Application Form – Thorough Healthcare Solutions

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Instructions

Please read carefully before completing

Please note that the form cannot be saved and must be completed in one sitting. Therefore, please make sure that you have all relevant information to hand including details and dates of all relevant education, experience and training.

Some questions and sections of the form are conditional and are dependent upon your answers to previous questions. Some sections must be completed or you will not be allowed to proceed. Starred fields are mandatory.

The application form has 7 pages. The final page has a submit button that will send the form through to us once pressed or clicked. A copy of the form in pdf format will be emailed to you

Personal Information

Position Applied For *

Location *

Please upload a passport sized photo of yourself *

Title *

Surname *

Forename(s) *

Any Previous Names

Address *

Town *

Post Code *

Email *

Home Tel. No.

Mobile Tel. No. *

Are you legally eligible for employment in the UK? *

Yes

Do you require a work permit? *

Yes

Do you hold a current driving licence? *

Yes

Have you access to a motor vehicle? *

Yes

Education

School/College/Further Education

Qualification

Year obtained

Other Information

Employment and Experience

Date From

Date To

Name and address of employer

Job Title/Duties

Date From

Date To

Name and address of employer

Job Title/Duties

Date From

Date To

Name and address of employer

Job Title/Duties

Date From

Date To

Name and address of employer

Job Title/Duties

Experience

Please indicate your length of experience in each of the following client groups (in years and months):

Adolescents

Dom Care/Homecare

Mental Health

Rehabilitative Care

Autism

Respite Care

Palliative Care

Sensory Impairment

Auxiliary/Hosptial

Learning Disability

Physical Disability

Training

Please indicate which of the following courses you have taken, You will also be asked if it is complete and if so, what year it was completed.

Manual Handling/Hoist Training

Yes No

Infection Control

Yes No

Basic Life Support

Yes No

Food Hygiene

Yes No

Makaton

Yes No

Health and Safety Awareness

Yes No

Restraint Training

Yes No

Physical Intervention Techniques

Yes No

NVQ-2/3/4

Yes No

Medication

Yes No

Dementia Awareness

Yes No

Mental Health Awareness

Yes No

Challenging_Behaviour_Management

Yes No

Experience, Knowledge and Skills

Please give a brief summary here. We will contact you should we require more information.

This information will be treated as confidential in accordance with the Data Protection Act 1998.

Health Screening

This appointment will be subject to satisfactory completion of the Health Declaration overleaf.
I declare that the information given is correct to the best of my knowledge and that omissions or false statements may disqualify me from employment or lead to dismissal. I will give Thorough Healthcare Solution Limited permission to contact referees or any previous employers.

Tick the box to accept

I Accept

Date of Acceptance

Personal Health Questionnaire

Please tick if you are currently receiving treatment or have ever received treatment for:

Asthma

Yes No

Eye trouble

Yes No

High Blood Pressure

Yes No

Recurring Chest Disease

Yes No

Back trouble

Yes No

Fainting attacks

Yes No

Mental Illness

Yes No

Recurring Headaches

Yes No

Deafness

Yes No

Fits or Blackout

Yes No

Muscle/Joint trouble

Yes No

Stomach Trouble

Yes No

Diabetes

Yes No

Heart Trouble

Yes No

Recurring Bowel trouble

Yes No

Shortness of Breath

Yes No

Do you have any medical condition which may affect your ability to work?

Yes No

Are you currently consulting a doctor about a specific condition?

Yes No

In the last three years, have you had any time off work for any health related reason?

Yes No

Inoculations

Rubella

Yes No

Tetanus

Yes No

Hep B

Yes No

Polio

Yes No

Tuberculosis

Yes No

Varicella

Yes No

MRSA & COVID-19 Disclosure

I confirm that to the best of my knowledge I am clear of MRSA or Covi1d 19 at present. Should I come into contact or have any suspicion that I may have come into contact with any person with MRSA or displaying symptoms of Covid-19. I will inform Thorough Recruitment limited immediately.

I certify that I am in good physical and mental health. I declare that all information declared herein are true and correct to the best of my knowledge and that I have not omitted relevant details. I agree to inform you of any changes in my health and personal circumstances and that if false statements have been made, then it may result in the termination of my employment contract should my application process further.

Print Name

Signed

Check to sign

Date Signed