APPLICATION FORM

Please ensure that you complete the application form in full as we cannot accept CVs. Please complete with black ink and
block capitals. This form will be kept in confidence.
Please note that no applicant will be unfairly discriminated against. This includes discrimination on account of age,
cultural/religious/political beliefs, disability, ethnicity, gender, race, relationship status, sexual orientation, and/or Trade Union
membership or stewardship.
If you have any special requirements to support you to complete this form (e.g. the need for large print or additional time)
please contact the office on 01733 857 580
Position

Position applied for: support worker

Preferred employment type (e.g. part time, full time): Full time

Personal Details

Surname: Patel First name(s): Neelam

Current Address: Postcode:

18 Kathrines Mews, PE78BA
Hampton Hargate

Telephone number (home): Telephone number (mobile):

07448292845

Email address: [email protected]

Own Transport YES / NO NO How long has your licence been held?

Details:

Are you a United Kingdom (UK), European Community National Insurance Number:
(EC) or European Economic Area (EEA) National TL431453B
(please circle) YES / NO
YES
If no, please detail current immigration status and the Are you related to a member of staff or Service User,
relevant visa currently held (including Visa number): please circle only one: YES / NO NO

Equality Act 2010

Under the Equality Act 2010 the definition of disability is if you have a physical or mental impairment that has a “substantial”
and “long term adverse effect” on your ability to carry out normal day-to-day activities. Further information regarding the
definition of disability can be found at: www.gov.uk/definition-of-disability-under-equality-act-2010.
For the purposes of this application and the interview stage only, is there anything you would like us to be aware of
so that we can make reasonable adjustments during the process? YES / NO / PREFER NOT TO DISCUSS
NO
Alves iCare Ltd.
Education

Examinations Passed, Qualifications Gained and Year

School/College/University Obtained
(All qualifications will be subject to a satisfactory check).

London Metropolitan University, 2023 PASS

Training Courses Attended or Completing

Subject
(evidence of attending courses is Location/Details Date
required)

NVQ Level 5 in LONDON

OCT 2023
Health and Social Care

Alves iCare Ltd.

Employment History
Please record below the details of your full employment history beginning with your current or most recent first.
Use a separate attached sheet if required; please sign the sheet(s).

Name and address of your most Pure Heart Care Service,

recent/last employer:

Start date and end date: SEP 2022 TO OCT 2023

Nature of business: CARE SERVICES PROVIDER

Position held and reason for leaving:

Administrator

Name and address of employer prior

to the employer listed above:

Start date and end date:

Nature of business:

Position held and reason for leaving:

Name and address of employer prior

to the employer listed above:

Start date and end date:

Nature of business:

Position held and reason for leaving:

Alves iCare Ltd.

Name and address of employer prior to
the employer listed above:

Start date and end date:

Nature of business:

Position held and reason for leaving:

Please detail here any gaps in employment and state why:

For Study and Work location change

Alves iCare Ltd.

Supporting Statement

Please add here your reasons for applying. You should refer to the job description and person specification to guide you.
It would also be of value to describe particular strengths and talents that set you apart from others as well as including
skills gained from work, home and other activities.

Alves iCare Ltd.

Referees
You must provide references from your two most recent employers. Please provide a character reference if you are unable
to obtain two professional references, e.g. in the case of an applicant who has been raising children for ten years. All will be
contacted, therefore please inform the referees of the fact that you have used their name. If you are unable to provide the
required references, please discuss the matter with us.

Current or Most Recent Employer

Name: Pure heart care services

Address:
peterborough

Email:

Tel No:

Job title: Administrator

Previous Employer To The One Above

Name:

Address:

Email:

Tel No:

Job title:

Character Reference

Name: aditi barot

Address:
18 st katherines mews , Hampton peterborough

Email:

Tel No:

Relationship to you: Friend

Alves iCare Ltd.

Safeguarding
Ex-Offenders Declaration
Please note this section will only be seen by those involved in the recruitment process and will be treated with the strictest
of confidence.
Rehabilitation of Offenders Act 1974
Alves iCare Ltd. aims to promote equality of opportunity and is committed to treating all applicants fairly regardless of
ethnicity, disability, age, gender or gender re-assignment, religion or belief, sexual orientation, pregnancy or maternity
and marriage or civil partnership. undertakes not to discriminate unfairly against applicants on the basis of a criminal
conviction or other information declared.
Answering 'yes' to the question below will not necessarily prevent your employment. This will depend on the relevance of
the information you provide in respect of the nature of the position and the particular circumstances.

Are you currently bound over or do you have any current UNSPENT convictions that have been issued by a Court or
Court-Martial in the United Kingdom or in any other country?
YES NO NO

Do you have any current UNSPENT police cautions, reprimands or final warnings in the United Kingdom or in any other
country?
YES NO NO

Privacy
Alves iCare Ltd. will only collect data for specified, explicit and legitimate use in relation to the recruitment process. By
signing this application form, you consent to holding the information contained within this application form. If successfully
shortlisted, data will also include shortlisting scoring and interview records. We would like to keep this data until the
vacancy is filled. (We cannot estimate the exact time period, but we will consider this period over when a candidate
accepts our job offer for the position for which we are considering you). When that period is over, we will either delete your
data or inform you that we would like to keep it in our database for future roles. We have privacy policies that you can
request for further information. Please be assured that your data will be securely stored by the Registered Manager and
only used for the purposes of recruiting for this vacant post. You have a right for your data to be forgotten, to rectify or
access data, to restrict processing, to withdraw consent and to be kept informed about the processing of your data. If you
would like to discuss this further or withdraw your consent at any time, please contact the Registered Manager or
Operations Manager on 01733 857 580.

Alves iCare Ltd.

Declaration

The information in this application form is true and complete. I agree that any deliberate omission, falsification or
misrepresentation in the application form will be grounds for rejecting this application or subsequent dismissal if employed
by Alves iCare Ltd. Where applicable, I consent that Alves iCare Ltd. can seek clarification regarding professional
registration details.

19/12/2024
Name: NEELAM PATEL Date:

Signature: NEELAM PATEL

Alves iCare Ltd.