Live-in Carer Application Form

Looking for satisfying work and being able to work with a diverse range of clients? Apply today.

Carer Application Form



Personal details




Passport and work permit details





Data Barring Service (DBS)





General Information





Preferences regarding work

Please specify which types of work you would prefer. You should tick all appropriate boxes.


References

Please give the names, occupation and contact addresses / details of 3 people we can contact for references. One of which must be your current or most recent employer. If you have not been employed please provide the name of a professional person who can comment on your suitability for this position.

Reference 1


yesno

Reference 2


yesno

Reference 3


yesno

Professional Experience

Personal Hygiene

Bath / shower / strip washCare of hairCare of feetDressing / undressing
Bed bathCare of eyesCare of fingernailsMouth careUse of bath aids

Toileting

Applying a conveenAttaching a night bagBedpans / commodesChanging a catheter bag
Continence careEmptying a catheter bagStoma careOther (please specify below)

Care Duties

Assisting with medicationPressure area carePhysical restraint skills
Simple dressing proceduresPalliative careOther (please specify below)

Nutrition

FeedingPreparing meals
Food handlingOther (please specify below)

Mobility

Moving and handling clientsUse of hoists
Use of walking aidsOther (please specify below)

Practical Tasks

BedmakingCollecting benefitsLight housework

Recording temperatureShoppingOther (please specify below)

Administrative Abilities

ConfidentiallityObserving/recording changesSign language
Report writingArranging appointmentsRecording instructions from GP




Training Received

Manual handling (adult)


YesNo


Infection control


YesNo


Fire safety


YesNo


First aid


YesNo


Essential food hygiene


YesNo


Observational skills


YesNo


Lone worker


YesNo


Management of aggressive or violent behaviour


YesNo


Abuse awareness (POVA)


YesNo


Abuse awareness (POCA)


YesNo


Safeguarding Training (Adult)


YesNo


Health & safety (incl COSHH and RIDDOR)


YesNo


Basic life support (Adult)


YesNo


Medication


YesNo


Other certification

Do you consent to the use and processing by Cheriton Homecare of personal data for the purpose of farthing your application for a position as a self employed care assistant with the company?

yesno

Do you agree to our privacy policy, so that we can contact you about your application?

yesno




Declaration

The information that I have given in this application form is, to the best of my knowledge, complete and accurate in all respects, and I am not aware of any reason why I am not fit for this work. I understand that knowingly giving false information will disqualify me from registration with the agency.