Apply - Domestic Care Group

Filling in an Application Form

The easiest way to complete an Application form is by filling out the below form on our website.

However, you can click the below links to download a pdf copy which can be printed out and filled in.

Click here to download Application Form pdf.

For application form pdf copies, once completed please take a photo, or scan a copy to: recruitment@domesticcareni.com

Application Form

1Personal Details

2Additional Details

3Next of Kin

4Convictions/Investigations

5Employment

6Criteria

7References

Hidden

Full Application Form below:

What role are you applying for?(Required)

Personal Details

Name(Required)

Title First Last

Maiden Name (if applicable)

Home Phone Number

Mobile Number(Required)

Email(Required)

Address(Required)

Street Address Address Line 2 City/Town County Postcode

Right to Work(Required)

I confirm that i have a right to work in the UK.

Additional Details

Your National Insurance Number:(Required)

Are you registered with NMC or NISCC?(Required)

Yes

What is your NMC/NISCC number?(Required)

What is your NMC/NISCC certificate expiry date?(Required)

DD slash MM slash YYYY

Do you have your own form of transport?(Required)

Yes

Driving Licence No.

Have you worked for an agency within the last 3 months?(Required)

Yes

Which agency or agencies did you work for?(Required)

Next of Kin

Name(Required)

Address(Required)

Contact No.(Required)

Relationship to you:(Required)

Consent(Required)

Please tick to confirm that the person named has given their consent to be contacted as your next of kin.

Convictions/Investigations

INVESTIGATIONS/REPORTS

1. 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)

Yes

If yes, provide full details below:(Required)

2. Have you ever been reported to NMC/NISCC?(Required)

Yes

If yes, provide full details below:(Required)

CONVICTIONS/OFFENCES

Due to the services provided the majority of posts within the Company are governed by the Protection of Children & Vulnerable Adults (NI) Order 2003 and the Rehabilitation of Offenders (Exceptions) Order NI 1979. Disclosure of offences will not automatically debar you from applying for the post.

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)

Yes

If yes, provide full details below:(Required)

All disclosures will be reviewed for compatibility with the post.

Employment History

Our governing body, RQIA requires all applicants to provide a full employment history. Please detail your employment history from when you left school to present.

Please also include periods of time when you were not in paid employment, caring for relatives, time spent in education/training, travelling or volunteering at home or abroad.

No Employment History

Please check this box and move onto the next part if you have never had a job before.

Current/Most Recent Employer

Job Title

Employer (Name & Address)

Start Date (mm/yy)

End Date (mm/yy)

Hourly Rate/Salary

Reason for leaving

Previous Employers (please list all since living school)

Job Title

Employer (Name & Address)

Start Date (mm/yy)

End Date (mm/yy)

Hourly Rate/Salary

Reason for leaving

Please click on the + button to add more employers.

Do you need to add any more employers to your employment history?(Required)

Yes

Break in Employment

Do you need to provide details of any periods you were not working since leaving school?(Required)

Yes

Date from(Required)

DD slash MM slash YYYY

Date to(Required)

DD slash MM slash YYYY

Please provide details for this break in employment:(Required)

Do you need to provide any further details of period you were not working?(Required)

Yes

Please provide further details of dates and reasons for further periods of not working:(Required)

Job Criteria

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

Qualifications (please list any relevant qualifications)

Course

Qualification gained

Place of study

Dates Attended (mm/yy – mm/yy)

References

Please complete the details of two references which must include your present/most recent employer. • Relatives cannot be named as referees. • Character references can be sought from a GP, religious official or friend who is not a relative.

We will only seek references after an offer of employment is accepted. We may seek references from your previous employers if one from your current/most recent employer is unobtainable. Please note we are required to obtain a reference from all previous employments within Health & Social Care. Please complete reference details in full.

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

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)

Employed From

DD slash MM slash YYYY

Employed To

DD slash MM slash YYYY

Reference 2 (Character/Employer)

Is this a character or employer reference?(Required)

Character

Employer

Name of Reference 2 (Employer/Character)(Required)

Company Name

Address (inc. postcode)(Required)

Telephone Number(Required)

Email address(Required)

Capacity Known(Required)

Employed From

DD slash MM slash YYYY

Employed To

DD slash MM slash YYYY

Consent(Required)

Please tick the box to allow us to complete and receive references for yourself.

Declaration

Declaration(Required)

I confirm I understand and accept offers of employment and subsequent appointment will be subject to the outlined declaration.

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.

– Registration with the appropriate body as required under statutory regulation i.e. NMC/NISCC.

-Access NI: Should you be successful in obtainning 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).

How did you become aware of this job role?(Required)

Name of staff member who referred you:(Required)

Signature(Required)

Date(Required)

DD slash MM slash YYYY

1Personal Details

2Additional Details

3Next of Kin

4Convictions/Investigations

5Employment

6Criteria

7References

Hidden

Full Application Form below:

What role are you applying for?(Required)

Personal Details

Name(Required)

Title First Last

Maiden Name (if applicable)

Home Phone Number

Mobile Number(Required)

Email(Required)

Address(Required)

Street Address Address Line 2 City/Town County Postcode

Right to Work(Required)

I confirm that i have a right to work in the UK.

Additional Details

Your National Insurance Number:(Required)

Are you registered with NMC or NISCC?(Required)

Yes

What is your NMC/NISCC number?(Required)

What is your NMC/NISCC certificate expiry date?(Required)

DD slash MM slash YYYY

Do you have your own form of transport?(Required)

Yes

Driving Licence No.

Have you worked for an agency within the last 3 months?(Required)

Yes

Which agency or agencies did you work for?(Required)

Next of Kin

Name(Required)

Address(Required)

Contact No.(Required)

Relationship to you:(Required)

Consent(Required)

Please tick to confirm that the person named has given their consent to be contacted as your next of kin.

Convictions/Investigations

INVESTIGATIONS/REPORTS

Yes

If yes, provide full details below:(Required)

2. Have you ever been reported to NMC/NISCC?(Required)

Yes

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)

Yes

If yes, provide full details below:(Required)

All disclosures will be reviewed for compatibility with the post.

Employment History

Our governing body, RQIA requires all applicants to provide a full employment history. Please detail your employment history from when you left school to present.

Please also include periods of time when you were not in paid employment, caring for relatives, time spent in education/training, travelling or volunteering at home or abroad.

No Employment History

Please check this box and move onto the next part if you have never had a job before.

Current/Most Recent Employer

Job Title

Employer (Name & Address)

Start Date (mm/yy)

End Date (mm/yy)

Hourly Rate/Salary

Reason for leaving

Previous Employers (please list all since living school)

Job Title

Employer (Name & Address)

Start Date (mm/yy)

End Date (mm/yy)

Hourly Rate/Salary

Reason for leaving

Please click on the + button to add more employers.

Do you need to add any more employers to your employment history?(Required)

Yes

Break in Employment

Do you need to provide details of any periods you were not working since leaving school?(Required)

Yes

Date from(Required)

DD slash MM slash YYYY

Date to(Required)

DD slash MM slash YYYY

Please provide details for this break in employment:(Required)

Do you need to provide any further details of period you were not working?(Required)

Yes

Please provide further details of dates and reasons for further periods of not working:(Required)

Job Criteria

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

Qualifications (please list any relevant qualifications)

Course

Qualification gained

Place of study

Dates Attended (mm/yy – mm/yy)

References

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

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)

Employed From

DD slash MM slash YYYY

Employed To

DD slash MM slash YYYY

Reference 2 (Character/Employer)

Is this a character or employer reference?(Required)

Character

Employer

Name of Reference 2 (Employer/Character)(Required)

Company Name

Address (inc. postcode)(Required)

Telephone Number(Required)

Email address(Required)

Capacity Known(Required)

Employed From

DD slash MM slash YYYY

Employed To

DD slash MM slash YYYY

Consent(Required)

Please tick the box to allow us to complete and receive references for yourself.

Declaration

Declaration(Required)

I confirm I understand and accept offers of employment and subsequent appointment will be subject to the outlined declaration.

How did you become aware of this job role?(Required)

Name of staff member who referred you:(Required)

Signature(Required)

Date(Required)

DD slash MM slash YYYY

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