Complete the form below and register for a role with Shire Homecare.

Once you have completed the form below, a member of the team will be in touch.

    Personal Details

    Date of application
    Moved to this address on
    Used until
    Used until

    Work Requirements

    Approx. no of hours wanted per week


    (Please select all where you are available)

    In line with EU Legislation under the terms of ‘Working Time Regulations, Shire recommends you do not exceed 48 working hours per week. Do you wish to waiver this right:

    Continuation of Address History

    By law, Shire is required to obtain 5 years of addresses - if you have lived at your current address for 4 years 11 months or less, you are required to complete the below to ensure we have 5 years of address history.

    Moved to this address on
    Moved to this address on
    Moved to this address on
    Moved to this address on
    Moved to this address on

    Eligibility of Employment

    Next of Kin

    Education and Training History

    Education

    Dates attended
    From
    To
    Dates attended
    From
    To
    Dates attended
    From
    To

    Employment History

    Your employment history must start with your most recent employer. Please account for all gaps in employment dating back to the year you left compulsory education. If you’re able to provide a CV including all this information, you will not need to complete the below.

    Attach your cv

    Previous Employer 1

    Dates
    From
    To

    Previous Employer 2

    Dates
    From
    To

    Previous Employer 3

    Dates
    From
    To

    Previous Employer 4

    Dates
    From
    To

    Previous Employer 5

    Dates
    From
    To

    Previous Employer 6

    Dates
    From
    To

    Please note that if you provided a CV to Shire, this may be submitted to prospective clients in order to secure you work. Shire will only submit your CV in your best interest and by signing this application pack, you are granting consent for us to do so.

    Referee Details

    By supplying details, you agree that Shire can contact referees to assess your suitability for the position you are applying for. Only referees within a Senior/Management capacity will be deemed as acceptable. Please provide a minimum of two professional referees including your most recent/last employer. References provided must cover a minimum of 2 years prior to the date of this application.

    Referee 1

    Employment dates
    From
    To

    Referee 2

    Employment dates
    From
    To

    Referee 3

    Employment dates
    From
    To

    Convictions Declaration

    Workers of Shire are subject to the Health and Social Care Act 2008 and will be subject to a Police Record Check through the Disclosure Barring Service. Please declare all criminal convictions, whether spent or not, charges, whether proceeded with or not, and warnings and cautions. Please note that information provided in this Convictions Declaration will be used when Shire apply for a DBS on your behalf through any suitable DBS platform, we deem appropriate.

    Have you ever been the subject of a conviction, caution, reprimand and/or warning:
    Date of issue

    Health Questionnaire

    Do you consider yourself to have any type of physical disability, diagnosed or undiagnosed?

    Do you consider yourself to have any type of learning disability, diagnosed or undiagnosed?

    Do you consider yourself to have any type of mental health conditions, diagnosed or undiagnosed?

    Have you ever suffered from a diagnosed mental health condition?

    Are you currently taking any medication prescribed by a doctor or hospital?

    Do you currently have/previously had any medical conditions that may affect your suitability for this role

    COVID-19 Vaccine information

    Have you had your first vaccination?<
    Date you had your first vaccination
    Have you had your second vaccination?<
    Date you had your second vaccination
    Have you had your booster vaccination?<
    Date you had your booster vaccination
    Please upload proof of any vaccination you have had, this can be download from the NHS app.

    Have you been advised by a medical profession that you are not a suitable applicant for the vaccine due to health complications?

    You are being asked questions regarding the COVID-19 vaccine due to the role you plan to undertake with Shire Homecare Services. No recruitment decision will be made based on the answer of this section solely. We are duty bound to ensure all reasonable steps are made to protect our workforce and service users.

    Communication Preferences and Consent

    Please let us know your preferred methods of communication which can be amended at any time via our website www.shire-hcs.co.uk. Note, these are preferred methods of communication and by granting consent to the General Data Protection Regulations declaration below, you are agreeing to all forms of communication providing there is a legitimate business reason.

    Please tick to confirm you understand and give consent for Shire Healthcare and/or Shire Homecare Services to collate, process and store necessary information you provide via our website, including but not limited to; general enquiries, care requests, referrals, application registration including ongoing compliance during your employment. All data is handled with sensitivity and in accordance with the data protection legislation. For more information on our privacy policies, click here. to view our privacy policy.

    General Data Protection Regulations

    All personal data provided by you will be kept as confidential and stored on our secure data management platforms in accordance with The General Data Protection Regulations. In order to do so, we need your consent to collate, store and when required, send selected data to third parties for the purpose of finding you suitable employment, audit requests, managing your payments and/or training. This consent covers all information we may require whilst representing you; including but not limited to your application, training and compliance, placements, payroll and general day-to-day correspondence. To remain effective, we will need to communicate with you via a selection of methods including; phone, email, SMS and post. By signing the below, you’re also granting consent for us to do so and agree to the terms in our privacy policy which can be accessed via our website.

    Signature (please type your name acting as a signature):
    Date:

    Application Declaration

    I declare that to the best of my knowledge and belief the information given by me in this application is true, and I understand that the above information forms the basis of my contract of employment. I understand that if any of the information supplied by me is found to be falsely declared, my contract may have been fundamentally breached, and my employment may be terminated immediately. I understand that I may not be offered a post until a satisfactory response has been received with respect to my DBS Register status, and that should I subsequently be offered a post, that offer will be subject to receipt of two satisfactory references, one of which must be from my previous employer, and that confirmation of the employment will be subject to a satisfactory criminal record check from the DBS. I understand that until a satisfactory response is received from the DBS, and my employment is confirmed, I will be supervised at all times at work, and will not seek or have unsupervised access to vulnerable people. If the post I have applied for is as a Registered Nurse, my confirmation of employment will also be subject to a satisfactory search of the Nursing and Midwifery Council records and registers. By my signature, I authorise Shire Homecare Service or Shire Healthcare Services to request a DBS and a criminal record check from the Barring Service, on initial employment and at any time during my employment thereafter as and when required. I understand that Shire Homecare Services and/or Shire Healthcare Services will use information provided throughout the registration process, including my identification documents to undertake this check on my behalf via any chosen DBS application platform we deem suitable. I understand I have an obligation to inform my employer immediately if my DBS Register status or criminal status changes at any time during my employment, such as by being charged with an offence, the administering of a warning, criminal conviction, referral to any register of barred Care workers, or withdrawal of any registration required by my employment status.

    Signature (please type your name acting as a signature):
    Date: