Home Care Interest Form

CURRENT DETAILS

First Name Last Name Current Role —Please choose an option—CarerNamed CarerCare CoordinatorNurseWellbeing CoordinatorAssistant Wellbeing CoordinatorWellbeing CompanionHead HousekeeperHousekeeperLaundry AssistantKitchen AssistantChefMaintenancePainter & DecoratorPlumberElectricianHome AdministratorService Coordinator Care Home Currently Working At —Please choose an option—CulverhayesCedar ParkOrangeryWinfield LodgeWoodsideLarkhall SpringsSt. Teresa's Your Current Residential Area Postcode What’s Your Visa Status —Please choose an option—Sponsored – Tier 2 Skilled WorkerSponsored – Tier 2 DependentBritish / Irish CitizenIndefinite Leave to RemainAsylum Seeker / RefugeeEU Settlement SchemePre- Settlement Scheme

PREFERRED / INTENDED DETAILS TO WORK IN HOME CARE

Type of Employment Interested to Work —Please choose an option—Part TimeFlexible Shifts Preferred Shift of Work —Please choose an option—Day Time (Between 8am to 1pm)Evening Time (Between 1pm to 10 pm)All Day (Between 8am to 10 pm)Over Night Cover / Sleep In (From 8:30am to 9:00am) Preferred Shift Timing —Please choose an option—Only Short Shifts (3 hrs per day)Only Short Shifts (4 hrs per day)Only Long Shifts (8 hrs per day)Only Long Shift (12 hrs per day)Mix Shift (Between Short Shifts (3hrs) and Long Shifts (8 hrs)Mix Shift (Between Short Shifts (4hrs) and Long Shifts (8 hrs)Mix Shift (Between Short Shifts (3hrs) and Long Shifts (12 hrs)Mix Shift (Between Short Shifts (4hrs) and Long Shifts (12 hrs) Preference of Continuous Employment —Please choose an option—Short Term Employment (3 months to 6 months)Long Term Employment (1 year to 3 year)Continuous Employment (No limitation in time period to work) Mode of Transport you use for work —Please choose an option—WalkingCycling (Own a cycle)Driving (Holder of Driving License & Own a Car)E -Biking / E-ScooteringBusTaxi Tell us what interested you to be part of this opportunity