Gimscare Solutions

Step of

Personal details General information Declaration

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Personal Details

Tell us about yourself.

Step 1

Full name *

Email *

Phone *

National Insurance Number *

Address *

Date of birth *

Postcode *

Nationality

Right to work in the UK? *

Next of kin *

Who should we contact in an emergency?

Name

Phone

Relationship

General Information

Your experience, training and references.

Step 2

Do you have a UK driving licence?

Do you have a car?

Education & Qualifications

Add your most relevant qualifications (you can add multiple).

Employment History

Add your recent jobs (you can add multiple).

Voluntary Work

Add any voluntary roles (optional).

Other experience since leaving full-time education

Other interests / hobbies / achievements

Mandatory Training

List relevant mandatory training (you can add multiple).

Disciplinary history (if any)

Professional References

Please provide two professional references.

Reference 1

Name

Position

Company

Telephone

Address

Postcode

Email address

Length of time known (MM/YY)

Reference 2

Name

Position

Company

Telephone

Address

Postcode

Email address

Length of time known (MM/YY)

May we contact your referees before your interview?

Disclosures & DBS

These questions are 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.

Final Step

Availability, skills, equal opportunities and 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

Availability

Tick when you’re available. Add notes if needed.

Day	Morning	Afternoon	Evening	Night
Mon
Tue
Wed
Thu
Fri
Sat
Sun

Preferred hours / constraints (optional)

Earliest start date

Bank Details

Account holder name

Bank name

Account number

Sort code

Signature (Full Name)

Date

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

Equal Opportunities (Optional)

Used for monitoring only. You can choose “Prefer not to say”.

Gender

Age band

Ethnicity

Religion / belief

Disability

If yes, any adjustments needed? (optional)

Declaration

Signature (type your full name) *

Date *

By submitting, you confirm the information provided is accurate to the best of your knowledge.

Apply: Residential Support Worker

Personal details General information Declaration

Personal Details

Next of kin *

General Information

Education & Qualifications

Employment History

Voluntary Work

Mandatory Training

Professional References

Disclosures & DBS

Final Step

Confidentiality

Working Time Directive

Availability

Bank Details

Skills Evaluation

Equal Opportunities (Optional)

Declaration