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Beacon Health & Social Care - Application Form

GUIDANCE NOTES FOR APPLICANTS

Please read the guidance notes and information carefully before completing your application form.

The application form

Please complete your application form in black ink.

Applications will only be considered from candidates who meet the requirements set out in the person
specification. Please note that CVs will not be accepted.

The application form plays a key part in our selection process. We use the information to decide whether you
are shortlisted for interview. To do this, we will examine the ways in which you have demonstrated in the
application form how you meet the job requirements. We will not make assumptions about your achievements
and abilities. You must, therefore, be clear on the form about exactly how you match our requirements.

Completing the application form

In this recruitment pack you will find a person specification, setting out the role of the job, details of the
selection criteria and the attributes required by the successful candidate. You should study the information
carefully. It will help you fill in the application form.

The first part of the application form deals with general information about yourself; when listing your current
and previous employment, please ensure that dates are correct and in date order, with the most recent first.
Remember to explain any gaps in your employment history.

The second part focuses on the skills the successful candidate will need to do the job well. Please provide
clear details, or examples from your past experience, which relate specifically to the essential criteria. If you do
not tell us, we cannot make assumptions about your experience or ability. The information provided can be
taken from any aspect of your life that you consider relevant. This may be your current and previous
employment (paid or unpaid), experience gained at home, in the community or through voluntary, leisure or
school activities.

Any desirable criteria shown under the minimum requirements on the person specification should be
addressed in the ‘How do you meet the valued behaviours in the personal specification?’ box on the form.

The information provided on how you meet the essential criteria will also be used as a basis for the interview,
which will be structured around the areas of values and skills outlined in the person specification, if you are
shortlisted for interview, the details and examples you give here will be used as the basis for questions and you
will be asked to discuss your experiences in more detail. During the interview, you will also be expected to
demonstrate how you meet the valued behaviours for the role set out in the person specification.

Selection

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The applicants who appear from the information available on the application form to be best qualified and have
the experience required will be invited to attend for interview. The panel of assessors will recommend from the
interviews the candidate(s) considered most suitable for appointment. The successful candidate(s) will be
subject to pre-employment checks that cover each area as health, nationality, etc.

References

Your references must be from your most recent employer and previous employer or, if you have been in
education in the last five years, your last school, college or university.
DATA PROTECTION

The personal data that the application form collects about you will be used for the purposes of processing your
application. If your application is successful, it will be used to form the basis of your staff record.

Where you are unsuccessful in the selection process, manual records will be kept for 6 months then destroyed.

I agree to Beacon Services + Limited holding and processing the data supplied on this form and on the
application form, provided that proper regard is had to such data protection principles as may be in force. For
the purposes of electronic communications, inclusion of your name in the Signature field below will be taken
as acceptance of the above conditions.

Signature: [Link]

Date: 14/11/2023

RESTRICTIONS

Carers working at Beacon Services + Limited who have the opportunity for access to young persons or
vulnerable adults are exempt from the provisions of the Rehabilitation of Offenders Act 1974. If you have
received any convictions, which for other purposes are ‘spent’ under the provisions of the Act, you are not
entitled to withhold information and, in the event of employment, any failure to disclose such convictions could
result in dismissal or disciplinary action by Beacon Services + Limited. Any information given will be
completely confidential and will be considered only in relation to your application for a position to which the
order applies.

Is there any reason that you cannot work with young persons or vulnerable Yes  No ×
adults?

Have you ever been refused employment, or had your employment terminated Yes  No
whilst working with young persons or vulnerable adults?
×
Have you ever been subject to any formal investigation or police investigation Yes  No
whilst working with young people and vulnerable adults?
×
Do you have any cautions (including any final warnings or reprimands) or Yes  No 
convictions which are not ‘protected’ as defined by the Exceptions Order ×
1975* to the Rehabilitation of Offenders Act 1974?
*As amended by the 2013 Exceptions Order

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If yes, please give dates and details of any convictions:

Are there any other matters that may be relevant to your suitability to work for Beacon Services +
Limited? (There is no obligation to disclose a protected caution or conviction as defined by the
Exceptions Order 1975* or any circumstances ancillary to that protected caution or conviction).

PREVENT AND FUNDAMENTAL BRITISH VALUES

Beacon Services + Limited, has a legal and moral obligation to ensure our staff and Service
Users are not exposed to views that conflict with, or undermine, fundamental British Values. All
visitors should read the statements below and indicate if they agree, and then sign the declaration
below.

Beacon Services + Limited is acting in the best interests of staff and Service Users and not making
any unfavourable judgement about visitors or their views and opinions.

I confirm that I will not incite an audience to violence, breach of the peace or Yes × No

racial hatred, and I understand that such words or actions are contrary to  public
orders and as such will not be regarded as lawful speech.

I confirm that I will respect the rights and freedom of others as protected by Yes × No

the law (for example, I must not make statements which are actionable or 
defamation). I will respect the freedom of speech of others and will ensure that
no groups face unlawful discrimination as a result of my words or actions.

I confirm my support for fundamental British values including democracy, the Yes × No rule

of law, individual liberty and mutual respect and tolerance of those with  different faiths and
beliefs. I fully understand that freedom of speech does not extend to individuals or organisations
not committed to these values.

Signature: [Link]

Date: 14/11/2023

APPLICANT COMMITMENT TO SAFEGUARDING

This form must be read in full, signed and dated, and returned with your completed application form.
Application forms returned without this signed declaration will not be accepted.

Beacon Services + Limited is committed to safeguarding and promoting the welfare of young people and
vulnerable adults and expects all staff to share this commitment. Successful applicants will be required to apply
for Disclosure from the DBS. The payment of the DBS is payable by the employee.

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Rehabilitation of Offenders Act 1974

Staff working at Beacon Services + Limited, who have the opportunity for access to young persons, are
exempt from the provisions of the Rehabilitation of Offenders Act 1974.

The company actively promotes equality of opportunity with the right mix of talent, skills and potential, and
welcome applications from a wide range of candidates, including those with criminal records. Beacon
Services + Limited selects all candidates for employment based on their skills, qualifications and experience,
in comparison against a prepared personal specification.

For those positions where a Disclosure is required, staff are not entitled to withhold information regarding
convictions. Any failure to disclose such convictions could result in dismissal or disciplinary action by the
company. Where a Disclosure is to form part of the recruitment process, the company encourages all
applicants called for interview to provide details of their criminal record at an early stage in the application
process (i.e. via the application form).

Agreement Statement

I confirm that I have read, understood and agreed with Beacon Services + Limited, Safeguarding Vulnerable
Groups – Essential Recruitment and Selection Practice Policy; and the Policies for Safeguarding Young People
and Adults at Risk (attached).

I confirm that I am not registered on the Children and/or Adults Barred List(s) held by the DBS (formerly held by
the ISA), disqualified from work with children, or subject to any sanctions imposed by a regulatory body. I am
aware that if applicable to the post, I will be required to apply for, or allow Beacon Services + Limited to take
a copy of my disclosure certificate which will be retained and stored by Beacon Services + Limited in
accordance with DBS (formerly CRB) Code of Practice.

For the purposes of electronic communications, inclusion of your name in the Signature field below will be
taken as acceptance of the above conditions.

Signature: [Link]

Date: 14/11/2023

PERSONAL DETAILS

Forenames: Dorothy Surname: Mukanga

Home address in full: 48 8th Avenue Roodeport Address for correspondence (if different from home
North, Johannesburg address):8609 Odzi Township Mutare, Zimbabwe

Home telephone number:+27734175597 Work telephone number (if it may be used):

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 Mobile telephone number: +27734175597 Email address: mukangadorothy02@[Link]

National Insurance Number: tn210495f

Do you own a car? Yes ×  No  Current driving licence: Yes ×  No 
UK/European Economic Area National Yes  No ×
If no, please give details of work permit currently held: l require certificate of sponsorship l have funds
Have you ever lived and/or worked abroad – if so, please provide details (including where and when)
N/A

Availability for work with Beacon Services + Limited: Note:

Monday AM  PM  Evening ×
➢ Must be able to work
Tuesday AM ×  PM  Evening  at least 2
Wednesday AM  PM  Evening × evenings a week
➢ Work all day on a
Thursday AM ×  PM  Evening 
Saturday or
Friday AM  PM  Evening × Sunday, or
Saturday AM × PM  Evening  ➢ Saturday and
Sunday full days
every other week

Sunday AM  PM × Evening 

Standards
In order to guide the interview process, we would like you to indicate your personal philosophy of Care
by completing the following statement.

Is to offer consistent, unconditional care, enabling each service

user to live in an environment that encourages positive
I believe that the purpose of Care from a Care
relationships, mutual respect, trust, and consideration for
Service is:
others.

To receive quality care that is tailored to my individual needs and

preferred. I would also like to feel respected, listened to and involved
If I were a Service User in The Agency, I would in decision-making
like:

I believe that people should be at the centre of their own care

I believe that the Service User’s family and and help shape their treatment.l think it is your right to know
relatives would like from The Agency: what to expect and where to find more information if its needed

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 I will be providing compassionate, person -centered care that is
I believe that I can support Service User in The tailored to the individual’s needs
Agency because:

As a member of The Agency Care team I feel Trusted

valued when:

Mutual respect, trust, open communication and non-judgmental

I believe that a good relationship between me attitude
and the Service User depends on:

Actively participating in the lesson by explaining, solving, struggling,

I believe that I learn best when: making mistakes and learn from them

I believe that a good team work is made by: Having mutual respect ,common and aligned goals, open
communication,and patience

I believe that my role in relation to the Service To provide a safe, supportive and therapeutic environment, whilst
User is: encouraging the service user to take responsibility for their own care

My other beliefs and values of relevance to my Individuality, independence, privacy, partnership, dignity,
job are: respect and rights

Have you previously applied for a post within Beacon Yes  No x 

Services + Limited Care Ltd in the last six months?

If yes, please give details:

EMPLOYMENT HISTORY

Most Recent or Current Employer

Hours worked per week

Mrs Natasha Van Rooyen
Frailcare@[Link] 40 hrs
+2711568-9255
Paid/Unpaid
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Care Assistant (Volunteer) at Serenity Haven Frail Care
Starting from 02/2020 – current From: 02/2020

Responsibilities • Monitored and assisted residents through Current

individual service plans.
• Assisted with feeding and monitored intake to help patients achieve
nutritional objectives.
• Performing healthcare-related tasks, such as monitoring vital signs
and medication, and kept a daily journal of medical intake.
• Turned and positioned bedbound Patients to prevent bedsores and
maintain comfort levels.
• Planned, prepared, and served meals and snacks according to
prescribed diet.
Notice Period: 1 week
Position(s) held if applicable (starting with current post) and brief details of
responsibilities: Operations Manager Salary:0000

Previous Employers (most recent first)

Hours worked per week

Mr Marlon Anderson 35 hours
Marlonysibanda70@[Link]
+263771083952 Paid/Unpaid

Personal care Assistant (Private Residence) From: 01/2016-09/2019

Responsibilities : • Assisted with daily living activities, running errands, and

household chores. • Entertained, conversed and read aloud to keep
patient mentally alert.
• Transported individual to events and activities, medical
appointments, shopping trips.
• Assisted with dressing guidance, grooming, meal preparation, and
medical reminders.
• Supported client with mental support and physical activities to
accomplish quality of life and sustain needs.

Hours worked per week;37 hours

Mr George Smith
Cleaner Paid/Unpaid:paid
Smith@[Link]
+27735063045 From: 01/2015

Hours worked per week: 40 hours

Serenity Haven Frail Care
41 kliprand Avenue Discovery, Roodeport Home Paid/Unpaid: unpaid
Care
From: 02/2020

Private residence Hours worked per week:35 hours

26 Avondale Harare, Zimbabwe
Paid/Unpaid: paid

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 From: 01/2016- 09/2020

Hours worked per week

OCD Marketing
26 shamrock street Florida Paid/Unpaid
Marketing Company
From: Month/Year

PLEASE ACCOUNT FOR ANY PERIOD(S) OF UNEMPLOYMENT

EDUCATION AND QUALIFICATIONS

HIGHEST EDUCATION ATTAINED

3/09/2021-04/09/2022 School/University Course/Major Qualification
Chilton college Course Elderly Care

PROFESSIONAL QUALIFICATION
03/09/2021-04/09/2023 School/University Course / Major Qualification
Chilton college Course Special needs
for Adults
and children

First Aid and

CPR

COURSES CURRENTLY PURSUING

Expected Date of Completion School / Course
University

QUALIFICATION DETAILS
Secondary Education
Name of school/college: From: To:

Subject Qualification Grade/Result Awarding Body

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Chilton college Elderly Care 09/2021 09/2022

Name of college/university: From: To:

Subject Qualification Grade/Result Awarding Body

Caredemy Autism Spectrum Disorder in Adults 2023 2023

Name of college/university: From: To:

Subject Qualification Grade/Result Awarding Body

Caredemy Care certificates (1 to 15 standards) 2023 2023

Name of college/university: From: To:

Subject Qualification Grade/Result Awarding Body

Name of college/university: From: To:

Subject Qualification Grade/Result Awarding Body

Name of college/university: From: To:

Subject Qualification Grade/Result Awarding Body

Name of college/university: From: To:

Subject Qualification Grade/Result Awarding Body

Name of college/university: From: To:

Subject Qualification Grade/Result Awarding Body

HOW DO YOU MEET THE VALUED BEHAVIOURS IN THE PERSONAL SPECIFICATION?

Qualifications, experience and position held

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 REFERENCES

References will be taken up prior to start of employment.

Please give details of three references (if possible), one of whom should be your most recent employer and previous
employer. One should be a character reference.

Name: Mrs Natasha Van Rooyen Name: Mr Marlon Anderson

Address:41 kliprand Avenue Discovery Address: 26 Avondale Harare Zimbabwe

Email: frailcare@[Link] Email: marlonysibanda70@[Link]

Telephone Number: +2711568-9255 Telephone Number: +263771083952

Relationship (e.g. manager) manager Relationship (e.g., manager) boss

Name: Mr George Smith NEXT OF KIN DETAILS

Name: Zenzele Nyathi
Address: 26 shamrock street Florida Address: 48 8th Avenue Roodeport North

Email: Smith@[Link] Email: sibandazenzele12@[Link]

Telephone Number: +27735063045 Telephone Number: +27814720464
Relationship: (e.g. friend) Pastor Relationship: Spouse

PROFICIENCY IN LANGUAGES
Native Languages

Speak Read Write

High Moderate Low High Moderate Low High Moderate Low

English ×    ×   × 

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Other Languages         

………………………………

Proficiency In IT
Excel/ Microsoft Office and suchlike equivalent packages

Experience Multitasking Typing speed

High Modera Low High Moderat Low High Moder Low

te e ate
Excel ❑ ❑× ❑ ❑ ❑× ❑ ❑× ❑ ❑
Microsoft Office ❑× ❑ ❑ ❑× ❑ ❑ ❑× ❑ ❑
Other: Microsoft word ❑× ❑ ❑ ❑× ❑ ❑ ❑× ❑ ❑

Other Skills

Flexible
Excellent communication
Caring
Compassionate
Friendly

DECLARATIONS

To the best of my knowledge and belief the information I have given is correct. I understand that my application will be
disqualified or, if already appointed, disciplinary action considered, if I have knowingly given false information.

I am also aware of and agree to accept the conditions set out in the accompanying information relating to provision of
information of criminal convictions.

By completing this declaration, you agree that you have read and understood the terms and conditions of your
employment.

For the purposes of electronic communications, inclusion of your name in the Signature field below will be taken as
acceptance.

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Signature: [Link] Date: 14/11/2023

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Statement in Support of Application (continue on a separate sheet if required).
Please state why you believe you are a suitable candidate for this post by explaining how you meet these
requirements and the experience which you have which is relevant. Please give examples of particular
achievements.

I believe l have all the skills and experience listed in the job description, and im confident that l can make
an immediate impact on your company, l have more than 5 years of experience in taking care of Elderly
people and physical challenged people with dignity and respect. Empathy is embedded in my personality.

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OTHER INFORMATION
Earliest Date Available if Appointed

Are you subject to any restrictions or covenants from your previous employer which may restrict your working
activities? If yes, please give details  Yes  No×
This role may require you to work a varied shift pattern which will include some weekends as demanded by the
business, are you willing to do so, if required?

❑ Yes ❑ No
If no, please give more detail

Have you had any criminal convictions (including spent convictions under the rehabilitation of offenders Act 1974)? If
yes, please give details.  Yes  No×

You are required as part of your application to complete a Disclosure and Barring Service check? Will you be willing to
take part in this (the cost will be covered by the company)?  Yes×  No

Have you applied for employment with this company before?  Yes×  No
Are you related to any employee working at this company?  Yes  No×

DECLARATION
Yes No
 × Are you bound by any bond to serve the government, or any organisation?
 × Have you ever been convicted in a court of law in any country? If yes, what were the circumstances?
 × Have you been dismissed or suspended from the service of any employer?

×  Are you willing to work overtime?

If yes to any of the above, please give details here
I’m willing to work overtime because im flexible

Have you ever interviewed with the Company or its

affiliates before? ◻ Yes ◻ ×No If yes, list job title & location applied for

Have you ever been employed by the Company or

its affiliates before? ◻ Yes ◻× No If yes, list date(s), job title(s) & location(s)

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 Do you have any relatives employed by the
Company or its affiliates? ◻ Yes ◻× No If yes, list name, relationship, job title and location

CERTIFICATION & AUTHORIZATION

I certify that all entries are true and correct. I understand that all information on this application is subject to verification. I
agree and understand that, in the event of my employment by the Company, I shall be subject to dismissal if any information
that I have given in this application is false or misleading, regardless of time of discovery.

DATE: ________14/11/2023__________________ SIGNATURE OF APPLICANT: D.Mukanga_________________________

I authorize the Company to inquire into my educational, professional and past employment history references as needed to
research my qualifications for this position. I hereby give my consent to any former employer to provide employment-related
information about me to the Company and will hold the Company and my former employer harmless from any claim made on the
basis that such information about me was provided or that any employment decision was made on the basis of such information.

I hereby acknowledge that I have read and agree to the above statements

DATE 14/11/2023________________________ SIGNATURE OF APPLICANT _D.Mukanga___________________________

FOR OFFICIAL USE ONLY

Date of
Designation Department Grade Starting Pay
Commence

Interviewed By Recruitment Sources:

Date Source Name:

FOR OFFICE USE ONLY:

To the best of my knowledge, based on the information given throughout this pre-employment questionnaire, the
applicant, (……………………………………………………………………………………) is both mentally and physically fit for the post applied
for.

Manager signature _____________________________

Date _____________________________

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 BANK DETAILS

We kindly ask you to fill in the below information as soon as possible (This information will be required at a
later stage, if you succeed and are offered a role. Please be advised that you must provide your bank details):

NAME ON CARD __________FNB______________

SORT CODE _______650498_______________________

ACCOUNT NUMBER ___________63059046426_____

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