Position Applied For:

PERSONAL DETAILS

Name*:

First Name*:

Last Name*:

Address*:

Postcode*:

Main Telephone*:

Other Telephone*:

Email Address*:

Do you require a work permit to work in the UK?*:YesNo

If yes, do you have one?*:YesNo

Do you have a current, full UK driving licence?*:YesNo

If yes, do you currently own a car you could use for work?*:YesNo

National Insurance
Number*:

What languages do
you speak and/or read?*:

How did you
hear about us?*:

SECONDARY EDUCATION

FURTHER/HIGHER EDUCATION

OTHER/PROFESSIONAL QUALIFICATIONS

FULL EMPLOYMENT HISTORY

We are required to have a full employment history and also details of any gaps in employment. We cannot offer employment without a complete history. If there is not enough room, please attach further information on a separate sheet.

GENERAL

Why do you
want to be a
care worker?*:

What qualities do
you have that would make
you a good care worker?*:

What hobbies and
interests do you have?*:

PROTECTION OF VULNERABLE ADULTS

THIS SECTION MUST BE COMPLETED IN FULL

Please note that because of the nature of the work for which you are applying, if you are selected for the post you will be required to have a satisfactory DBS enhanced disclosure prior to your appointment being confirmed. Please note that this post is exempt from the provisions of the Rehabilitation of Offenders Act 1974 and therefore you are required to declare convictions which are otherwise "spent". A criminal record will not necessarily be a bar to employment.

REFERENCES

Please give the name of two referees below, one of which must be your current or most recent employer. Referees cannot be related to you through family or marriage.

Referee Name*:

Company Name*:

Address*:

Postcode*:

Telephone*:

Email Address*:

 

Referee Name*:

Company Name*:

Address*:

Postcode*:

Telephone*:

Email Address*:

DECLARATION

I declare that, to the best of my knowledge and belief, the information given is true and I understand that employment will be considered subject to the particulars being correct.

I confirm that I am aware that a work status check may be carried out and I give my permission for my personal information to be shared with the UK Border Agency for this purpose. I understand that these details may then be held by the UKBA.

Signature*:

Date*:

If you have any questions about this form or require any help in completing it, please call our Recruitment Department on 020 7091 0399 or e-mail us at recruitment@carebyholistic.com.

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