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Requesting a recruitment project
Recruitment Referral form
Step
1
of
3
33%
Case Manager information
Your Name
*
First
Last
Your contact number
Your email address
*
Client information
Client's name
*
Client's address
*
Street Address
Address Line 2
City
ZIP / Postal Code
Client's date of birth
*
MM slash DD slash YYYY
Your client's medical condition
*
Acquired or traumatic brain injury
Spinal Injury
Cerebral Palsy
Complex orthopedic
Other
If other, then please specify
Please give a brief overview of your client
*
Please include information such as their condition, whether they are mobile, require personal care, challenges they face and any relevant family information relating to their current living arrangements
How many hours of care and support are you seeking to implement for your client in total?
*
Please indicate the ratio of support staff to client required
*
1:1 support
2:1 support
Recruitment requirements
Please enter the approximate date that you would like to have support in place for
*
MM slash DD slash YYYY
How many support workers would you like to recruit for your client?
*
1
2
3
4
5
6
7
8
9
10
Please tell us the pay rate that you would like the support worker(s) to be paid
*
This is the rate the your job will be advertised at. Your recruitment team will email you to confirm the total employment cost which will include holiday pay and employers national insurance so that you can advise your client’s solicitor or deputy.
Please provide information on the likely hours and shift pattern required
*
For example:
Monday – 10:00 – 16:00
Tuesday – 09:00 – 15:00
Wednesday – 08:00 – 20:00 etc etc
Are you seeking to recruit workers to cover nights?
*
Yes
No
If yes, then please indicate the type of night care required
Waking Night
Sleeping Night
Both
Gender of care staff required
*
Male
Female
My client does not mind
Does your client require car drivers?
*
Yes
No
Some car drivers in the team, but maybe not everyone needs to be
Do you require your support worker(s) to have any specific clinical skills or experience?
*
Yes
No
If yes, then please list the clinical skills and experience that your client ideally requires
Epilepsy and Seizure Management
PEG Management
Bowel Management
Catheter Care
Tracheostomy Care
Ventilation
SATS and Oxygen Monitoring
Medication Administration
Autonomic Dysreflexia
Nebulisers
Oral suctioning
Please give an indication of the likely duties that the support worker(s) will be performing
Personal Care
Meal preparation
Accessing the community
Motivation and initiation
Accompanying to appointments
Assisting to find voluntary work or paid employment
Assisting with Diary, appointment and correspondence management
Working alongside a therapy team
Undertaking physio exercises
Undertaking speech and language exercises
Accompanying to the gym
Accompanying to hydrotherapy sessions
Please include any other relevant information to assist the recruitment team find a good match for your client
List things here like their likes and dislikes, whether they have any age preference, whether the client has any pets, whether your client has any specific interests. The more information we have the better the chance of long term success.
