1.

Application Form
Please Return to the Home You
Wish to Apply to

Post Applied For: Wellbeing Assistant

Please write clearly in black ink or type.

PERSONAL DETAILS (BLOCK CAPITALS PLEASE)

Surname: PRICE-COLLIER Forename: CALEB

Former Initials: CPC
Surnames if
Different: MR
Address: 17 LLYOD CLOSE, LAWLEY VILLAGE, Preferred Title:
Tel No (home): N/A
Tel No (business): N/A
Town: TELFORD Post Code TF3 5JE
Tel No (mobile): 07305 970226
Email Address: CALEBTPC@OUTLOOK.COM
Do you need a work permit to / No Preferred Full-Time
be employed in the UK? Work
Arrangements:
If you have a work permit, when does it expire? (Please note that your current work permit may not be valid for this post)

Please tick shift availability: Mornings x Evenings z Weekends x

Afternoons x Nights x At short notice

EDUCATION AND PROFESSIONAL QUALIFICATIONS

Secondary School / Dates Examinations Taken Date Result

College /
From To
University
TELFORD LANGLEY 2012 2017 ENGLISH 2017 B
“ “ “ MATHS “ D
“ “ “ SCIENCE “ C
“ “ “ IT “ C
“ “ “ SPORT “ C
Professional qualifications currently held; how obtained, grade and date and any other relevant
educational or training courses, with dates:

PRESENT POST

Title of Post: SUPPORT WORKER Salary/Rate of Pay: £8.21 / hour

Name of Employer: CARETECH Business of Employer: CARE
Address: CHARLTON ARMS APARTMENTS, Date Commenced: 24/02/2020

Date Ended: PRESENT

Town TELFORD Post Code TF1 1AH
Please outline your responsibilities, to whom you are responsible and staff responsible to you
(if applicable):
At CareTech my responsibilities are all around, from cleaning the complex to caring for the
people that I support. Charlton Arms Apartments is a challenging behaviour unit with a range of
needs from high functioning autism to complex needs and that’s where I come in. I help assist
them with their personal care, change their bed sheets, make them their breakfast and help
them get dressed where needed. When supporting the people with more challenging behaviour,
I must remain vigilant and always be on my feet being careful not to get caught off guard and
smacked. These people often create mess and that is where I need to think fast and clean that
mess up to ensure a clean living environment. Here at Charlton Arms, there is one person that
ligatures and requires a close eye, when ever supporting them, I must always be looking out for
any signs they may attempt to hurt themselves.
Reason for leaving or wishing to leave: The Farmstead is closer to home, within walking
distance in fact.
Period of notice required to terminate 4 weeks
present employment:

PREVIOUS EMPLOYMENT

Name and Address of Position Held Dates of Employment Reason for Final Grade/Salary
Employer Leaving
SWANTON CARE Support 12/03/19 09/06/19 5,074.56
worker

Description of Duties: At Darwin Place, I would assist the people I supported in their every day lives
from the moment they get up, helping out with their personal care and getting them some breakfast,
to the evening. Here I would encourage independence where possible.
Name and Address of Position Held Dates of employment Reason for Leaving Final
Employer Grade/Salary
SWANTON CARE Support 16/11/19 20/02/20 2,000
worker

Description of Duties: In the community, I would do the same as I did when I worked for swanton at
Darwin Place

Name and Address of Position Held Dates of Reason for Leaving Final Grade/Salary
Employer Employment

Description of Duties:

Name and Address of Position Held Dates of Reason for Leaving Final Grade/Salary
Employer Employment

Description of Duties:

RELEVANT SKILLS, ABILITYS, KNOWLEDGE, EXPERIENCE, AND YOUR REASON FOR

APPLYING FOR THIS JOB
 OTHER INFORMATION

Do you hold a current driving No Do you have access to a car? No

licence?
Disabilities
selected for an interview, do you require any special arrangements to No
be made on account of a disability?
“yes”, please give brief details of the effects of your disability on your day-to-day activities, and any
other information that you feel would help us to accommodate your needs during your interview
and fulfil our obligations under the Equality Act 2010:

Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975

ave you any convictions that are not spent under the Rehabilitation of Offenders No
Act?
“yes”, please provide further details:

As this post is covered by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975, both
spent and unspent convictions must be declared.

1. REFERENCES
Referee 1 Referee 2
itle: Miss itle: Me
ull Name: Christine Ward-Poole ull Name: Kealan Gosney
ob Title: Service Manager ob Title: Team Leader
rganisation: SWANTON CARE rganisation: CareTech
ddress:The Dingle, Much Wenlock ddress: Charlton Arms Apartments

own Telford Post Code TF13 6AT own Telford Post Code TF4 1AH
el No: el No: 01952 256105
ax No: ax No:
mail Address: N/A mail Address: N/A
lease state if we may obtain this es lease state if we may obtain this es
reference prior to an reference prior to an
interview. interview.
2. DECLARATION
declare that the information given in this application form is true and complete. I understand that if I
have given any misleading information on this form or made any omissions, this will be sufficient
grounds for terminating my employment.
ignature: ate:
ame:
he information provided to you on this form as an applicant will be stored either on paper records or a
computer system in accordance with the Data Protection Act 1998 and will be processed solely in
connection with recruitment.