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Employee of the Month

Home
About us
Our Services
Costs
Join Our Team!
- Join Our Team
- Training
TIMESHEETS
Contact Us
Employee of the Month

Home
Register

Our Services

Personal Care

Live in Care

Respite Care

Dementia & Alzheimers Care

Palliative Care

Elderly care

Supported Living

Personal Details 1

Name

Title

First Name *

Middle Name

Last Name *

Phone *

Mobile No *

Email Address *

Date of birth *

National Insurance No *

NMC Pin No

Address

Street Address *

Address Line 2 *

City *

State / Province / Region *

ZIP / Postal Code

Country *

Personal Details 2

Nationality *

Gender *

Religion *

Race/Ethnicity *

Sexual Orientation *

Upload ID Photo *

No file chosen

Employment Eligibility

Are you permitted to work in the United Kingdom?YesNo

Can you provide evidence to prove eligibility?YesNo

Permit/Document No

Upload a copy of your passport/permit

No file chosen

Upload a proof of address and other relevant documents

No file chosen

What visa/permit/status do you currently hold? *Working HolidayWork PermitLeave to RemainBritish NationalOther

Please state what visa/permit you hold

Driving Details

Do you have full Driving Licence that allows you to drive in the UK? *YesNo

Do you have access to a car that you can use for work?YesNo

Does you car insurance include Class 1 business insurance? (in order to use you vehicle for work you must have class 1 business insurance)YesNo

Are all your documents up to data and valid?YesNo

Have you been banned from driving. or do you have any current endorsements on you licence?YesNo

How would you travel to work if assigned? *

Langauages

English - Spoken *FluentGoodFair

English - Written *FluentGoodFair

Other Languages Spoken

Next of kin details

Title

First Name *

Last Name *

Relationship *

Phone *

Mobile No *

Email Address *

Address

Street Address *

Address Line 2 *

City *

State / Province / Region *

ZIP / Postal Code

Country *

Date available to start *

Your History

Employment HistoryPlease give satisfactory explanations of any gaps in employment

EMPLOYER *

POSITION *

DUTIES *

DATE FROM - TO *

SALARY ON LEAVING *

EducationPlease supply documentary evidence.

INSTITUTION *

COURSE *

YEAR *

GRADE *

Upload CV if you have one.

No file chosen

Reference 1

Relationship *

Name *

Email *

Phone *

Address *

City *

State / Province / Region *

ZIP / Postal Code *

Reference 1

Relationship *

Name *

Email *

Phone *

Address *

City *

State / Province / Region *

ZIP / Postal Code *

Mandatory Training

Please check which training you have completed and the date on the notes (certificates must be provided) *Manual HandlingBasic life supportThird ChoiceHealth and SafetyInfection ControlFirst AidMedicationDOLLS & Mental CapacityDiploma in Health & Social Care L2Diploma in Health & Social Care L3Upload the documents?

Upload

No file chosen

Mandatory Documents

BRP *

No file chosen

Passport *

No file chosen

Entry Clearance *

No file chosen

Health Declaration

Do you or have ever suffered from long term illness? *YesNo

Have you ever required sick leave for a back or neck injury? *YesNo

Do you suffer with any back or neck injuries? *YesNo

Have you been in contact with anyone who is suffering from a contagious illness within the last six weeks? *YesNo

Do you suffer with a communicable disease? *YesNo

Are you currently receiving active medical attention? *YesNo

Do you suffer with a communicable disease? *YesNo

If you have answered ‘yes’ to any of the above, please give details:

Are you registered disabled? *YesNo

How many days have you been absent from work due to illness in the last 12 months? *

State reason(s) for absence *

GP Details

GP Name *

GP Address *

City *

ZIP / Postal Code *

Country *

May we contact your Doctor for health check?YesNo

The above information will be held in strict confidence. If you aware of any health issue that you feel may affect your ability to undertake responsibilities of the post it is your responsibility to inform the Care Manager immediately. Again any details discussed in the meeting will be held in strict confidence.

I understand that my GP may be contacted for details about my health.

DBS Declaration

Do you have a current DBS (Disclosure Barring Service) certificate?YesNo

Please enter disclosure number

Date of issue

Upload

No file chosen

Reference Number (if applicable)

I understand that a DBS check will be sort in the event of a successful application.

Terms of employmentIf any provision of this Agreement should be held to be invalid it shall to that extent be severed and the remaining provisions shall continue to have full force and effect. You may be required to use personal vehicle to and from work. No fuel re-imbursement will be given. You are responsible for meeting the cost of DBS Disclosure. Employer, in some circumstances, may agree to advance the cost only if you agree it to be deducted from your pay. Carers will achieve QCF Level 2 within 2 years of start of employment. All care staff and trainees, including all staff under 18, will register on and successfully complete Skills for care certified training programme. The Company has written and published a formal policy/procedure document covering employee grievances which relates to your employment. The document is entitled “Employee Discipline” and is available for review at any reasonable time. Please contact your Manager for further information, or to request to review a copy. If you are dissatisfied with any disciplinary or dismissal decision relating to you then you should, in the first instance, apply in writing, to the Care Manager stating the grounds for your appeal. The person who will consider the appeal may vary according to individual circumstances. The Company has written and published a formal policy/procedure document covering employee grievances which relates to your employment. The document is entitled “Employee Grievances” and is available for review at any reasonable time. Please contact your Care Manager for further information, or to request to review a copy. If a grievance cannot be resolved informally then you must put your grievance, in writing to your Care Manager. A simple form has been designed for this purpose. Employees with reading or language difficulties should seek assistance, for example, from a work colleague. Subsequent steps, including the right of appeal are explained in the formal document. The following documents form part of this statement: Employee handbook Policy and procedure manual Notices

I have read and agree to the terms

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First Name

Last Name

Name of Bank/Building Society

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About Us

Qualitcare24-7 is a homecare agency based in Portsmouth that specializes in providing high standard domiciliary care services such as Nursing and Personal Care for people in the comfort of their own homes.

Resources

Contact Us

Qualitcare24-7 Ltd
320 Victory Business Centre
Somers Road North
Portsmouth
PO1 1PJ

Phone: 023 9217 8770
Mobile: 07464 608 626 | 0800 368 9885
email: info@qualitcare247.co.uk

Office Opening Hours: Mon - Fri 9am - 5pm
Care Services Provided 24 Hrs a day, 7 Days a week

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