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origin care specialist spinal injury care

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	Registration Form

	Frequently Asked Questions

	Managing Your PA Guide

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Before you spend time completing the application form, we would like to bring the following points to your attention:

All our clients require their PA's to drive - it is essential therefore that you have a current driving licence for manual and automatic vehicles which is valid in the UK/EC. NB - you do not need your own vehicle.
For various reasons (including motor insurance and the issue of companionship), our clients prefer their PA's to be aged 21-40*

You must be able to work legally in the UK (e.g. by virtue of being a UK/EC citizen, having a Working Holiday Visa, UK Ancestry Visa, be on the BUNAC programme etc). If you are not sure you can work legally in the UK, please contact your nearest British Embassy/High Commission for information. As an employment agency, ORIGIN cannot obtain work permits on your behalf.

You must be available to work for a minimum available commitment of 4 months made up of placements usually lasting 7 – 14 days with time off in between. Of course, we hope you will stay with ORIGIN a great deal longer than this.

Registration is free of charge.

For further clarification regarding job description requirements please telephone 020 7617 7894

Many thanks

Application Form
About You	* Required Fields
Title*
First Name*
Last Name*
Address*
Postcode*
Home phone
Mobile
Fax
Email*
Re-Type Email*
Date of birth*
Nationality*
Are you a British citizen or from the EU?*	Yes No
If you are not a British citizen or from the EU, you need a British work visa/permit. Do you have a valid work visa/permit?* NB - as an employment agency, ORIGIN is not able to aid you in obtaining a work visa/permit. Please contact your local British consulate for advice on this subject.	Yes No
If ‘Yes’, please describe and give validity dates*
Marital Status*	Single Married Divorced Widowed
Sex*	Male Female
Height*
Weight *
Do you have a current driving licence and is it either valid in the UK/EU or an International Permit?*	Yes
What type of driving licence/permit do you have? *	If other please describe.
Can you confirm your commitment to being able to work with ORIGIN for a minimum of 4 months?*	Yes No
English Language Level? *
The Work of a PA and Personal details
As a PA, your duties will include domestic tasks such as washing & ironing, shopping, cooking & general cleaning.
Are you willing to carry out these duties?*	Yes No
As well as domestic support, a PA will also be expected to help clients with personal care including getting up, going to bed, washing & toiletting
Are you willing to carry out these duties?*	Yes No
Are you prepared to do live-in work?*	Yes No
Are you willing to travel & work away from home?*	Yes No
Do you have any allergies or dislikes which may affect the type of placements you would accept?*	Yes No
If Yes, please give details
Do you smoke?*	Yes No
Do you have/have you ever had any disability or medical condition, including any back or joint problems (no matter how minor), which might affect your ability to perform this role?*	Yes No
Have you suffered from any significant illnesses or medical conditions?*	Yes No
If you have answered Yes to either of the previous questions, please give details & suggest how any difficulties might be overcome (Origin is an equal opportunities employer)*
From what date are you available to work?*
Your Previous Employment
Name of Current or Last Employer (Your current employer will not be contacted without your consent)*
Address*
Postcode*
Telephone Number*
Position Held*
Date Started*
Date Finished*
Reason for leaving (if applicable)
References
Please give details of two referees - One work reference & one character reference. (Your referees will not be contacted until a job offer has been made or without your consent.)
Work Reference (not a relative or just a friend)
Name*
Organisation*
Address*
Postcode*
Tel. number*
Fax number
Character Reference (not a relative or just a friend)
Name*
Address*
Postcode*
Tel. number*
Fax number
Declaration of criminal record
All posts are exempt from the rehabilitation of Offenders Act 1974 & thus applicants must declare all cautions or convictions, irrespective of how long ago the offence was committed. As part of meeting our responsibilities under the National Care Standards Act, ORIGIN (in common with all care agencies) is required to obtain an Enhanced Disclosure from the Criminal Records Bureau for all employees and, for non-UK residents only, also a Certificate of Good Conduct from your home Embassy or police check from your home country. NB – if you do not already have them, we will work with you on arranging how to apply for these documents and you should not delay sending in this registration form as the checks can be processed later.
Have you ever been convicted of a criminal offence?*	Yes No
Please explain why you feel you would be good at or why you are interested in the role of a Personal Assistant helping someone with a spinal injury - a minimum of 30 words.*
Additional Information Please use this space for any additional information which will support your application.
Please let us know how you heard of ORIGIN, i.e. which paper, magazine or website? *
Company Status Depending on circumstances, Origin can act either as an Employment Agency when we introduce you to placements where you will be working with the client & are paid by the client or as an Employment Business when we organise placements where you will be working with the clients but are employed & paid by us.
*I hereby confirm that the information I have given is true & correct. (Please Tick)
UK NI number (if you have one)
Date*
If you would like to attach your cv please click here.

* This post is exempt from the Employment Equality (Age) Regulations 2006 as per section 8(2).