Opieka Job Application Form

Job Application Form

Please fill out and complete the below form
Full Name *

First Name Last Name
Address *

Address Line 1

Address Line 2

Town/City County

Post Code
Phone Number *
Contact Number
E-mail *
National Insurance Number *
Do you hold a Full Drivers License? *

Yes No
Do you own a car that you are willing to use in connection with work? *

Yes No
Do you have business car insurance? (This is a requirements if you use your vehicle for work purposes) *

Yes No
Are you fluent in any other languages apart from English? If so please state

Education/Training:

Education History *

	Place of Education	Type of Qualification	Subject/Course	Result	Date/Year Achieved
1
2
3
4
5
6
7
8
9
10
11
12
13
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17
18
19
20

Other Qualification's/Training Acquired

	Place of Education	Type of Qualification	Subject/Course	Result	Date/Year Achieved
1
2
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5
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9
10
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15

References:

One of the References has to be your most recent employer
Reference 1 *
Name of Reference
Relationship *
Address *

Address Line 1

Address Line 2

Town/City County

Post Code
Please provide either Phone, Email or both.
Phone
Email
example@example.com
May we approach reference prior to interview? *

Yes No
Reference 2 *
Name of Reference
Relationship *
Address *

Address Line 1

Address Line 2

Town/City County

Post Code
Please provide either Phone, Email or both.
Phone
Email
example@example.com
May we approach reference prior to interview? *

Yes No
Do you require any special facilities if you were to be selected for an interview? If so, please give details.
Please note that all candidates are treated qually regardless of their age, sex, sexual orientation, marital status, race, ethnic origin, religious belief's or disability.

General Information
Opieka provides domiciliary services to Clients in their own homes. To support you application please explain why you are interested in this role and what you feel you could bring to this role. Please include any additional information in support of your application including relevant skills and personal qualities. *
Please list your interests or hobbies: *
If offered the position, will you continue to work in any other capacity? *

Cover Letter & Resume:
Cover Letter
Resume
Additional Information
We are obliged by law to check your identity and that you are permitted to work in the UK. You will be required to provide us with the necessary evidence (original documents) before an offer of employment can be made.

Under the Rehabilitation Act 1974, most sentences awarded by a Court for Criminal offences may be regarded as spent and disregarded, for most purposes, after a specified period of time and need not then be disclosed.
However this post is exempt from the Rehabilitation of Offenders Act 1974 and you must therefore declare any and all convictions/cautions/reprimands/warnings you may have had. As you will be working with vulnerable individuals, prior to commencing in post you will be required to undergo a Disclosure and Barring Service Check (previously known as a Criminal Records Bureau check).
Have you at any time been convicted of a criminal offence or received a Police caution and or reprimanded or warning? *

Yes No
If the answer is Yes, please give full details including the nature of the conviction/caution/reprimand/warning, which Police Force was involved, the outcome and dates. Having a criminal record will not necessarily bar you from working for us. This will depend upon the nature of the position and the circumstance and background of your offences. *
Data Protection Act 1998

The information you provide to us will be used for the purposes of considering your application and assessing your suitability for the job only and will be processed in accordance with the Data Protection Act 1998.

By submitting this application form you are consenting for your details to be used in our recruitment process in accordance with the Data Protection Act 1998.
Send Application:
By clicking the submit button below, I certify that all of the information provided by me on this application is true and complete, and I understand that if any false information, ommissions, or misrepresentations are discovered, my application may be rejected and, if I am employed by one of our affiliates, my employment may be terminated at any time.

In consideration of my employment, I agree to conform to the hired company's rules and regulations, and I agree that my employment and compenstation can be terminated, with or without cause, and with or without notice, at any time, at either my or the company's option.

I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company.

Disclosure

I authorise Opieka Ltd to conduct a reference check with my present employer, previous employer(s) or any personal reference(s).

I understand that reference information may include, but not be limited to, verbal and written enquiries or information about my employment performance, professional demeanour, rehire potential, dates of employment, salary and employment history.

My signature below authorises my former or current employers and referees to release information regarding my employment record with their organisations and to provide any additional information that may be necessary for my application for employment to Opieka Ltd, whether the information is positive or negative.

This form may be photocopies, reproduced as a facsimile or email, and these copies will be as effective as a release or consent as the original which I sign.
Date *

Day Month Year
Date
Signature *

Clear
Should be Empty:

	Morning Shift (7am - 2:30pm)	Afternoon Shift (2:30pm - 10pm)
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Sunday

	Morning Shift (7am - 2:30pm)	Afternoon Shift (2:30pm - 10pm)
Monday
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Job Application Form

Employment Desired:

Education/Training:

Current Employment:

Previous Employment:

References:

General Information

Cover Letter & Resume:

Additional Information

Send Application: