Parkmanor Private Nursing Home

Dunmurry
Belfast

Ref No: hk/06/10

APPLICATION FOR EMPLOYMENT

All information provided on this form will be treated in the strictest confidence

Please complete in Block Capitals in your own handwriting

POSITION APPLIED FOR HOUSE KEEPER

CANDIDATE’S NAME HUGH DALZELL

Notes
• This application form should be returned with the Equality Monitoring form and Health Declaration in
the envelope provided to:-
The HR Department, Malone Lodge Hotel & Apartments, 60 Eglantine Avenue, Malone Road,
Belfast, BT9 6DY. Tel : (028) 9038 8000

• Your application for employment will not be considered unless the company are in receipt of your
Equality Monitoring form

• Appointments are dependant upon receipt of satisfactory references

• This application form must be completed in full

• If you are employed by the company you will not be permitted to undertake any other employment
without the express consent of the company

How did you hear of this vacancy? online

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Personal Details

Surname Mr/Mrs/Miss/Ms/other DALZELL MR

First Name/s HUGH

Home Address: 3 RIVERBANK, CONWAY ESTATE, DUNMURRY, BELFAST

…………………………………………………………………….Post BT17 9DF

Previous Address if moved within last 5 years ……………………………………………………..

…………………………………………………………………….Post Code ……………………...

Telephone Number (mobile) 07754599398

Email address: becca_dxo@hotmail.co.uk

City/Town of Birth: LISBURN

National Insurance Number BT219171C

Have you previously worked for the company? Yes / No

If Yes, when and in what position? ……………………………………………….………………

Do you require a Work Permit? Yes / No

Do you hold a current Driving Licence? No/Provisional/Full/HGV

Do you own your own car? Yes / No

or have you use of a car on a regular basis? Yes / No

Do you require any special arrangements for attendance at interview? If so, please specify.
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Education
Please give details of educational qualifications gained up to leaving school, eg, ‘O’, GCSE, ‘A’ etc
Examination Year Qualification Subject Grade/Result

Please give details of any third level qualifications

University/College Degree/diploma Date of award Course title Result

Membership of professional bodies. Please confirm if by election or by examination

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Do you have a working knowledge of any other language? YES / NO

If YES give details…………………….……………………….……………………………...…….
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Are you currently attending any course of study? YES / NO

If YES give details…………………….……………………….………………………………..…….
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Employment History

Name and Address of Current Employer: South Eastern Trust

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 Date Appointed 05/06/2005 Position/Designation driver grade 2

Duties and Responsibilities:

• LOADING MEDICATIONS AND MEDICAL EQUIPMENT TO AND FROM
EMERGENCY VEHICLE.
• KEEP RECORDS OF ALL JOURNEYS TO COVER HOPSIPALS EXPENSES ON
EMERGENCY VEHICLES.
• TO ENSURE THE CAR IS MAINTAINED AND CLEAN AT ALL TIMES
• REPORTING ANY FAULTS WITH THE EMERGENCY VEHICLE OR MEDICAL
EQUIPMENT TO MY SUPERIOR.
• ENSURE PATIENTS CONFIDENCIALITY AT ALL TIMES.

Present Wage/Salary: VARIES per week/month/annum

Have you a Bonus Scheme Yes/No Pension Scheme Yes/No Company Car Yes/No
Any other major benefits …………………..………….……….…………………………….…….
Period of Notice required: NOT GIVEING UP MY CURRENT EMPLOYMENT
May we contact your current employer if you are under consideration for appointment? Yes/No

Previous Employment – commencing with most recent (not current employer)

Name & Address of Position Dates Brief details of your role Reason for
Employer Held From / To Leaving
SOUTH EASTERN BANK Moving and handling, patients, INSUFFICIENT

TRUST PORTER oxygen tanks, hospital equipment, WORK

delivery of internal and external AVAILABLE

mail

Collect bloods and urine from

wards for delivery to laboratories

CENTRAL TAXIS TAXI 1998- Driving wheelchair taxis bus. COMPANY

( no longer exists) DRIVER 2005 Taking patient to and from TAKE OVER

hospital
MEDI CLEAN
BEVIOUR PARK DOMESTIC 1993- CLEANING AND TEMPORY

HOSPITAL 1994 HOUSEKEEPING DUTIES POSITION AND

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BELFAST WASTE DISPOSAL BARRIER FOUND FULL

CLEANING SERVING OF TIME

MEALS TO PATIENTS EMPLOYMENT

Training
Date Details of Training Attended
YEARLY HEALTH AND SAFTEY
YEARLY MOVING AND HANDLING
YEARLY FIRE SAFTEY
YEARLY HEALTH AND SAFTEY WHEN USING EQUIPMENT

Please demonstrate how you meet the ‘Essential’ and ‘Desirable’ criteria (continue on a separate
sheet, if necessary) …My previous experience in housekeeping in a hospital environment I feel
would make me a good candidate for this position. I feel that working with the general public in the
position of porter and also taxi service for the disabled make me a good communicator.
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What influenced you to make this application?…I like working with the general public and work
well as part of a team...…………………..…….……………………….
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What are your medium term career objectives (ie next 2 years)? I would like to continue to work in
health care.…..……….……..……………….
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References

Please nominate two referees both of which should normally be previous employers.
(Referees will be sought only if you are under consideration for appointment)

Name …Mrs Florence Graham……………………………… Mrs J English

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Address …c /o Out of hours …………………………… c/o Out of hours
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…The Whitehouse Lagan Valley The Whitehouse Lagan Valley
Hospital Hospital
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Post Code BT281JP… …………………........Post Code BT281JP……………………...........
Telephone No. …………………….. Telephone No. ……………………....
Business ……02892665141……………………… Business 02892665141 ………………………
Relationship MANAGER…………………Relationship Line manager………………………...

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If you are short-listed for interview, what period of notice of attendance would you require?

…None I live locally.…………….……………………….…………………………………….

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I declare to the best of my knowledge, the information on this form is correct. I understand that any
false statement may disqualify me from employment or render me liable to dismissal.

Signature …HUGH DALZELL…………………………………………..

9/8/2010…………………….