Shadow shift application

Before completing this application please be aware that your travel costs and hours worked will not be paid by Martlets.

If you have any questions please contact carehome@martlets.org.uk, this mailbox isn’t monitored daily so please allow 72 hours for a response.

Very good experience in a friendly atmosphere.

Name*
First Last
Work address*
Street Address Address Line 2 Town/City Post code
Phone number*
Alternative phone number*
Email address*
Date of birth*
Job information
Job title*
Professional registration number (if applicable)
Expiry date
Current DBS?*
- Yes
- No
Date (if applicable)
Disclosure number (if applicable)
Are you allowed to legally work in the UK?*
- Yes
- No
Do you have any working restrictions?*
Please give dates of your mandatory training
Manual handling date*
Infection control date*
Data protection date*
Manager's full name*
Manager's contact phone number*
Manager's email address*
Has your manager agreed to support this shift*
- Yes
- No
Other than the information above is there any subject you would like to cover?*
Person centred holistic care will be the focus of the shift, covering areas below:
- Communication/Assessment
- Pain
- Breathlessness
- Nausea and vomiting
- Agitation
- Respiratory secretions
- Mouth care/ Eating and drinking
- Bowel and bladder care
- Spirituality
The mentor will discuss and show you where possible the methods and tools used to assess, monitor, identify and record important information. They will be able to help you identify when and who to call for assistance.
Emergency contact information
Name*
Phone number*
Alternative phone number*
Relationship to you*
Phone
This field is for validation purposes and should be left unchanged.

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