Personal Details
Address *
Post Code *
Nationality *
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Afghanistan
land Islands
Albania
Algeria
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AndorrA
Angola
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Antarctica
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Australia
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Canada
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Chile
China
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Cocos (Keeling) Islands
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Congo
Congo, The Democratic Republic of the
Cook Islands
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Cote D'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
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El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
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Finland
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Gabon
Gambia
Georgia
Germany
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Gibraltar
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Greenland
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Guam
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Guinea
Guinea-Bissau
Guyana
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Heard Island and Mcdonald Islands
Holy See (Vatican City State)
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Hungary
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Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
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Kenya
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Korea, Democratic People'S Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People'S Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Jamahiriya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia, The Former Yugoslav Republic of
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Federated States of
Moldova, Republic of
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
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Niger
Nigeria
Niue
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Northern Mariana Islands
Norway
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Palestinian Territory, Occupied
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russian Federation
RWANDA
Saint Helena
Saint Kitts and Nevis
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Samoa
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Serbia
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Slovenia
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Somalia
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South Georgia and the South Sandwich Islands
Spain
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Sudan
Suriname
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Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan, Province of China
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
NI Number *
Email Address *
Place of Birth
Telephone Number *
Mobile Number
How long have you had a licence?
Are you a United Kingdom(UK), European Community(EC),European Economic Area(EEA) National
Please detail your current immigration status and the relevant visa currently held (including Visa number)" *
Are you related to any of our current members of staff or Service Users?
Equality Act 2010 - Under the Equality Act 2010, the definition of disability is if you have a physical or mental impairment that has a “substantial” and“ long-term adverse effect ”on your ability to carry out normal day-to-day activities. Further information regarding the definition of disability can be found at : www.gov.uk/definition-of-disability-under-equality-act-2010.
For the purposes of this application and interview stage only, is there anything you would like us to be aware of so that we can make reasonable adjustments during the process?
Education* (All qualifications will be subject to a satisfactory check).
Examinations, Qualifications
Training Courses attended or completing (evidence of attending courses is required)
Professional Memberships / Registrations
Employment History
Please record below the details of your full employment history beginning with your current or most recent first. Any gaps must be explained. Use a separate attached sheet if required; please sign the sheet(s)
Current / Most recent employer
Employment History (2)
Please provide at least two references from your past employments.
Reference (1)
Reference (2)
Safeguarding/Ex-Offernders Declaration: Please not this section will only be seen by those involved in the recruitment process and will be treated with the strictest confidence.
The Rehabilitation of Offenders Act 1974 aims to promote equality of opportunity and is committed to treating all applicants fairly regardless of ethnicity, disability, age, gender or gender re-assignment, religion or belief, sexual orientation, pregnancy or maternity and marriage or civil partnership. Genius Care Limited undertakes not to discriminate unfairly against applicants on the basis of a criminal conviction or other information declared.
Answering 'yes' to the question below will not necessarily prevent your employment. This will depend on the relevance of the information you provide in respect of the nature of the position and the particular circumstances.
Are you currently bound over or do you have any current UNSPENT convictions that has been issued by a Court or Court-Martial in the United Kingdom or in any other country? *
Do you have any current UNSPENT police cautions, reprimands or final warnings in the United Kingdom or in any other country? *
We will only collect data for specified, explicit and legitimate use in relation to the recruitment process. By signing this application form, you consent to holding the information contained with in this application form. If successfully shortlisted, da ta will also include short listing scoring and interview records. We would like to keep this data until the vacancy is filled. (We can not estimate the exact time period, but we will consider this period over when a candidate accepts our job offer for the position for which we are considering you).When that period is over, we will either delete your data or in form you that we would like to keep it in our database for future roles.
We have privacy policies .Please be assured that your data will be securely stored by the Registered Manager and only used for the purposes of recruiting for this vacant post.
You have the right for your data to be deleted, corrected, or accessed, to restrict processing, to revoke consent, and to be kept informed about the processing of your data. If you would like to talk about this more or revoke your consent at any time, please get in touch with the registered manager to discuss.
Declearation
The information in this application form is true and complete. I accept that any willful omission, fabrication, or misre presentation in the application form will result in the rejection of this application or, if employed, the subsequent termination. Where applicable, Icon sent that can seek clarification regarding professional registration details.