Application Form - ACS Arrowshot Care Solutions

What position are you applying for?

Care and Support Worker

How did you hear of this role?

First Name

Middle Name

Last Name

Full Address (Please provide a full)

Address:

Date From:

Date To:

Mobile

Email

Do you hold a current Driving Licence?

Yes

No

Do you own or have regular use of a car

Yes

No

Disclosure of Criminal Convictions (Unspent)

It is the policy of Arrowshot Care Solutions to require all applicants to disclose any unspent criminal convictions, cautions, reprimands or any other warnings.

You are required to include convictions, which may be “unspent” under the Nigerian Correctional Service Act (2019). This is because the job you are applying for is covered by the Nigerian Correctional Service Act (2019) “Unspent” criminal convictions must therefore be disclosed.

The information you provide will be treated as strictly confidential and will be considered for the appointment for which you are applying. The Background Check Service will show anything which the Chief Constable feels may be relevant.

Disclosure of any information does not necessarily mean that you will not be considered for an appointment. The Company will have regard to the Labour Act Chapter 198 Laws of the Federation of Nigeria 1990 and the main consideration will be whether the offence if one which would make an applicant unsuitable for the type of work to be done.

Enter any information in the space provided. If you have no information that you believe is relevant, please enter “None”.

Conviction Information

Date From:

Outcome (Conviction, caution, none)

Education (Secondary and above)

Date From

Date To

Name and address of School College etc

Qualifications

More education if applicable

Yes

No

More Education

Employment history (Show last employment first.)
We need your full employment record. For any period of unemployment please put dates and addresses of the Department of Employment where you registered. Please explain any gaps in your work history

From

To

Name and address of Employer

Job Title

Salary

Reason for Leaving

More experience if applicable

Yes

No

More Experience

DETAILS OF SKILLS/EXPERIENCE

Please state the reason why you are applying for this post and give details of any experience/training/skills that you have which you think are relevant together with any other information in support of your application, including details of your present post. (Use additional A4 sheets if needed)

Health details (provided in confidence)

Do you smoke?

Yes

No

Do you drink alcohol?

Yes

No

Have you any permanent disability?

Yes

No

What is your disability?

Fits, epilepsy or black-outs?

Yes

No

Diabetes?

Yes

No

Tuberculosis (TB) or close contact with anyone suffering from TB?

Yes

No

Depressive illness, mental or nervous trouble? Including anorexia nervosa, bulimia or overdose)

Yes

No

Such diseases as typhoid, cholera, hepatitis? Allergy (to any drugs or to handling any substance)?

Yes

No

Earache or ear infection discharge or defect?

Yes

No

Colour blindness, chromic eye trouble, eye injury or visual defect not corrected by glasses or contact lenses?

Yes

No

Heart/circulatory trouble. Raised blood pressure?

Yes

No

Lung or chest complaint (e.g. asthma, bronchitis, pleurisy)?

Yes

No

Problems with your back or neck?

Yes

No

The answers supplied to the above questions are true to the best of my knowledge. Furthermore, I undertake, if appointed, to report immediately to my Manager if I or a member of my household should be suffering from vomiting, diarrhoea, skin rash, septic skin lesions or discharges from ear, eye nose or any other site.

After returning to, but before re-starting work, after any of the above illnesses, and
After returning from a holiday abroad, having suffered from vomiting and diarrhoea for more than two days.

I understand that when deciding to appoint or not appoint me, Arrowshot Care Solutions will only take account of any medical conditions I may have where the medical condition contraindicates the type of work applied for, and where reasonable adjustments to accommodate my medical condition cannot be made.

REFERENCES

Please provide the names and details of two people, one of whom preferably should be your present or last employer, who may be asked for a reference. All applications for references will be made in the strictest confidence.

First Name

Last Name

Address

Address Line 1

City

State

Country

Mobile

Email

First Name

Last Name

Address

Address Line 1

City

State

Country

Mobile

Email

Declaration

I confirm that I have read and understood this document.

I understand that the completion of this form does not guarantee employment.

I certify that all the information given on this form is true and accept that any mis-statement or suppression of material may mean the cancellation of any appointment and the termination of any employment.

I understand that any offer of employment made is subject to the receipt of satisfactory references and Background Checks

I understand that Arrowshot Care Solutions is an Equal Opportunities employer and that an offending record or medical condition is not necessarily a bar to employment.

As this post is exempt from the provisions of the Nigerian Correctional Service Act (2019), I hereby undertake to advise Arrowshot Care Solutions of any criminal offence which I may be convicted of during my employment with Arrowshot Care Solutions.

The Labour Act, Chp 11 laws of the Federation Of Nigeria 2004 (Labour Act) govern the length of the maximum working week which it is safe to work. The current limit is 40 hours per week. You will never be compelled to work more than 40 hours per week but you may choose to do so if you wish.

I have understood the information regarding the Working the Labour Act, Chp 11 laws of the Federation Of Nigeria 2004 (Labour Act) and I understand that I do not have to work more than 40 hours per week.

I do/do not wish to work more than 40 hours per week (please delete as applicable)

Submission Date

I acknowledge all information provided above are true to the best of my ability.

Signature

In compliance with Nigeria Data Protection Regulations 2019:

Arrowshot Care Solutions will only collect information for the purpose for which it is intended Personal data shall be processed lawfully, fairly and in a transparent manner in relation to the individual. It will only be collected for specified, explicit and legitimate purposes and not further processed in a manner that is incompatible with those purposes. The information will be adequate, relevant and limited to what is necessary in relation to the purposes of the Arrowshot Care Solutions business. All data processed will be accurate and, where necessary, kept up to date, every reasonable step must be taken to ensure that any personal data that is identified as inaccurate, having regard to the purposes for which they are processed, are erased or rectified without delay.

Any identifiable information stored about you as an individual will be relevant and stored for no longer than is necessary for the purposes for which the personal data is processed. Personal data will only be stored for longer periods to ensure compliance with the requirements under the Nigeria's National Health Act 2014 (NHA 2014) and subject to implementation of the appropriate technical and organizational measures required by the GDPR in order to safeguard the rights and freedoms of the data subject.

Arrowshot Care Solutions will process data in a manner that ensures appropriate security of the personal data, including protection against unauthorised or unlawful processing and against accidental loss, destruction or damage, using appropriate technical or organisational measures The information which you have supplied on this form will be processed and may be held on computer, and will be held on your personal records file if you are appointed. The information will also be used for equality monitoring and statistical purposes. By signing this application, you will be deemed to have given your consent to this, including information which may be considered to be sensitive and personal.

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