Application Form

Domiciliary Care Workers needed to join our fast expanding team

Verrolyne Services is an established and renowned Care Organisation.

We have been providing compassionate and professional care to services over London and Essex with love, patience and understanding.

Due to our success, we are always in the lookout for new team members to join us.

We will provide you with clients, the training and everything else you need to help us keep the high standard that we have set.

All we ask from you is that you give 100% each time you step out the door.

– Be courteous
-Kind and passionate
-Proactive and hardworking
-Flexible and able to work on a rota including alternate weekends
-Be willing to commit to Training in with in house training.

Currently we are recruiting carer in the areas below to join our team:-
-Waltham Forest

If you have an interest in care job please ring us on 01708-320475

Employment Application Form

*Notice:Every Field Is mandatory So Don't leave empty any feild otherwise system will reject your Application*

Applicant Information
Employment History

Below, please describe past and present employment positions, dating back five years. Please account for all periods of unemployment. If you attached a CV/Resume, this section must still be completed.

Length of Employment

Previous Employment
Name and address of Employer Dates Employed Post Reason for Leaving
From To
Academic Qualifications (GCE/O Level, A Level, GCSE, Degree, etc.)
Date Passed Organisation/School
(Please include address and telephone number)
Professional/Vocational Training and Qualifications (RMN, RGN, NVQ etc.)
Date Passed Organisation/School
(Please include address and telephone number)

Please give the names of two people who have knowledge of your work performance. Please include at least ONE Professional reference.

Personal Information

Language Form

Please Read and Initial Each Paragraph, then Sign Below

Equal Opportunities Recruitment Monitoring

Verrolyne Services Ltd is an Equal Opportunities Employer and as such we wish to demonstrate our commitment to equality. To do so, we need to monitor the applicant's sex, age, martial/family status, religion, disability, colour and ethnic origin. This is to ensure that no job applicant or employee receive less favourable treatment because of these factors.

Our selection criteria and procedures are frequently reviewed to ensure that individuals are selected, promoted and treated on the basis of their relevant merits and abilities.

All employees are given opportunity and are encouraged to progress within the organisation.

We are committed to an on-going programme of action to make this policy fully effective and would ask you co-operation by filling in this survey. The information which you give on the form will be treated in the strictest confidence and will not be used for any purpose other than monitoring.

Job Description

Job Title:Health Care Assistant
Reports To: Office Manager
Accountable to: Annabelle Augustin, Director

The Support Worker will support individual users to live as independently as possible within the community.

Principal Activities

Support Workers support service users in maintaining their own personal health, social, therapeutic, and domestic care.

Areas of support will be as follows:
  1. Personal Care - supporting the client, with privacy and dignity, to:
    1. Wash his/her body and hair
    2. Dress
    3. Use the toilet
    4. Eat and Drink
    5. Maintain personal grooming
    6. Prepare meals, taking into account any special dietary needs
    7. Empty Commode
  1. Health Care - to work alongside other professionals in assisting the service user with:
    1. Catheter care/Continence
    2. Stoma care
    3. Ointments — with authorisation letter only (speak to office)
    4. Eye drops — with authorisation letter only (speak to office)
    5. Prompts for medication
    6. Care and observation of pressure areas
    7. Bowel Care
  1. Therapeutic Care- under the supervision of designated therapists assisting the service user with:
    1. Maintenance of mobility
    2. Maintenance of daily living/functional skills
    3. Other therapeutic care as agreed
  1. Domestic Care — to work with the service user to maintain their physical environment. Tasks may include:
    1. Laundry- washing and ironing
    2. Cleaning areas of the home
    3. Lighting/turning on fire
    4. Checking household security
  1. Social care — supporting the service user to create and maintain relationships and activities within their local community. Tasks involved may include:
    1. Collecting pensions/benefits and prescriptions
    2. Providing information
    3. Conversation and listening
    4. Emotional support — befriending
    5. Promoting local networks of support — links with family and friends
    6. Assisting with recreational/social activities as part of the care plan
    7. Letter writing
    8. Advocacy
    9. Support in hospital, hospice, day care or residential setting


All of the above activities are governed by the operational policies, standing financial instructions, policies and procedures and standards of care as well as legislation and professional standards and guidelines.

Other duties/responsibilities

As a term of your employment with Verrolyne Services Ltd, you can be required to undertake such other duties commensurate with your grade and/or hours of work at your initial place of work or at any other establishments, as may be reasonably required of you.


Timesheets and Rota Process


By the end of each week you are required to have completed a timesheet which indicates the number of hours worked during the preceding week (or lesser period) and signed by an authorised representative of the client/s.

The timesheet must be submitted to the office on the following Monday between 10.30am — 15.00pm.

Failure to submit a timesheet for hours worked may delay payment for those hours.

Failure to submit timesheets on time will result in the company fining you £20.00 for late submission and being given a warning under the disciplinary process.

Failure to further co-operate in the Verrolyne Services Ltd business' timesheet process may constitute a breach of you contract for which damages might be claimed.

Rota Process

You are required to collect a copy of your rota from the office between 10.30am — 15.00pm every Friday so that you know which client's you are expected to be looking after and at what time. Failure to collect your rota will result in the company fining you £20.00.

You must give the office four(4) weeks' notice for changes regarding requests for holiday leave, study leave or any other non-attendance so that no client is left unattended. You must also inform the office if you are going to be late to a client.

Failure to turn up to a Client will result in a £20.00 fine being charged to you for each client you fail to turn up to and you having to go through the disciplinary process.

Failure to co-operate in the Verrolyne Services Ltd Business' rota process may constitute a breach of you contract for which damages might be claimed.

Please sign this copy of this process as acceptance of these terms and return to the office so the document can be held on your personal file.

Confidentiality Agreement

This agreement to be issued and signed annually

You have been allowed access to confidential information and record regarding people who use our services, other employees and Verrolyne Services Ltd.

It is vital that you treat all such information as strictly confidential.

Individual Agreement to opt out of the 48 hour maximum average working week

This agreement is made between:

Verrolyne Services Ltd


("The worker")

48 hour maximum average working week

Health & Safety Policy

The Health and Safety at Work Act 1974 imposes certain obligations on an employer not only to take all such actions as are reasonable to safeguard the health and safety of their employees, but also to be able to show that they are doing so, by producing adequate written policies and procedures. Verrolyne Services Ltd fully accepts its responsibilities under the Act.

The Act refers to what is reasonable in given working situations.  Verrolyne Services Ltd will:

  • Assess the risks in the workplace.
  • Have written health and safety procedures
  • Ensure that the workplace satisfies health, safety and welfare requirements.
  • Ensure safe and clear access to and egress from the building, including fire exits.
  • Regularly check the premises room by room for structural defects, worn fixture and fittings or electrical equipment, and take the necessary remedial action.
  • Ensure that all equipment is suitable for its intended use and is properly maintained and used.
  • Ensure that all staff is aware of the fire procedure.
  • Ensure that all members of staff are aware of the procedure in case of accidents.
  • Ensure that all members of staff are aware of and carry out their health and safety responsibilities as set out in their job descriptions.
  • Prohibit smoking on the premises
  • Provide appropriate protective gear.
  • Ensure any appropriate training is provided.

The Management considers this matter of such importance, that breach of health and safety procedures by staff constitutes misconduct and will be dealt with as a disciplinary matter.


Employees will also be made aware of their responsibilities under the Health and Safety at Work Act and will:

  • Take reasonable care of their own health and safety and that of others around them.
  • Co-operate with the employer on matters of health and safety
  • Use work equipment correctly
  • Provide guidance to service users and act responsibly to ensure their health and safety
  • A Health and Safety Manual is available from the office on request
  Service users will also be made aware of their responsibilities and will:
  • Agree to use the equipment in a safe manner with regard to the health and safety of those around them [or the management can ask them to desist etc

It is not possible to detail here all the health and safety matters that come up on a day-to-day basis, so staff and management must constantly be mindful of their responsibilities individually and collectively for the safety of themselves and their colleagues.

Guidelines on Discipline and Grievance


Statement of Intent
  • Verrolyne ServicesLtd is committed to providing a work environment that is safe, fair and free from discrimination for all. The agency has a responsibility to ensure staffs are not subjected to behavior that may constitute unlawful discrimination, harassment, vilification or victimization.
  • An essential part of developing that environment is ensuring that staffs are encouraged to come forward with their grievances in the knowledge that the responsible supervisors will take prompt and effective action to address complaints of discrimination and harassment. Grievances that are not addressed have the potential to grow into major problems that can cause tension, low morale and reduced performance and productivity. Unresolved or poorly handled grievances can also lead to legal action against the agency.
  • This Policy does not limit the right of any staff member to seek the advice and assistance of their union or professional association. At any time staff members may also seek the assistance of an external agency in the resolution of their grievance.

The Policy applies to all staff of Verrolyne Services Ltd and covers all staff grievances of unlawful discrimination and harassment. A grievance may involve unlawful discrimination if it contains allegations of unfair and inequitable treatment on the basis of a person's race, ethnic and ethno-religious origin or nationality; sex or sexual preference (including transgender); marital status; status as support worker; pregnancy or potential pregnancy; age; disability; religious, trade union or political affiliation. Vilification on the grounds of race, homosexuality and HIV/Aids status is also unlawful. Unlawful harassment is unwelcome and offensive or intimidating behavior, comments or images based on any of these grounds. The most common forms of harassment are racial and sexual harassment.

  • The grievance may be against another staff member/s or client (service user). In certain circumstances, these Procedures may be used to deal with a complaint against a person who is not an employee but who is involved in the agency's activity e.g. care and support workers.

These Procedures also cover the use of the Verrolyne Services Ltd computing and telephone facilities (including voicemail, email and the Internet).

  • Grievances should be treated seriously and sensitively, having due regard to procedural fairness, and confidentiality and privacy. Requirements relating to confidentiality and privacy extend to the use and storage of any information and records related to a grievance.
  • Grievances should be handled quickly and as close as possible to their source. This may be modified by the nature of the grievance and the staff member's wishes. Staff should raise concerns as early as possible after the incident/s occurred.
  • Wherever possible, grievances should be resolved by a process of discussion, cooperation and conciliation. The aim is to reach an acceptable outcome that minimizes any potential detriment to ongoing relationships.
  • Both the staff member raising the grievance (the complainant) and the person against whom the grievance is made (the respondent) will receive appropriate information, support and assistance in resolving the grievance. Parties may bring a support person to any interview.
  • No person should be victimized because they raise a complaint or are associated with a grievance.
  • Staff should not instigate grievances that are frivolous or malicious. All staff are expected to participate in the grievance resolution process in good faith.


Preliminary Action

Before initiating the grievance procedures, the complainant is encouraged to try to resolve any grievance directly with the person/s concerned. If this is not possible or appropriate, the complainant should proceed to Step 1 of these Procedures.

Staff can seek advice at any stage from the Citizens Advice Bureau

Step 1 - Talk to the immediate supervisor

Where the complainant has been unable to resolve the grievance themselves, they should take the matter up with their immediate supervisor. Where the grievance involves that person, the complainant should refer the matter to the next most appropriate member of staff, e.g. the supervisor's supervisor.

The supervisor should address the grievance with a view to resolving it expeditiously, normally within two weeks of receiving the complaint. This would usually involve the supervisor:

  1. carefully listening to the staff member's concerns and their desired outcomes;
  2. providing the staff member with a copy of this document, explaining the grievance procedures and the range of options open to them;
  3. after consultation with the Executive Director, either attempting to resolve the matter or referring the matter to Stage 2 or 3 of these Procedures if it is unsuitable for resolution at this level;
  4. keeping all those involved informed about the progress of the matter and monitoring the situation during and after the resolution process.

In any action taken the supervisor should ensure procedural fairness for all parties involved, which would normally include such steps as fully informing the respondent of the allegations made against them and providing them with an opportunity to respond.

At the end of their direct involvement with the matter, the supervisor should make appropriate file notes on the grievance resolution process and outcomes, which should be stored in a separate and confidential grievance file.

Step 2 - Referral to the Managing Director

If the complainant believes the grievance has not been resolved to their satisfaction during Step 1, they can refer the matter to the Managing Director. The Managing Director may require the complainant to put the grievance in writing. The Managing Director should consult with a director before taking any action and would then normally try to resolve the matter within three weeks of receiving the grievance, following similar

Step 3 - Referral to a Director

If the grievance remains unresolved, or is felt to be of such a serious nature that it cannot be resolved without investigation, it may be referred in writing to a Director. The complaint may be referred by the complainant, the supervisor or the Managing Director.

After giving due consideration to the grievance a Director may do one or more of the following:

a) If the complaint is not clearly within the scope of the agency's processes for misconduct/serious misconduct may:

  1. Refer the complaint back to the relevant supervisor or to a nominee, with advice, for resolution
  2. Seek to resolve the matter directly

b) If the complaint is against a senior member of staff and falls within the scope of the agency's provisions for staff misconduct/serious misconduct or unsatisfactory performance, follow the appropriate disciplinary procedures.

c) If necessary, contact an appropriate outside agency.

Any determination made by a Director in accordance with Step 3 of these Procedures with regard to the grievance will be final save for the complainant/respondent's right to pursue the matter outside the agency.


Outcomes will vary from case to case depending on the nature and circumstances of each grievance. Outcomes could include:

  • The complainant gaining a better understanding of the situation and no longer feeling aggrieved;
  • The complainant receiving a verbal or written apology;
  • The respondent receiving a verbal or written reprimand;
  • One or both parties agreeing to participate in some form of counseling ;
  • Disciplinary action where the agency's policy were found to have been breached, and/or where misconduct/serious misconduct or unsatisfactory performance has occurred.
Disciplinary Action

Disciplinary action may be taken where:

  • A grievance is found to have been malicious or vexatious;
  • A person victimizes another person because of their involvement in the grievance;
  • Unnecessary disclosure of information (a breach of confidentiality) has occurred.
The usual structures for disciplinary procedures are as follows:
  1. Verbal, or oral warning, usually with a specified period for action/improvement and when the record will be removed from the employee's file (even though this called "verbal" it is important that both you and the employee have a record of what has happened and what is agreed).
  2. First written warning, again with specified actions/time period
  3. Final written warning
  4. Dismissal — with a specified notice period, unless it is summary or instant (1 week for 1 month — 2 years service, with an additional week for each additional year up to 12 weeks).

The procedure may start at any point, depending on the seriousness of the offence, but it is important that you remember that even summary or instant dismissal should have a time period for investigation/right of reply/appeal.

The following shall constitute Misconduct and /or serious misconduct for which disciplinary action may be considered by Verrolyne Services Ltd.

Misconduct Serious Misconduct
Timekeeping Theft, fraud and deliberate falsification of records
Absenteeism Physical violence
Health and Safety breaches Serious bullying or harassment
Unauthorized use of company facilities Deliberate damage to property
Computer hacking Serious insubordination
Use of company vehicles Misuse of an organization's property or name
Poor performance of duties Bringing the employer into disrepute
Attendance of doctors/dentists appointments Serious incapability whilst on duty brought on by alcohol or illegal drugs
Acceptance of gifts or inducements Serious negligence which causes or might cause unacceptable loss, damage or injury
Conduct outside work Serious infringement of health and safety rules
Dress code Serious breach of confidentiality
Undertaking other employments  
Non work related posters etc.  
Commercial confidentiality  
Carrying out cash collections  
Performance of public duties  

Minor issues can be dealt with informally through discussion with the employee concerned, but if this does not result in a change of behavior or the outcome agreed, then disciplinary procedure may need to be used.

No-poaching policy

You covenant with the Company that you will not directly or indirectly on your own account or on behalf of or in conjunction with any person or other business for a period of 12 months after the Termination Date of your agreement with Verrolyne not to poach any employee, self employed workforce as per this agreement of the Company.

Poaching fees:

Poaching of Verrolyne workforce or customers will be considered as a service and will incur a finder's fee as below;

Poaching of Verrolyne workforce or customers will be considered as a service and will incure a finder's fee as below;

Verrolyne Services workforce - £ 1500 invoiced as a off fee

Verrolyne Services customer — 6 weeks placement fee invoiced as a on off fee

Personal Development and Appraisals

Verrolyne Services Ltd is committed to Personal Development Training of our staff.

All Verrolyne Services Ltd employees will have three monthly Training, Development and Welfare meetings with Management and yearly Appraisals.

Training, Development and Welfare meetings take the form of an informal talk, discuss any concerns you may have regarding personal and work issues, and you training and development with Verrolyne Services Ltd will be discussed with you to establish any further skills or refresher courses you may feel you need.

Manual Handling Training and Risk Assessment will be reviewed on a six monthly basis, any change in policies and procedures within the company will be relayed to you in the form of a newsletter, as well as at informal meetings.

Verrolyne Services Ltd employees are expected to attend these meetings.

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