephone No Email Second ReferenceType of Reference Current Employment Previous Employment Character Reference Reference Name Place of Work Job Title Telephone No Email SafeguardingPlease note this section will only be seen by those involved in the recruitment process and will be treated with the strictest of confidence. Wyville Home Care Limited aims to promote equality of opportunities and is committed to treating all applications fairly regardless of ethnicity, disability, age. gender or gender re-assignment, religion or belief, sexual orientation, pregnancy or maternity and marriage or civil partnership. Wyville Home Care Limited undertakes not to discriminate unfairly against applicants on the basis of a criminal convocation or other information declared. Answering YES to the question below will not necessarily prevent your employment. This will depend on the relevance of the information you provide in respect of the nature of the position and the particular circumstances. Are you currently bound over or do you have currently UNSPENT convictions that have been issued by a Court or Court-Martial in the United Kingdom or in any other country? Yes No Do you have any current UNSPENT police cautions, reprimands or final warnings in the United Kingdom or in any other country?: Yes No Privacy PolicyThis information in this application form is true and complete. I agree that any deliberate omission, falsification or misrepresentation in the application form will be grounds for rejecting this application or subsequent dismissal if employed by Wyville Home Care Limited. When applicable, I consent that Wyville Home Care Limited can seek clarification regarding professional registration details. I agree to the privacy policy.Wyville Home Care Limited will only collect data for specified, explicit and legitimate use in relation to the recruitment process. By signing this application form, you consent Wyville Home Care Limited holding the information contained within this application form. If successfully shortlisted, data will also include shortlisting scoring and interview records. We would like to keep this data until the vacancy is filled. (We cannot estimate the exact time period, but we will consider this period over when a candidate accepts our job offer for the position for which we are considering you). When that period is over, we will either delete your data or inform you that we would like to keep it in our database for future roles. We have privacy policies that you can request for further information. Please be assured that your data will be securely stored by the registered manager and only used for the purpose of recruiting for this vacant post. You have right for your data to be forgotten, to rectify or access data to restrict processing to withdraw consent and to be kept informed about the processing of your data. If you would like to discus further or withdraw your consent at any time, please contact Registered Manager or Data Protection Officer on 0116 3090 999. Work AvailabilityHow many hours you would like to do per weeks? Are you available to work full day? Yes No Monday Availability – Late 15:30 – 22:00Monday Availability – Morning 6:30 to 15:30Tuesday Availability – Morning 6:30 to 15:30Tuesday Availability – Late 15:30 – 22:00Wednesday Availability – Morning 6:30 to 15:30Wednesday Availability – Late 15:30 – 22:00Thursday Availability – Morning 6:30 to 15:30Thursday Availability – Late 15:30 – 22:00Friday Availability – Morning 6:30 to 15:30Friday Availability – Late 15:30 – 22:00Saturday Availability – Morning 6:30 to 15:30Saturday Availability – Late 15:30 – 22:00Sunday Availability – Morning 6:30 to 15:30Sunday Availability – Late 15:30 – 22:00If work availability is not described above, please specify below.Agreement for Work Availability I agree with my work availability and I agree that if I need change my work availability then I need to come to office and fill up work availability change request form. It’s up to management to approved or declined.You can not change your work availability during your probation period (6 months) and then after you allow to change every 6 months. (You must give 6 weeks notice) Applicant Signature*Other Files Upload Drop files here or Select files Max. file size: 10 MB. PhoneThis field is for validation purposes and should be left unchanged.
