Healthcare Assistant – Nights

We are delighted you want to be part of our team!

Please fill in the application form below to apply now:

1. Personal Details

   • Name (Required)
   • Maiden Name (if applicable)
   • Home Phone Number
   • Mobile Number (Required)
   • Email (Required)
   • Address (Required)
   • Right to Work (Required)
   • National Insurance Number (Required)
   • Are you registered with NMC or NISCC? (Required)
   • NMC/NISCC number (Required)
   • NMC/NISCC certificate expiry date (Required)
   • Do you have your own form of transport? (Required)
   • Driving Licence No.
   • Have you worked for an agency within the last 3 months? (Required)
   • Which agency or agencies did you work for? (Required)

2. Next of Kin

   • Name (Required)
   • Maiden Name (if applicable)
   • Address (Required)
   • Contact No. (Required)
   • Relationship to you (Required)
   • Consent (Required)

3. Convictions/Investigations

   • INVESTIGATIONS/REPORTS
     • Have you ever been the subject of an Adult or Child Abuse investigation or been previously referred to the Independent Safeguarding Authority/DBS as a result of misconduct involving a child or a vulnerable adult? (Required)
     • If yes, provide full details below: (Required)
     • Have you ever been reported to NMC/NISCC? (Required)
     • If yes, provide full details below: (Required)
   • CONVICTIONS/OFFENCES
     • Do you have any convictions that are not “protected” as defined by the Rehabilitation of Offenders (Northern Ireland) Order 1978, as amended in 2014? (Required)
     • If yes, provide full details below: (Required)

4. Employment History

   • Current/Most Recent Employer
     • Job Title
     • Employer (name & address)
     • Start Date (dd/mm/yy)
     • End Date (dd/mm/yy)
     • Hourly Rate/Salary
     • Reason for leaving
   • Previous Employers (please list all since leaving school starting with most recent)
     • Job Title
     • Employer (name & address)
     • Start Date (dd/mm/yy)
     • End Date (dd/mm/yy)
     • Hourly Rate/Salary
     • Reason for leaving
   • Do you need to add anymore employers to your employment history? (Required)
   • Break in Employment
     • Date from (Required)
     • Date to (Required)
     • Please provide details for this break in employment: (Required)
     • Do you need to provide any further details of period you were not working? (Required)

5. Job Criteria

   • Please provide any other information which may be relevant to this application, detailing how you meet each of the criteria: (Required)

6. Qualifications

   • Course
   • Qualification gained
   • Place of study
   • Dates Attended (mm/yy – mm/yy)

7. References

   • Reference 1 (Most Recent Employer)
     • Name of Reference 1 (Most Recent Employer) (Required)
     • Company Name
     • Address (inc. postcode) (Required)
     • Telephone Number (Required)
     • Email address (Required)
     • Capacity Known (Required)
     • How does this person know you?
     • Employed From (dd/mm/yy)
     • Employed To (dd/mm/yy)
   • Reference 2 (Character/Employer)
     • Is this a character or employer reference? (Required)
     • Name of Reference 2 (Employer/Character) (Required)
     • Company Name
     • Address (inc. postcode) (Required)
     • Telephone Number (Required)
     • Email address (Required)
     • Capacity Known (Required)
     • How does this person know you?
     • Employed From (dd/mm/yy)
     • Employed To (dd/mm/yy)

1. Consent

   • Please tick the box to allow us to complete and receive references for you:

2. Declaration

   • I confirm I understand and accept offers of employment and subsequent appointment will be subject to the outlined declaration.
   • Offers of employment and subsequent appointment will be subject to:
     • The information I give being correct and any omissions, misleading or false information may provide grounds for withdrawal of offer or termination of employment.
     • Satisfactory references, Enhanced Access NI disclosures, evidence document checks, medical information and relevant registration checks as deemed acceptable to the company.
     • Training And/or Induction Will Not Be Paid :
       • If pre-employment checks are not satisfactory.
       • If you do not complete the induction process.
       • If we withdraw offer of employment.
       • If you do not complete induction to a satisfactory standard.
       • If you do not commence employment with the company.
     • Registration with the appropriate body as required under statutory regulation i.e. NMC/NISCC.
   • Access NI: Should you be successful in obtaining a position with the company any offer will be subject to receipt of a satisfactory Enhanced Access NI check and employment may not commence until the disclosure has been received. You will be required to complete an application for an Enhanced Access NI check if you are invited to interview. All information provided will be kept in the strictest confidence and only be used for the purposes of assessing your suitability for the post you have applied.
   • The company has a policy on the Recruitment of Ex-Offenders which is available on request.
   • Access NI have a written Code of Practice which can be downloaded from the following website: https://www.nidirect.gov.uk/
   • The company’s Access NI Data Policy and GDPR Privacy Notice for Job Applicants is available to view on the company website: www.domesticcareni.com, located in the footer (bottom of the website).
   • Please note: We reserve the right not to shortlist due to an incomplete application form.

3. Access NI Disclosure Consent

   • I agree to the Access NI Disclosure information.
   • I understand that