PA Application Form - Prequalification

If you would like to apply to join our team, please complete our online application form. Once you have completed and submitted the form, we will contact you within 2 working days. Successful applicants will be invited to attend one of our Recruitment sessions, where you will learn more about our company and this rewarding job whilst having the opportunity to meet our team.

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Items marked with an asterix (*) are mandatory.

Driving, Accomodation and Language

Step 1/9

What type of driving licence do you have? *
What types of vehicles are you licensed to drive? *
Where was your driving licence issued? *
Are you aged 21 or over?
(For car insurance purposes you must be aged 21 or over. This position is exempt from the Employment Equality (Age) Regulations 2006 as per section 8(2)) *
All positions require you to live in the home of the client, therefore are you able to live away from home for up to 2 or 3 weeks at a time? *
English Language Level? *
Are you able to commit to work for Active Assistance for a minimum of 6 months?
(We may accept your application even if you cannot commit to a full 6 months, but you may be required to contribute towards the cost of induction training.) *

Step 2/9

Nationality and Work Permits Are you a British or Swiss National or a National of the European Economic Area (EEA)? *
Do you have a valid work permit enabling you to work in the UK? *

* You are a national of the EEA if you are a national of one of the following countries:

Austria, Belgium, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, Netherlands, Norway, Poland, Portugal, Slovakia, Slovenia, Spain, Sweden.

If you are unsure of your eligibility to work in the UK, or if you know that you are unable to work in the UK without a sponsor for a work permit, please visit http://www.bia.homeoffice.gov.uk/workingintheuk/ where you will find information on the various options open to Foreign Nationals who want to come and work in the UK.

Personal Details

Step 3/9

Title *
Full Name *
Address *
Town/City *
Postcode / Zip Code *
Country *
Home Telephone (with STD code) *
Mobile Telephone (with STD code)
Email Address *
Date of Birth * Month Year
Nationality *

Personal Details

Step 4/9

Gender
What is your height? *
What is your weight? *
Have you ever had a drink or drugs problem? *
If yes, please provide details of your drink or drugs problem
Are you a vegetarian? *
If yes, will you still cook meat/fish?
Have you at any time suffered from any physical or mental medical conditions? *
If yes, please provide details of your medical conditions
Are you taking any prescribed medicine? *
If yes, please provide details of any prescription drugs you are taking
As a PA you will be expected to do some moving and handling. Have you had/do you have any back problems? *
If yes, please provide details of any back problems you have
Do you have any allergies/dislikes? (including pets) *
If yes, please provide details of any allergies you have
Are you a smoker? *
Do you have any problems working with a client who smokes? *
What are your Hobbies and Interests?
Why are you interested in Care Work?

Present or last employer

Step 5/9

Thank you for completing the Personal Details questions. We now need some information about your work experience. If you do not have a current or previous employer please type 'NONE' into the mandatory fields.

Employer *
Employer Address *
Employer Address 2
Employer Address 3
Employer Town / City *
Employer Postcode / Zip Code
Employer Country *
Position Held *
Salary *
Date Started * Month Year
Date Finished Month Year
Reasons for leaving
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Experience

Step 6/9

Do you have any experience of working in care? *
Please select any relevant care experience you have
Please give details

Qualifications Do you hold any formal care-related qualifications? *
Please select qualifications obtained

Declaration of Criminal Record

Step 7/9

The position you are applying for is listed in Schedule 1, Part II of the Rehabilitation of Offenders Act (Exceptions) Order 1975, Active Assistance is entitled to ask Exempted Questions as defined by Section 113(5) of the Police Act 1997 about you. From October 2003, Active Assistance is required by the Domiciliary Care Agencies Regulations 2002 to acquire a criminal record certificate in relation to any person who is a care manager or domiciliary care worker.

This means that if your application is successful we will obtain from the Criminal Records Bureau a criminal record certificate relating to you, before your appointment is confirmed. You are however encouraged to tell us about your criminal record before we obtain a criminal record certificate.

Have you been convicted for a criminal offence?*
Please give details

Having a criminal record will not necessarily bar you from working with us. This will depend on the nature of the position and the circumstances and background of your offences. Active Assistance has a written policy on the recruitment of ex-offenders and we will give you a copy of it on request.

Active Assistance observes the "Code of Practice for Registered Persons and Other Recipients of Disclosure Information" published by the Criminal Records Bureau at www.crb.gov.uk on behalf of the Home Office, and we will give you a copy of it on request.

Personal Care Assistant Duties

Step 8/9

As a PA, your duties will include general house work. Please confirm that you are prepared to help with washing, shopping, cooking and general cleaning *
As well as general tasks you will be required to help with personal care. Please confirm that you are prepared to help with getting up, going to bed, washing and toiletting *
As a PA, your duties will include driving the client's vehicle. Clients will provide vehicle insurance for PAs to drive. Please confirm that you are prepared to do this and give brief details of your driving experience (eg. how often you drive, types of vehicle). *
Driving Experience Details *

Other

Step 9/9

When would you be able to start work? * Year
Where did you hear about Active Assistance? *
If other then please specify
Submit