First
Name: *
Last
Name: *
Address:
*
City:
*
Post
Code: *
Country:
*
Cell
Number (incl. code):
Other
contact number (incl. code): *
E-mail
Address: *
Best
Time to Reach You: *
Morning
Afternoon
Position
Applying For: *
Live-in
Care-worker
Domicillary
Care-worker
Nationality:
*
United Kingdom
European Comunity
European
Economic Agency
Other
If
you answered Other to the previous question then please supply details
of your nationality and any permit currently held which entitles you to
work in the UK, include the permit number, validity and expiry date:
Do
you require special arrangements to enable you to attend for interview?
Do
you have a drivers licence valid for use in the UK *
No
Yes
Available
Start Date: *
Please
provide details of your education and other qualifications: *
Please
provide details of any courses attended:
Previous
Employer #1 - Company Name:
Previous
Employer #1 - Phone (incl. code):
Previous
Employer #1 - Dates Employed:
Previous
Employer #1 - Supervisor Name:
Previous
Employer #1 - Job Duties:
Previous
Employer #1 - Reason for Leaving:
Previous
Employer #2 - Company Name:
Previous
Employer #2 - Phone Number (incl. code): *
Previous
Employer #2 - Dates Employed:
Previous
Employer #2 - Supervisor Name:
Previous
Employer #2 - Job Duties:
Previous
Employer #2 - Reason for Leaving:
Supporting
Information - Please describe how you match the requirements of the job
description and the personal specification. Also please tell us about
yourself, to support your application:
Reference
#1 - Name
Reference
#1 - Job Title
Reference
#1 - Address
Reference
#1 - Country
Reference
#1 - Phone (incl. code):
Reference
#1 - Email
Reference
#1 - Relationship
May
Reference #1 be approached before interview?
Yes
No
Reference
#2 - Name
Reference
#2 - Job Title
Reference
#2 - Address
Reference
#2 - Country
Reference
#2 - Phone (incl. code):
Reference
#2 - Email
Reference
#2 - Relationship
May
Reference #2 be approached before interview?
Yes
No
The following requested information has no bearing on your application
and is only used to assess the efficasy of our recruitment staff
Date
of Birth:
Gender:
Female
Male
I
would describe my ethnic origin as:
How
would you best describe your sexuality?
Please
indicate your religion or belief:
Do
you consider yourself to have a disability?
All
care-worker applications are subject to an enhanced CRB clearance.
Please could you declare the following:
Have
you got any unspent criminal convictions, cautions, warnings or
reprimands? *
No
Yes
Does
your name appear on the Protection of vulnerable adults list? *
No
Yes
*
Required