Society Of Our Lady Of Lourdes

Carer Application

Application Form for Carers. Please be aware that you are accountable for arranging your own visa, obtaining your own Global Health Insurance Card (GHIC) and getting appropriate travel insurance if the GHIC is not adequate (if you have health concerns). You are responsible for making your own travel arrangements. We will arrange for our Tour Operator to send you a booking form in due course.

Title

First Name

Surname

Date of Birth

Address incl Postcode

Telephone Number

Are you a returning Carer

Have you been to Lourdes before

Do you have any particular experience? Please list your experience, the relevant qualifications and dates

Are you a trained First Aider?

Where do you work now?

What is your current job title and responsibilities?

Are you registered disabled?

Do you have any physical / medical problems that might prevent you doing specific duties? If yes, please give brief details (please list your medications):

As a carer part of your remit is to do lifting and handling and direct individualised care. Would you be able to do this?

What was your last update on lifting and handling?

What is your Hepatitis B status?

What date was your last tetanus?

Do you speak any foreign languages, eg French?

State language and whether fluent (F), competent (C) or ‘enough to get by’ (GB)

Please give any other information you think relevant to this application.

I have read and agree to abide by the principles of the HELPERS POLICY (tick)

My references:

Name & address of referee

The Medical Team will assess your suitability for various tasks. We would like to retain your contact details. To do this we need your consent, which you can withdraw at any time. Please indicate your consent

How would you like us to contact you post Pilgrimage?

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Society Of Our Lady Of Lourdes

Society Of Our Lady Of Lourdes

Carer Application

Carer Application

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