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Online application
Stokes Case Management Online Application Form
Step
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I would like to apply for a position as a:
*
Support Worker – General
Support Worker – Brain Injury Experience
Support Worker – Spinal Injury Experience
Support Worker – Paediatric Experience
Support Worker – Learning Disabilities
Live in Support Worker / HCA
Healthcare Assistant – Complex Care Experience
Healthcare Experience – General
Registered Nurse – Adults
Registered Paediatric Nurse
Please select the most appropriate to your skills and experience.
Name
*
First
Last
Mobile Phone Number
*
Landline
Date of Birth
*
DD slash MM slash YYYY
Email
*
Address
*
Street Address
Address Line 2
City
ZIP / Postal Code
Current UK/EU Driving Licence
*
Yes
No
I confirm I have the right to remain and work in the UK
*
Yes
No
Photo Upload
Max. file size: 70 MB.
If possible please upload a photograph of yourself, similar to a passport photo, Just head and shoulders. This will be used for your ID badge if your application is successful.
Emergency Contact Details
Name
*
First
Last
Relationship to you
*
Phone Number
*
Email
Employment History
If you have an up to date CV, then please upload it here
Max. file size: 70 MB.
Last Employer
*
Date employed from
*
DD slash MM slash YYYY
Date employed to
DD slash MM slash YYYY
Leave blank if still employed
Please give a brief overview of your duties and responsibilities
*
Be sure to include any clinical skills that you used and the the clinical conditions of the clients you worked with.
Previous Employer
Date employed from
DD slash MM slash YYYY
Date employed to
DD slash MM slash YYYY
Leave blank if still employed
Please give a brief overview of your duties and responsibilities
Be sure to include any clinical skills that you used and the the clinical conditions of the clients you worked with.
Previous Employer
Date employed from
DD slash MM slash YYYY
Date employed to
DD slash MM slash YYYY
Leave blank if still employed
Please give a brief overview of your duties and responsibilities
Be sure to include any clinical skills that you used and the the clinical conditions of the clients you worked with.
Skills and Expertise
Experience
Adults
Children (0 – 18)
Elderly (65+)
Acquired or Traumatic Brain Injury
Spinal Injury
Cerebral Palsy
Motor Neurone Disease
Epilepsy
Dementia
Complex Care
Mental Health
Palliative Conditions
Please tick all the client ages and client conditions that you have had experience working with.
Clinical Skills
Tracheostomy
Ventilation
Oral suctioning
Stoma Care
Bowel Care
Catheter Care
Medication Admistration
Epilepsy Seizure Management
PEG Feeding
PEG Medication
Nebulisers
Please tick all of the following clinical skills where you received formal training and then used those skills in a care setting having been trained.
Certificates
Drop files here or
Select files
Accepted file types: jpeg, gif, png, pdf, Max. file size: 70 MB.
Please upload any certificates of formal clinical or mandatory training here. All certificates must be dated within the last 12 months
Education
Please select any of the following qualifications you have attained:
NVQ Level 2 – Health & Social Care
NVQ Level 3 – Health & Social Care
NVQ Level 4 – Health & Social Care
NVQ Level 5 – Health & Social Care
Diploma in Nursing
Degree in Nursing
Other
If you have selected "other", then please list your qualifications here
Certificates
Drop files here or
Select files
Accepted file types: jpeg, gif, png, pdf, Max. file size: 70 MB.
Please upload any certificates you have received for your qualifications here
References
You will be asked to provide contact details of a minimum of 2 and a maximum of 4 people that can provide you with an employment reference, one of them must be your most recent employer
Reference 1 – Company Name
*
Name
*
First
Last
Position
*
Email
Phone Number
*
Address
Street Address
Address Line 2
City
ZIP / Postal Code
Reference 2 – Company Name
*
Name
*
First
Last
Position
*
Email
Phone Number
*
Address
Street Address
Address Line 2
City
ZIP / Postal Code
Reference 3 – Company Name
Name
First
Last
Position
Email
Phone Number
Address
Street Address
Address Line 2
City
ZIP / Postal Code
Reference 4 – Company Name
Name
First
Last
Position
Email
Phone Number
Address
Street Address
Address Line 2
City
ZIP / Postal Code
Disclosure Barring Checks
All staff working for Stokes Case Management must have an up to date Enhanced DBS Certificate. If you have signed up for the DBS Update Service you will only need to provide a small amount of information in this section. If not we will require further information from you.
Please confirm whether your are registered with the DBS Update Service
Please Select
Yes
No
This is an online service that you would have needed to register your last DBS Certificate with within 3 weeks of receiving it. You will have agreed to pay £13.00 per year to sign up to this service. If you don’t remember doing this then please select “NO” in the options above..
Please provide the DBS Certificate number that your registered with the update service
The certificate number is located in the top right hand corner of the certificate
Address History
We need your address history covering the last 5 years. Please provide your addresses starting with the address before your current address. Give the month and year that you moved into each address.
Address
Street Address
Address Line 2
City
County / State / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Swaziland)
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Réunion
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Month and year from
Month and year to
Address
Street Address
Address Line 2
City
County / State / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Swaziland)
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Réunion
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Month and year from
Month and year to
Address
Street Address
Address Line 2
City
County / State / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Swaziland)
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Réunion
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Month and year from
Month and year to
Have you ever changed your surname since birth?
Yes
No
What was your previous surname?
What was the month and year that your surname changed?
Have you ever changed your nationality since birth?
Yes
No
What was your previous nationality?
What was the month and year that your nationality changed?
Convictions
Rehabilitation of Offenders Act 1974: State any convictions/offences, information of which you are not
entitled to withhold, under the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975, in view of
the nature of the work for which you are applying:
Do you have any convictions or offences to disclose?
*
Please select
Yes
No
If you answer yes, you will be requested to provide details
If yes, then please give details
Identification
At interview you will be asked to present at least 3 forms of identification to confirm your identity, eligibility to remain and work in the UK and to prove your address. Please indicate in this section which documentation you will be able to bring with you to interview from the groups below, all documents must be originals and not photocopies.
Group 1: Primary Trusted Identity Credentials
Current valid passport (any valid passport)
Biometric Residence Permit (UK)
Current driving licence (UK), full or provisional. Photo card only for Isle of Man/Channel Islands licences, which should be presented with the associated counterpart licence (except Jersey)
Birth certificate (UK and Channel Islands), issued at the time of birth. The full and short forms are both acceptable, including those issued by UK authorities overseas, e.g. Embassies, High Commissions and HM Forces (photocopies are not acceptable).
Adoption certificate (UK and Channel Islands)
Put a cross in each box as appropriate
Group 2b: Financial/Social History Documents
Mortgage statement (UK or EEA – non-EEA statements are not acceptable)
Bank/building society statement (UK and Channel Islands or EEA – non-EEA statements are not acceptable) 3 months
Bank/building society account opening confirmation letter (UK) 3 months
Credit card statement (UK or EEA – non-EEA statements are not acceptable) 3 months
Financial statement, e.g. pension, endowment, ISA (UK) 12 months
P45/P60 statement (UK and Channel Islands) 12 months
Council Tax statement (UK and Channel Islands) 12 months
Work Permit/Visa (UK – UK Residence Permit, valid up to expiry date)
Letter of sponsorship from future employment provider (non-UK/non-EEA only – valid only for applicants residing outside of the UK at time of application
Utility bill (UK), not including a mobile telephone bill 3 months
Benefit statement, e.g. Child Allowance, Pension 3 months
A document from central/local government authority or agency giving entitlement, e.g. from the Department for Work and Pensions, the Employment Service, HM Revenue and Customs, Job Centre, Job Centre Plus, Social Security (UK and Channel Islands) 3 months
EU National ID Card. ( must still be valid )
Cards carrying the PASS accreditation logo (UK and Channel Islands) Must be valid
Put a cross in each box as appropriate
Data Protection and GDPR
General Data Protection Regulation (May 2018): Stokes Case Management are registered with the Information Controllers Office and comply with all legislation relating to the use of the personal information you have supplied by registering for employment with us. You can find out more information about how we store and handle your personal data by contacting our registered head office.
The personal data that we will hold on file for you is as follows:
Your Name****
Your date of Birth****
Your Address ****
Your email address****
Your telephone number****
Your NI Number****
Your next of Kin information****
Your bank details****
Your Photo****
Your Work History****
Copies of your identification****
Your DBS Certficate No ****
In order for Stokes Case Management to provide you with employment opportunities, it will be necessary for us to hold and share your personal data to either comply with employment legislation, right to work in the UK checks, comply with Care Quality Commission and CSSIW regulations or to facilitate payments to you via our payroll provider and our outsourced recruitment provider. Stokes Case Management will not share your personal data with any third parties other than for the purposes stated above. Please check the box above to give your consent to the company doing so:
*
I give my consent
I do not give my consent
You have the following rights concerning your personal data: The right to be informed about the personal data we hold on file for you. The right to access the personal data we hold on file for you. The right to rectify the personal data we hold. The right to have erased the data we hold on file for you. The right to restrict the processing of data we hold for you. The right to data portability ( The right to data portability allows individuals to obtain and reuse their personal data for their own purposes across different services). The right not to be subject to automatic decision making including profiling.
*
I have read and understand my rights
Declaration
The information that I have given in this application is, to the best of my knowledge, complete and
accurate in all respects, and I am not aware of any reason why I am not fit for this work.
Please enter your name again by way of agreement to the declaration
First
Last