Application Form

Which location are you applying for?

Which role are you applying for?

When would you be able to start?

Available to work
Full TimePart TimeDaysNights

Professional, Academic or Other Qualifications

Including Educational Qualifications

(Continue on separate sheet if necessary)

Full Employment History

(Please give details of all previous posts, the most recent shown first)

(If offered employment with EveryDay Care your last two employers will be contacted for a reference)

(Continue on separate sheet if necessary)

References

1st Referee

2nd Referee

• We will verify references received before confirming any job offer.
• Referees will only be contacted if EveryDay Care is making an employment offer.
• Please indicate to us if there is any reason why we shouldn’t contact your referees.

Disclosure of criminal convictions

If you answered YES to any of the above, please provide details below

Protection of vulnerable adults

Misconduct

If you answered YES to any of the above, please provide details below

Personal Statement

EveryDay is a values-based organisation – meaning that we expect all of our staff to be Optimistic, Inclusive, Dedicated, Enabling, Responsive and Realistic. Using your understanding of what it means to be a Home Care Assistant, please use the space below to tell us what these values mean to you and how they would help you were you successfully appointed to EveryDay Home Care.

EveryDay is committed to interviewing all candidates with a disability who meet the minimum criteria for selection.

Do you have a disability which has a substantial and/or long-term effect on your ability to carry out day-to-day activities?

YesNo

If you wish, please use the space below to provide further information on your disability:

EveryDay Home Care offers guaranteed minimum 16 hour contracts to all employees from day one of their employment While we always try to provide employees with work in their preferred locations, occasionally we have to ask our Home Care Assistants to be flexible and work with customers in other locations in order to make up their contractual obligations to us. Please note that we do pay travel time and mileage.

Indicate below which areas are your preferred locations to work in, keeping in mind that we may from time-to-time require you to work in other locations when the need arises. (tick each which applies)

North Tyneside - Longbenton/Forrest Hall/WideopenNorth Tyneside - North Shields/Tynemouth/Whitley Bay/ Shiremoor North TynesideWallsend/HowdonNewcastle – Gosforth / Byker/ Walker

In order to plan rotas and map your availability to our existing contracts, please complete each of the following three sections to indicate your core hours (those hours you would prefer to work), your optional hours (those additional times you may be available to work) and your no-go hours (when you would not be available for work). Please note that while we will always try to be flexible, our standard working requirements are for five days each week to include a minimum
of one weekend day (tick each which applies)

Core Hours (your preferred hours of work)

No-Go Hours (times you would not be available for work)

Declaration

I confirm that the information provided is a true account. I also confirm that I am physically and mentally fit to fulfil the job for which I have applied. I consent to the Company checking any information provided on this application form, and I understand that giving false information may lead to any job offer being withdrawn, or to formal action up to and including termination of my employment.