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Full-time

Apply: Adult Support Worker

Complete the application form below. After submission, our team will review your application in the dashboard.

Closing: 31 Dec 2026

Step of

Personal details General information Declaration

% complete

Personal Details

Tell us about yourself (Adult Carer Application).

Step 1

Full name *

Email *

Mobile phone *

Home telephone (optional)

National Insurance Number *

Title (optional)

Previous names (if any)

Address *

Postcode *

Date of birth *

Place of birth (optional)

Nationality

Gender (optional)

Languages spoken (optional)

Religion (optional)

Passport number *

Passport expiry date *

Right to work in the UK? *

Visa type / restrictions (if applicable) *

Work permit? *

Work permit number (optional)

Work permit expiry (optional)

Next of kin *

Who should we contact in an emergency?

Name

Telephone

Relationship

General Information

Driving, education, employment, references & DBS disclosures.

Step 2

Do you have a UK driving licence?

Do you have a car?

If using your car for work, do you have business insurance?

Willing to produce driving licence & insurance?

Member of a union / professional organisation?

If yes, please state

Education / Qualifications & Training

Start with the most recent (you can add multiple).

Employment History & Work Experience

Last 10 years (include agencies). Explain any gaps in “Reason”.

Have you worked with children in the past 10 years? If yes, where, in what capacity and reason for leaving (if applicable)

Current salary (optional)

Monthly rate (optional)

Hourly rate (optional)

Other skills / experience relevant to the role

References

Please provide at least two referees (senior to you).

Current / Most Recent Employer

Name

Position / Relationship

Telephone

Address

Postcode

Email address

Length of time known (MM/YY)

Character Reference

Name

Position / Relationship

Telephone

Address

Postcode

Email address

Length of time known (MM/YY)

May we contact your referees before your interview?

Rehabilitation of Offenders / Disclosures & DBS

Required for regulated roles.

Any spent or unspent convictions (UK or overseas)?

Any investigation alleging abuse (UK or overseas)?

If yes, please give details

Do you agree to apply for Enhanced DBS checks?

Any pending investigation?

Pending investigation details (if any)

I authorise Gims Care Solutions to carry out a DBS check on my behalf (and retain update service checks).

Final Step

Confidentiality, working time, bank, skills, training, availability & declaration.

Step 3

Confidentiality

I have read and understand the confidentiality requirements and agree.

Signature (type full name)

Date

Working Time Directive

Do you wish to opt-out of the 48-hour weekly limit?

Signature

Date

Bank Details

Account holder name

Bank name

Account number

Sort code

Signature (Full Name)

Date

Areas of Experience

Enter length of experience (optional).

Hospitals

Dementia

Mental Health

Residential Homes

Learning Disability

Care of the Elderly

Nursing Homes

Palliative Care

Domiciliary Care

Skills Evaluation

A = experienced, B = familiar, C = no knowledge.

Personal Hygiene

Assisting with washing, shaving

Eye care

Mouth care

Stoma care

Toileting

Continence care

Catheter care

Use of commode / bed pan

Recording fluid balance sheets

Observations

Blood sugar testing

B/P recording

TPR recording

Urinalysis

Nutrition

Feeding patient

Meal preparation

Mobility

Use of hoist

Transferring / mobilising a patient

Other

Report writing

Pressure area care

Mandatory Training Updates

List relevant mandatory training (you can add multiple).

Availability for Work

How many hours would you like to work each week?

Which areas would you be able to work in? (list)

Slot	MON	TUE	WED	THU	FRI	SAT	SUN
Morning Calls
Lunch Calls
Tea Calls
Bed Calls
Nights (Waking/Sleeping)

Other work commitments that may impair duties?

If yes, details

Tick the area(s) you would be able to work in:

Barking and Dagenham Redbridge Havering Newham Tower Hamlets Thurrock Essex Ipswich

Equal Opportunities Monitoring (Optional)

Nationality

Language spoken

Age group

Disability

Ethnicity

How did you hear about this post?

Related to / know any member of staff?

If yes, details

Third Party Declaration

I allow information relating to my registration to be shared with relevant third parties (e.g. audits/frameworks) overseen by the governance lead.

Signature (type full name)

Date

Declaration

By signing, you confirm the information provided is accurate to the best of your knowledge and you agree to required checks and compliance.

Print name *

Signature (type your full name) *

Date *

Application summary

Role Adult Support Worker

Location Essex, Ipswich

Type Full-time

Tip

Make sure your email and phone number are correct — we’ll use them to contact shortlisted candidates.

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