S076 A LCG PR26 21 Aplication Form for Administrative Positions

EDUCATION

Education details

	Describe	Examination Passed	Qualification Gained
School/College/University
School/College/University
School/College/University

TRAINING HISTORY/PROFESSIONAL STATUS

	Courses, Skills, Abilities - Describe	Comments or Date Completed
1
2
3
4
5
6
7

Please supply copies of certificates, membership details, CV

Cancelof

EMPLOYMENT HISTORY

Current or most recent first. Information must cover the whole of your working life since you left school to date. State the reasons for any breaks in employment timeline.
Please give details of relevant experience and activities when not working. This may be taken from the work situation, voluntary work, charity or your own home. Please use a separate sheet and sign it or email it to us careers@lifecomecare.co.ik if insufficient space is available.
Name and address of your most recent employer or activity:
Nature of business
Telephone

Area CodePhone Number
Date employed (start)

DayMonthYear
Date
Date employed (end)

DayMonthYear
Date
E mail
example@example.com
Position held and reason for leaving
Salary / Rate
Name and address of employer prior to the employer listed above or activity
Nature of business
Telephone

Area CodePhone Number
Date employed (start)

DayMonthYear
Date
Date employed (end)

DayMonthYear
Date
E mail
example@example.com
Position held and reason for leaving
Salary / Rate
Name and address of employer prior to the employer listed above or activity
Nature of business
Telephone

Area CodePhone Number
Date employed (start)

DayMonthYear
Date
Date employed (end)

DayMonthYear
Date
E mail
example@example.com
Position held and reason for leaving
Salary / Rate
Name and address of employer prior to the employer listed above or activity:
Nature of business
Telephone

Area CodePhone Number
Date employed (start)

DayMonthYear
Date
Date employed (end)

DayMonthYear
Date
E mail
example@example.com
Position held and reason for leaving
Salary / Rate
Name and address of employer prior to the employer listed above or activity
Nature of business
Telephone
Date employed (start)

DayMonthYear
Date
Date employed (end)

DayMonthYear
Date
E mail
example@example.com
Position held and reason for leaving
Salary / Rate
Name and address of employer prior to the employer listed above or activity
Nature of business
Telephone

Area CodePhone Number
Date employed (start)

DayMonthYear
Date
Date employed (end)

DayMonthYear
Date
E mail
example@example.com
Position held and reason for leaving
Salary / Rate
Name and address of employer prior to the employer listed above or activity:
Nature of business
Telephone

Area CodePhone Number
Date employed (start)

DayMonthYear
Date
Date employed (end)

DayMonthYear
Date
E mail
example@example.com
Position held and reason for leaving
Salary / Rate
Name and address of employer prior to the employer listed above or activity:
Nature of business
Telephone

Area CodePhone Number
Date employed (start)

DayMonthYear
Date
Date employed (end)

DayMonthYear
Date
E mail
example@example.com
Position held and reason for leaving
Salary / Rate
Candidate Name

REFEREES
You must provide references from your two most recent employers. Please provide a character reference if you are unable to obtain two professional references e.g. in the case of an applicant who has been raising children for ten years. All will be contacted, therefore please inform the referees of the fact that you have used their name. If you are unable to provide the required references, please discuss the matter with us.
Current or Most Recent Employer*
Job title
E mail*
example@example.com
Address
Postcode
Tel No*
Previous Employer to the one Above
Job title
Address
E mail
example@example.com
Postcode
Tel No
Character Reference
Your name
Referee
Address
E mail
example@example.com
Postcode
Tel No
Relationship to you
ALL APPLICANTS MUST ANSWER ALL QUESTIONS ON THIS FORM.

FAILURE TO DO SO WILL INVALIDATE YOUR APPLICATION.

Lifecome Group - Head Office 128b Brixton Hill, London, SW2 1RS

Names Known and Addresses
Full name
Maiden name or other Names you are or were known
Date of birth

DayMonthYear
Date
Place of birth
Eyes colour
Height
Present address
I Have Lived at the Above Address Since
Previous Addresses: (Must Cover Previous 5 Years)
CRIMINAL RECORD Workers of LifeCome Care are subject to the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and will be subject to a Police Record Check through the DBS. Please declare all criminal convictions, whether spent or not, charges, whether proceeded with or not, and warnings and cautions. Please note, you may not be eligible for work in a Care setting if you are on the DBS Register(s

Please declare all criminal convictions, whether spent or not, charges, whether proceeded with or not, and warnings and cautions in the space provided below.

SIGNATURE and DECLARATION - IMPORTANT - READ BEFORE SIGNING

I declare that to the best of my knowledge and belief the information given by me in this application is true, and I understand that the above information forms the basis of my contract of employment. I understand that if any of the information supplied by me is found to be falsely declared, my contract may have been fundamentally breached and my employment may be terminated immediately.

I understand that I may not be offered a post until a satisfactory response has been received with respect to my DBS Register status, and that should I subsequently be offered a post, that offer will be subject to receipt of two satisfactory references, one of which must be from my previous employer, and that confirmation of the employment will be subject to a satisfactory criminal record check from the DBS.

I understand that until a satisfactory response is received from the DBS, and my employment is confirmed, I will be supervised at all times at work, and will not seek or have unsupervised access to vulnerable people. If the post I have appliedfor is as a Registered Nurse, my confirmation of employment will also be subject to a satisfactory search of the Nursing and Midwifery Council records and registers. By my signature, I authorize LifeCome Limited T/A LifeCome Care to request a DBS Register check and a criminal record check from the DBS, on initial employment and at any time during my employment thereafter. I undertake to inform my employer immediately if my DBS Register status or criminal status changes at any time during my employment, such as by being charged with an offence (other than motoring offences), the administering of a warning, criminal conviction, referral to any register of barred Care workers, or withdrawal of any registration required by my employment status.
Signed*

Clear
Date

DayMonthYear
Date
ALL APPLICANTS MUST ANSWER ALL QUESTIONS ON THIS FORM.

FAILURE TO DO SO WILL INVALIDATE YOUR APPLICATION.

Lifecome Group - Head Office 128B Brixton Hill, London, SW2 1RS

EDUCATION

TRAINING HISTORY/PROFESSIONAL STATUS

EMPLOYMENT HISTORY

REFEREES

Character Reference

Names Known and Addresses

EQUAL OPPORTUNITIES MONITORING

PLEASE NOTE

GENDER

AGE

SEXUAL ORIENTATION

ETHNIC GROUP

DISABILITY