Wells House, 3rd Floor, 15 Elmfield Road, Bromley, BR1 1LT
Tel: 020 8468 7888 Fax: 020 8468 7444
Email: info@bridgeshealthcare.co.uk
Website: www.bridgeshealthcare.co.uk

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APPLICATION FORM

Please use this form to ensure that you have filled out all the appropriate sections in the application pack.If any sections are not fully complete you will not be invited for an interview.

If for any reason you do not have FULL employment history, with unemployment periods for longer than three months please state why in the employment section on the application form.

PERSONAL DETAILS

EDUCATION

Please give details of your education using a separate sheet if necessary:

Schools / Colleges etc. From To Examinations/Qualification Date Obtained

QUALIFICATIONS & COURSES

Please give details of your qualifications using a separate sheet if necessary:

Employees / Colleges etc. From To Examinations/Qualification Date Obtained

ADDITIONAL INFORMATION & EXTENDED SKILLS

ie. Venepuncture / Male Catheterisation

FURTHER QUALIFICATIONS & TRAINING

Details of any further qualifications obtained or relevant courses attended. (please use continuation sheets if necessary)

PRESENT / LAST EMPLOYMENT

Please include any voluntary work:



PREVIOUS EMPLOYMENT DETAILS

Please give details of your previous FULL employment history:





SUPPORTING INFORMATION

Describe the particular skills and abilities you possess which best illustrate your suitability for this post, giving examples where appropriate. Say briefly why you are interested in this post and how you see yourself fulfilling this role.

REFERENCES

Please provide the details of two people to whom we may apply for references, at least one of which should be your current or most recent employer:


DISCLOSURE & BARRING SERVICE CHECKS

A Disclosure & Barring Service check will be requested in the event of you being offered the post. If you register with the DBS Update Checking Service your DBS will be checked as and when required.

SECURITY CHECK DISCLAIMER/CONSENT

A security check will be performed in the event of you being offered the post.

REHABILITATION OF OFFENDERS ACT 1974

Because of the nature of work for which you are applying, this post is exempt from the provisions of section 4 (2) of the Rehabilitation of Offenders Act 1974 (Exceptions) order 1975. Applicants are therefore not entitled to withhold any information about convictions which for other purposes are “spent” under the provisions of the Act and, in the event of employment, any failure to disclose such convictions could result from dismissal from the company. Any information given will be completely confidential and will be considered only in relation to an application for positions to which the order applies.

DATA PROTECTION POLICY

Bridges Healthcare is registered with the Information Commissioner’s Office.

DECLARATION

I understand the appointment offered will be subject to the information given on this form being correct. I hereby certify that this is the case.

INTERVIEW ARRANGEMENTS

SKILLS & COMPETENCIES

Please tick as appropriate to assist in identifying your skills and competencies and to address potential training requirements for all Healthcare Assistants.

PERSONAL HYGIENE COMPETENT REQUIRES TRAINING
Bath/shower/strip wash
Bed bath
Use of bath aids
Mouth care (including dentures)
Care of feet (excluding toenails)
Shaving
Dress/undressing patients
TOILETING    
Catheter care, emptying catheter bag
Care of the bowels
Use of bed pan/commodes, etc.
Fluids outputs/recording
MOBILITY    
Moving & Handling knowledge/training
Use of hoist
Use of aids to assist mobilising
OBSERVATIONS    
Temperature
Pulse
Apex
Blood Pressure
Blood Glucose levels
NUTRITION COMPETENT REQUIRES TRAINING
Fluid input and recording
Preparation of meal
Assisting in feeding patients
GENERAL    
Pressure area care
Eyes care and medication
Simple dressings procedure
Medication (care of)
Fluid input/output and recording
Light housework
Washing of personal laundry
Bed making, change a bed/draw sheet with patient in/on it
Sitting with a terminally ill patient
Loss issues dealing with bereavement
Personal safety
RECORD KEEPING    
Report writing/giving
Recording instructions from GP/DN/Professional staff
Observe changes in patient condition and appropriate action to follow

EQUAL OPPORTUNITIES

Bridges Healthcare will take positive measures to ensure that there is no discrimination, either direct or indirect, overt of unintentional, in respect of its selection processes, training and promotion opportunities, application of conditions of service, personnel policies and procedures etc., on the grounds of race, sex, age, marital status, disability, religion, creed, nationality, ethnic or national origins, social background or sexual orientation.

MONITORING INFORMATION

To ensure that our Equal Opportunities Policy is effective, detailed monitoring of applicants is carried out. This necessitates collecting information regarding disability, ethnic origin and the sex of applicants. Your co-operation would therefore be appreciated.

This information is solely used for monitoring purposes. It will be treated as confidential and this sheet will be detached from your application form on its receipt and before shortlisting takes place.

I consider my ethnic origin to be:

Some of this data may be held on computer and will be subject to the provisions of the Data Protection Act 1998.