APPLICATION PACK 

Please ensure all sections are filled in and all documents signed 

Job Description
Melton Care has an environmental policy, we aim to save paper where possible and reduce the destruction of trees. We will email you a copy of your job description, employment statement and other documents you have signed within this application pack. If you do not have email and prefer a hard copy please notify us and we will print one for you.
Job Title:  Home Care Assistant
Location: 
Responsible to:  Manager, Deputy Manager, Senior Care Assistant
Job purpose
To provide practical assistance of the highest quality to vulnerable people in their own homes by assisting them with tasks of daily living in a way that respects the dignity of the individual and encourages independence.
Responsibilities
	•	To assist with the planning and co-ordination of the delivery of services to service users ensuring that their personal, physical, emotional, social and spiritual needs are met.
	•	To ensure that the service provides opportunities for service users to exercise self-determination and choice and to participate in the life of a wider community.
	•	To ensure that the personal dignity of each service user is promoted and upheld and that their privacy is respected.

Main duties to include;
To assist service users who need help with getting up in the morning and going to bed in the evening, dressing, undressing, washing, bathing and visiting the toilet.
To help service users with mobility problems and other physical disabilities, including management of incontinence and help in the use and care of aids and personal equipment.
To help and support service users at end of life.
To help in the promotion of mental and physical activity of service users through talking to them, taking them out, sharing with them in activities such as reading, writing, hobbies and recreations.
To undertake a variety of general household duties including making and changing beds, assisting with preparing and cooking meals, to feed service users who need help, washing up and leaving all areas tidy and washing items of laundry.
To shop for food and other items, collect pensions and prescriptions and other local essential visits.
To prompt medication as prescribed and within the Health and Social Care Protocol (Revised December 2005) guidelines for social care staff.

Other duties;
	•	contribute to the development of and assist with the implementation of individually planned programmes of care and activities according to each service users needs.
	•	To maintain and update service users records and ensuring that the Manager is informed of any change in the health or circumstances of a service user.
	•	To develop and maintain relationships with the service users, families, friends and advocates.
	•	To attend/contribute to staff and service users meetings.
	•	To respond to emergencies or unusual situations.
	•	To deal with callers to the service users home (if requested).
	•	To comply with the agency's guidelines and policies at all times.
	•	To encourage service users to remain as independent as possible.
	•	To undertake any reasonable tasks relating to the provision of care and perform such other duties as may reasonably be required.
	•	To undertake direct tasks and participate in flexible working as required.

Special Instructions

To undertake the duties of the job in accordance with relevant legislative requirements, including Health & Safety.

To respect at all times the confidentiality of all matters that they may learn in the course of their employment and to respect the requirements under the Data Protection Act 1998.

To undertake training as required.

To maintain an awareness of current legislation issued orally or in writing e.g. by a manager, at staff meetings or through information bulletins, handouts, etc.

To follow universal precautions with particular regard to regular and effective hand washing to maintain good infection control.

I have read and fully understood the job role 

Sign __________________________________       Date _ _ / _ _ / _ _ 

EQUAL OPPORTUNITY MONITORING
PRIVATE & CONFIDENTIAL

Position applied for: ……………………………………………….…..
We are an equal opportunity employer. The aim of our policy is to ensure that no job applicant or employee receives less favourable treatment because of age, disability, gender reassignment, marriage and civil partnership, pregnancy or maternity, race, religion or belief, sex or sexual orientation.
Our selection criteria and procedures are frequently reviewed to ensure that individuals are selected, promoted and treated on the basis of their relevant merits and abilities and that no applicant or employee is disadvantaged by provisions, criteria or practices which cannot be shown to be justified.
To ensure that this policy is fully and fairly implemented and monitored, and for no other reason, would you please provide the following information:-
Date of Birth: …………………………………………
I would describe my ethnic group and sex as: - (please circle one box for your ethnic group and one box for your sex)
A) White      English    Scottish     Welsh       Irish
 Any other White background, please specify ………………………………. …

B) Mixed
 White and Black Caribbean     White and Black African
White and Asian
Any other Mixed background, please specify ……………………………………...…………...
C) Asian
 Asian British   Asian English    Asian Scottish    Asian Welsh
 Indian   Pakistani   Bangladeshi
Any other Asian background, please specify ……………………………………..…………..

D) Black
 Black British     Black English    Black Scottish    Black Welsh
Caribbean    African
Any other Black background, please specify ……………………………………..…………..

E) Chinese 
 Chinese British   Chinese English   Chinese Scottish    Chinese Welsh or other Ethnic Group 
Any other background, please specify ………………………………………..…..…………..

F) Sex
Male     Female

Name: ……………………………………
Signed: …………………………………..
Date: ……………………………………..

You must fill out each section and take care not to leave any questions unanswered. Please give FULL employment history and explain any gaps. MCS takes considerable steps to ensure we explore the employment history of each applicant. 
Title:  Forenames:                                                                           Surname:                     
Name you wish to be known by:         
Address:  
         
Post Code:  
Telephone Number:                                                                          Mobile Phone:  
Email:         
Date of Birth:         /       /                                        National Insurance Number:   

Please circle
Transport  
Do you hold a current driving licence:      Yes        No 
Do you have your own transport       Yes            No  
Do you have valid vehicle insurance to cover business purposes?                  Yes             No ( if no are you prepared to ensure you have this in place before you start    Yes      No 
Application Details  
Job title of position you are applying for:  
 Our service operates from 7:00a.m to 11:00p.m. Monday to Sunday and unless the job advert specifies otherwise, you would be expected to work during these times.   Please give details below of any times when you would not be available to work.       

Why do you want to work in Domiciliary Care?              

 
What skills/attributes can you bring to the role?     

      
 Employment History 
 Present / Last Employer Name and Address 

Postcode:  
Telephone Number:  
Job Title:          
Date Started:                                                                    Date Finished:  

Description of Responsibilities:    
           
Reason for Leaving:          
Previous Employers  
You MUST give details of all previous employment and explain any gaps between employers.  Please give dates when you started and finished. Continue on a separate sheet if necessary 

Employer name and address	Employed from	Employed till	

			

			

			

			

			

			

			
You MUST fill in this section and provide three referees If you are unable to provide a second/third reference from previous employers, we may accept references from a professional person known to you but not family and friends. 

Professional References  
Reference 1 (Present or most recent employer)  
Name of referee:                                                                          Position:   
Company Name:       
Mailing Address:  
         
Post Code:  
Telephone Number:                                                                          Fax:  
Email                                                                                                    Mobile Phone:   

Reference 2 (Previous employer)   
Name of referee:                                                                            Position:   
Company Name:       
Mailing Address:  
         
Post Code:  
Telephone Number:                                                                            Fax:  
Email                                                                                                      Mobile Phone:    

Reference 3 (Previous employer)  
Name of referee:                                                                             Position:   
Company Name:       
Mailing Address:          
Post Code:  
Telephone Number:                                                                            Fax:  
Email                                                                                                      Mobile Phone:   
Training and Development  
Do you have training in these mandatory training requirements? Please tick what you have and give dates
Moving and Handling   
Health and Safety   
RIDDOR (Reporting of Injuries Deaths and Dangerous Occurrences Regulations 1992)   
COSHH (Control of Substances Hazardous to Health)  
 Infection Control   

Medical History  
Information contained within this document is governed by the Data Protection Act 1998
Do you now, or have you ever, suffered from or received treatment for the following? 
1.   Respiratory symptoms, disorders, or diseases? ( including asthma, tuberculosis, bronchitis, allergies)              No / Yes
 2.   Skin symptoms, disorders or diseases? ( including eczema, dermatitis, allergies) No / Yes
 3.   Psychological/psychiatric symptoms, disorders or diseases? (including anxiety, depression, stress, alcohol / drugs / substance misuse or dependence anxiety, episodes of disorientation, agitation, episodes of self-harm, violence, aggression)   No / Yes
 4.   Back or neck symptoms, disorders or diseases?  No / Yes
 5.   Impairment or disability of the upper or lower limbs?   No / Yes 
6.   Uncorrected vision problems? (including recurring eye infections, tunnel vision) No / Yes 
7.   Hearing problems? (including recurring ear infections, hearing deficits) No / Yes 
8.   Neurological symptoms, disorders or diseases? (including epilepsy, dizzy spells, blackouts)
  No / Yes
 9.   Cardiovascular symptoms, disorders, or diseases? (including high blood pressure, angina, blood disorders or diseases) No / Yes 
10. Gastrointestinal symptoms, disorders, or diseases? (including diarrhoea, vomiting, Crohns, Irritable Bowel Syndrome, Diverticulitis, food borne diseases) No / Yes 
11. Endocrine disorders or diseases? (including diabetes)   No / Yes 
12. Immuno-deficiency symptoms, disorders or diseases?  No / Yes 
13. Communication (speech) problems?  No / Yes 
14. Any other health problems not mentioned above? No / Yes 
15. Have you ever had any health problems related to your work? No / Yes 
24. How many days sickness absence have you had during the last 2 years?       (please give details below)  Please give additional details here – continue on a separate sheet if required.          
DECLARATION  
I confirm that I have read this document fully and that all the information given to Melton care services is correct to the best of my knowledge and belief.  I am aware of the need to protect service users and myself and agree to notify you should my circumstances alter.  I am aware that where I have provided false information as part of this assessment process Melton care services has the right to dismiss me.
Print Name:                                                                                                   Date:                    
  
Rehabilitation Of Offenders Act  
Because of the nature of the work for which you are applying, this work is exempt from the provisions of section 4.2 of the Rehabilitation of Offenders Act 1974 (Exemption Order 1975). Applicants are therefore, not entitled to withhold information about convictions which for other purposes are ‘spent’ under the provisions of the Act and in the event of employment, any failure to disclose such convictions could result in dismissal or disciplinary action. Any information given will be completely confidential and will be considered only in relation to the application for positions in which the Order applies, and should be entered at the end of any particulars you give in support of your application. A copy of our recruitment and selection policy is available upon request. A criminal record will not necessarily be a bar to obtaining a position.  
Have you ever been convicted of a criminal offence?   Yes      No  
Have you ever been involved in court proceedings?   Yes      No     
You must complete the new DBS Disclosure form, even if you have one already with your current employer     
Marketing Information  
How did you hear about Melton Care Services?   
  Job Centre/Job Centre Plus           Newspaper Advert               Facebook               Social Media 
Melton care services Employee (please give name)                 Radio                     Leaflet Drop 
 Other (please state)  

I confirm that the information I have provided in support of this application is complete and true and understand that knowingly to make a false statement could be a criminal offence.  
I consent to Melton care services checking the details I have provided in support of this application form against the various data sources in order to verify my identity and process this Registration. These details may be recorded and used to assist other organisations for identity verification purposes such as the DBS.  
Melton care services reserves the right to hold this registration form and any other data required to process your registration (whether in the UK, European Union or elsewhere) and keep for as long as necessary in line with the Data Protection Act.  
I consent to my personal information being shared as described above and I further consent to my personal file being made available to the Care Quality Commission, Skills for Care (the workforce development organisation for social care) and Local Authority Social Services. 
I acknowledge the terms and conditions laid down by Keystone Healthcare and agree to abide by them.   
Print Name:                                                                      Signed:    
Date:      /      /   

Next of Kin Details  
Name:                                                                                                     Relationship:  
Telephone Number:                                                                              Mobile Number:  
Mailing Address:    
Country:                                                                                                  Post Code:    
Bank Details  
Name of Bank/Building Society:  
Address:  
Account Holder:  
Account Number:  
Sort Code:    

Please note that all information will be kept strictly confidential

Time sheet recording          
I acknowledge that I am responsible for self-managing my time sheet, I do this by creating a log in and log out at each service users house. 
I acknowledge that on Mondays I will submit a time variance sheet for any genuine reason I was unable to log in / out
Failure to do either of the above will result in a non payment and will have to be investigated by the office to ensure the visit was carried out and will result in the payment being made a month late 
This is a costly and time consuming exercise and if it is a regular occurrence i.e.: - more than 3 times I will have 10% of the call deducted to pay towards costs I have incurred. 
Signed ____________________________________________                            
Training and uniforms 
Melton Care is continuously providing training/ uniforms and this can be costly and time consuming 
Whilst we endeavour to give you as much training as you need to be competent in your role we do have to cover our costs should you decide to leave our employment within 12 months.
We do not charge for training we have provided ‘in house’ and where you have been to training to an outside provider we will only recover what the actual cost was and will provide you with the certificates (and receipts if required) so that you may have proof of your training. 
You sign this to say that if you have been on training that has cost Melton Care Services and you leave within 12 months that this will be taken out your final wage (not including Induction Training)
You sign this to say if you leave and you do not bring back your uniforms or they are not reusable at the end of your employment that the cost of the uniforms will be taken out your final wage.

Signed _____________________________________________

Staff mileage guidelines

You must produce current insurance certificate with ‘business’ cover added.
A copy of this plus driving license and current MOT must be kept on our files and up to date copies must be brought to the office when requested.
Staff cannot claim to their first call or home from their last as this is classed as going to and from work.
Staff must complete a mileage form stating clients name and postcodes to and from the destinations claimed for.
A break of 3 hours in between calls is classed as being at home and restarting the day’s work, therefore first and last call cannot be claimed.
You sign to say you have read and fully understand these rules otherwise we cannot pay mileage or offer work that we would knowingly require you to drive to.

Signed ________________