Kays Carers Job Application

Name: *

First Name Last Name

Birth Date *

Day Month Year

Phone Number: *

Area Code Phone Number

E-mail Address: *

National Insurance Number *

Are you citizen of the EU? *

Do you need a work permit? *

Do you have a car for work use? *

Next of Kin; Name and Contact details

What hours are you seekiing?

Part Time Full Time

Do you hold a full clean Driving Licence?

If yes do you have a car you can use for work?

If yes do you have Business Insurance?

Education History

Please list any Care related qualifications

Employment History - A full employment history must be detailed beginning with your current employment and covering all reasons for gaps in any given year. At least 10 years of history required.

Please detail any disciplinary action within the previous 3 years, including any curennt, "live" formal warnings

If you have an Enchanced DBS on the update service, please give details of the DBS number and date of issue

REHABILITATION OF OFFENDERS ACT 1974 - NOTICE TO OFFENDERS

1.Do you have any convictions, cautions, reprimands or final warnings that are not “protected” as defined by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (as amended in 2013)

2.The amendments to the Exceptions Order 1975 (2013) provide that certain convictions and cautions are protected and are not subject to disclosure to employers and cannot be taken into account

Do you have any convictions to disclose?

If yes, please provide further information. This information will be treated as confidential and will not necessarily preclude you from employment

Signature

Clear

Failure to declare or the falsification of any of the above details will result in the withdrawal of any job offer.

References

Please give the name and address of three referees, one of whom must be your current or most recent employer. References from relatives or friends are not accepted.

Reference 1

Name

First Name Last Name

Status

Address

Street Address

Street Address Line 2

City County

Postal Code

Phone Number

Area Code Phone Number

Reference 2

Name

First Name Last Name

Status

Address

Street Address

Street Address Line 2

City County

Postal Code

Phone Number

Area Code Phone Number

Reference 3

Name

First Name Last Name

Type a question

Address

Street Address

Street Address Line 2

City County

Postal Code

Phone Number

Area Code Phone Number

This organisation seeks to work in a flexible and family-friendly manner with its staff, however, unsocial hours are part and parcel of a quality care service. Weekend working is a requirement for all staff, the frequency of which will be determined at interview.

Please indicate any holiday dates if already booked

Period of notice required in present post

Earliest start date

Did you complete this application yourself?

I declare that to the best of my knowledge, all the information contained and documented herein is complete and truthful.

Signature

Clear

Date

Application of Employment