Caregiver Application - Blanche Caring Heart

Caregivers

We don’t just give care We take care as well.

We're provides quality local caregivers in your community for professional, attentive in-home care.

Caregiver application

At Blanche Caring Heart, we select Caregivers who are passionate about providing in home care to those in need on a daily basis. To apply for a position please complete the form below.

Name*
First Middle Last
Status
Internal Notes
Email*
Enter Email Confirm Email
Phone*
Mobile Phone
Position(s) applied for*
Referral Source*
- Advertisement
- Employee
- Relative
- Walk-in
- Internet
- State Employment Agency
- Private Employment Agency
- Other
Other
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
How long at this address?*
Previous Address
Street Address Address Line 2 City Region Post Code
How long at this address?
What days and hours are you NOT available for work?
Have you previously worked at this agency?
Are you legally eligible to work in the United Kingdom? (Proof of eligibility required.)*
Applicants considered for hire will be subject to a thorough background screening process that includes a criminal background check, and may include a motor vehicle check and drug screen. (Please note that some positions require you to be insured and bonded.)
Do you have reliable transportation to and from work and for travel between worksites, if required?
- Yes
- No
Do you have relatives currently employed by this agency?
- Yes
- No
If yes, please list:
Are you able to perform the essential functions of the job for which you are applying, with or without reasonable accommodations?
- Yes
- No
If no, describe the functions that cannot be performed:
Secondary School Background:
Secondary School Name, City*
How many years attended*
Did you obtain your GCSE'S (Maths and English)or the Equivalent?*
- Yes
- No
Did you attend College?*
- Yes
- No
University Background
University Name/City*
How many years attended*
Graduated?*
- Yes
- No
Course/major*
Employment History
List your last three (3) employers, assignments, or volunteer activities, starting with the most recent, including military experience.
Employer 1 name*
Employer 1: Telephone*
Employer 1: Date Employment Started (month and year)*
DD slash MM slash YYYY
Employer 1: Date Employment Ended (month and year)*
Employer 1: Summarise the nature of the work performed and job responsibilities*
Employer 1 Address*
Street Address Address Line 2 City Region Postcode Country
Employer 1: Job Title*
Employer 1: Immediate Supervisor and Title*
Employer 1: Starting Hourly Rate/Salary*
Employer 1: Reason for leaving*
Employer 1: Final Hourly Rate/Salary*
Employer 1: May we contact for reference/verificaton?*
- Yes
- No
- Later
Employer 2: name
Employer 2: Telephone*
Employer 2: Date Employment Started (month and year)
DD slash MM slash YYYY
Employer 2: Date Employment Ended (month and year)
Employer 2: Summarise the nature of the work performed and job responsibilities*
Employer 2: Address
Street Address Address Line 2 City Region Postcode Country
Employer 2: Job Title
Employer 2: Immediate Supervisor and Title*
Employer 2: Starting Hourly Rate/Salary
Employer 2: Reason for leaving
Employer 2: Final Hourly Rate/Salary
Employer 2: May we contact for reference/verificaton?
- Yes
- No
- Later
Employer 3 name
Employer 3: Telephone*
Employer 3: Date Employment Started (month and year)
DD slash MM slash YYYY
Employer 3: Date Employment Ended (month and year)
Employer 3: Summarise the nature of the work performed and job responsibilities*
Employer 3: Address
Street Address Address Line 2 City Region Postcode Country
Employer 3: Job Title
Employer 3: Immediate Supervisor and Title
Employer 3: Starting Hourly Rate/Salary
Employer 3: Reason for leaving
Employer 3: Final Hourly Rate/Salary
Employer 3: May we contact for reference/verificaton?
- Yes
- No
- Later
Employer 3: Comments and other skills, licenses/certifications and qualifications:
References
List name and telephone number of three professional references that are NOT related to you. If not applicable, list three school or personal references that are not related to you, whom have knowledge of your work ethic, experience, and abilities.
Reference #1 Name*
Reference #1 Telephone*
Reference #1 Years Known*
Reference #1 Relationship*
Reference #2 name*
Reference #2 Telephone*
Reference #2 Years Known*
Reference #2 Relationship*
Reference #3 name*
Reference #3 Telephone*
Reference #3 Years Known*
Reference #3 Relationship*
By submitting this form I certify that the facts contained in this application and/or interview(s) are true and complete. Any misrepresentation or falsification of information or significant omissions will be cause for rejection of my application or for subsequent discipline up to and including my dismissal from employment if discovered at a later date.
I understand that, if employed, my employment is not guaranteed for any term, and my employment may be terminated by the employer or myself at any time and for any reason with or without notice. No representative of this agency other than the owner(s) is authorized to make any assurance or promise of continued employment and any such assurance must be in writing signed by the owner(s).
The employer, this agency, is an Equal Opportunity Employer. The employer does not discriminate in employment and no questions on this application is used for the purpose of limiting or excusing any applicant's consideration for employment on a basis prohibited by local, state, or federal law.

Blanche Bongo

Registered manager

Blanche Bongo has over thirty eight years of experience in the Care and Services Industry.

John henry

Care Co-Ordinator

John has experience in ensuring that the level of care that is provided to our clients does not fall short of any expectations that is expected of a care provider.

Lysa Mayasi

Care Co-Ordinator

Lysa has nineteen years experience in the Care Services Industry.

Why Should I apply to Blanche Caring Heart?

We are a CQC registered home care agency. We care for our clients and our employees. We provide our caregivers with qualification, appreciation events, prizes, and extended education and training opportunities.

Where can I work?

We currently have 1 branch office that covers Kent and Greater London as well Nationwide when it comes to our live-in care positions. You can work in a position that is most convenient for you and you can choose the jobs that are closer to your home.

What types of shifts do you offer?

We are constantly growing and have a wide variety of shifts you can choose from. We have long shifts, short shifts, day shifts, night shifts, transportation shifts and live-ins*. (Live-ins available Nationwide. We are available 24hrs a day 7 days a week so we are flexible and will work around your schedule.

Do you hire private contractors?

At Blanche Caring Heart, you are part of the team. You will be considered an employee of Blanche Caring Heart which means payroll taxes are automatically deducted from your weekly paycheck and if there are any questions, we are here for you! We are fully bonded and insured and are there for you every step of your employment with us.

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Caregivers

We don’t just give care We take care as well.

Secondary School Background:

University Background

Employment History

References

Blanche Bongo

Registered manager

John henry

Care Co-Ordinator

Lysa Mayasi

Care Co-Ordinator

Why Should I apply to Blanche Caring Heart?

Where can I work?

What types of shifts do you offer?

Do you hire private contractors?

24/7 service available

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