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.