Email: enquiries@edenrosecarerecruitment.co.uk
Phone: 0333 404 8926
Application Form

Page 5

APPLICATION FORM - CARE WORKERS

HEALTH DECLARATION/MEDICAL QUESTIONNAIRE

Please complete the following questionnaire regarding your health status and your fitness to carry out the duties as described in the job description of a Home Carer.


Personal Care:

Bathing or showering
Hair washing and dressing
Helping to the toilet/using aids
Moving and handling
Incontinence care
Medication assistance
Health related tasks

Preparation Of Food:

Menu planning
Preparing culturally suitable food
Feeding

General Duties:

Housework
Laundry and Ironing
Shopping
Finances

Have You Ever Worked With People Suffering From:

Dementia/Alzheimer’s Disease
Stroke
MS
Cancer
Learning Disability
Physical Disability

Children:

Employment in child care




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RECOMMENDATIONS

If you recommend a friend we will reward you with a £50.00 John Lewis voucher or we can make a donation to your favourite charity.

Address

41 Blenheim Square,
North Weald Bassett,
Epping

Contact

Email: enquiries@edenrosecarerecruitment.co.uk
Phone: 0333 404 8926

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