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Primely Care
We Are Expanding our team across the UK.
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1
Full Name
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Prefix
First Name
Middle Name
Last Name
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2
What type of Care Work Are You Interesting In?
*
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Choose As Many As Like
Home Care - Live In
Home Care - Perm
Home Care - Term
Home Care - Overnight
Care Home - Perm
Care Home - Term
Other
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3
Current Address
*
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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4
Phone Number
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5
Email Address
*
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The best email address to reach you on. We promise not spam you, only relevant information,
GDPR Love Us, We do not want to spam you.
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6
Birth Date
*
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-
Month
Day
Year
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7
Do you have eligibility to work in the UK
*
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YES
NO
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8
Years of Experience
*
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6 months- 1 Year
2 Years -3 years
4 Years - 5 Year
5 Year & Above
6 months- 1 Year
2 Years -3 years
4 Years - 5 Year
5 Year & Above
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9
Where do you work now?
*
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Care Home
Agency
Hospital
Other
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10
Available Start Date
*
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When are you available to start
/
Date
Day
Month
Year
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11
National Insurance Number
*
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12
How would you describe your cooking abilities?
Competent
Competent to a good standard
Good family cook
Plain cook
Trained
Not confident
Baking
Other
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13
NATIONALITY
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14
Do you have eligibility to work in the UK(United Kingdom)?
*
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YES
NO
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15
Type of eligibility to work in the UK
*
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Residency
Work permit
Visa
Other
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16
Can you work where there's pets?
*
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Yes
No
Maybe
Other
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17
Are you prepared to care for a client’s animals, including feeding and walking if necessary?
*
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Yes
No
Maybe
Other
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18
Are you prepared to care for a client that smokes?
*
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Yes
No
Maybe
Other
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19
Type of client you are prepared to care for?
*
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Female
Male
Both
Couple
Other
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20
Let us know your preference (some may abuse carers from certain cultural backgrounds. Are you willing to work with these clients?
*
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Yes, I am comfortable working with these clients
No, I would prefer to avoid working with these clients
Maybe, I would like to give it a try
Other
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21
Do you possess a current driving licence valid for use in the UK?
*
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YES
NO
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22
I am a
*
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Smoker
Non Smoker
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23
Do You Have DBS?
*
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Updated Disclosure and Barring Service Within the last 6 Month, Don't Worry If You Do Not Have One.
YES
NO
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24
DBS Certificate Number
If You Have said Yes to the previous question
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25
DBS Date of Issue
Date your DBS was issued
-
Date
Year
Month
Day
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26
Type of eligibility to work in the UK
*
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Residency
Work permit
Visa
Other
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27
Why Would You Like to Work As A Carer?
Tell Us Why You Want To Join Us
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28
Type Of Visa You Currently Hold
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29
Are you prepared to work with a Smoker?
*
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YES
NO
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30
What are you hobbies and interests?
*
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This would allow us match you with a client.
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31
Upload Your Resume
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Max. file size
: 10.6MB
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32
References
*
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Please give names of two referees from whom we may obtain references. One should be your current or most recent employer; the other should be from someone in connection with your work or education if you are still a student. We do not accept references from friends or relatives. You must supply correct contact details.
Name: First and Last Name of first reference
Please enter the email of your first reference
Please enter your first reference phone Number
Address of your first reference
Position Held
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33
References
*
This field is required.
Please give names of two referees from whom we may obtain references. One should be your current or most recent employer; the other should be from someone in connection with your work or education if you are still a student. We do not accept references from friends or relatives. You must supply correct contact details.
Name: First and Last Name of Second reference
Please enter the email of your Second reference
Please enter your Second reference phone Number
Address of your Second reference
Position Held
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34
Education and Qualifications
*
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Please give details of any professional, technical, academic or vocational qualifications, (start with your most recent qualification).
Qualification
Year Obtained
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35
Education and Qualifications
Please give details of any professional, technical, academic or vocational qualifications, (start with your most recent qualification).
Qualification
Year Obtained
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36
How Would You Describe Your Ethnicity
White –British
White -Irish
White –European
Other White background
Black or Black British -Caribbean
Black or Black British -African
Other Black background
Asian or Asian British -Indian
Asian or Asian British -Pakistani
Asian or Asian British –Bangladeshi
Chinese
Other Asian background
Mixed –White and Black Caribbean
Mixed –White and Black African
Mixed –White and Asian
Other Mixed background
Other Ethnic background
I prefer not to say
Other
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37
At Primelycare, we aim to ensure every carer is treated fairly while on placement and that all carers have equal opportunity to find work. Unfortunately, in small number of placements you may experince abuse due to your cultural background, We can't always avoid these situations, but will try our best to only show placements you are comfortable with based on the question below. The following selection allows you to choose wether you are comfortable with these placements. If you have any question about our policy towards discrimination please contact us
*
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I understand
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38
Medically and physically fitness
*
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I declare that to the best of my knowledge that I am medically and physically fit to undertake the duties of a care worker.
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39
National Minimum Data Set for Social Care. The NMDS-SC is an online database which holds data on the adult social care workforce. It is the leading source of workforce intelligence and holds information on around 25,000 establishments and 700,000 workers across England. As part of our working practice we provide information for the purposes of data analysis. Personal data provided is pseudonymised so an individual cannot be identified from the NMDS-SC data base. A date of birth and National Insurance number are used within the data base to produce a unique identifier for each worker’s record.
*
This field is required.
I declare that to the best of my knowledge that I am medically and physically fit to undertake the duties of a care worker.
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40
To ensure the safety of our customers and carers like you, we would like to know your Covid-19 vaccination status. This information may appear on your profile. It may be used to match you with potential clients and will be added to your record with Primely Care.Should you have any questions, please contact us at hello@primelycare.com or refer to our privacy policy on our website.You are fully vaccinated when you have received: - The second dose in a 2-dose series vaccine, such as the Pfizer, AstraZeneca or Moderna vaccines or,- The single dose vaccine such as Johnson & Johnson Janssen vaccine
I understand
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41
What is your vaccination status?
We do not discriminate
I am fully vaccinated
I intend to get fully vaccinated
I am medically exempt
I do not intend to get vaccinated
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42
Identification -
*
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Take a Selfie. This would be use for your ID Photo,
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Max. file size
: 10.6MB
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43
Identification
*
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Passport Or Birth Certificate,
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Max. file size
: 10.6MB
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44
Proof of Right to Work
*
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Proof of Right to Work (this could be your Passport or Visa page
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Max. file size
: 10.6MB
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45
Proof Of Address
*
This field is required.
Proof of address (bank statement or utility bill within three(3) months).
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Max. file size
: 10.6MB
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46
How did you hear about us
*
This field is required.
Please Select
Company Website
Google
LinkedIn
Social Media
Event
Family / Friend
Please Select
Please Select
Company Website
Google
LinkedIn
Social Media
Event
Family / Friend
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47
GDPR Consent
*
This field is required.
I consent to having PrimelyCare collect my details via this form
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48
Declaration
*
This field is required.
I hereby confirm to the best of my knowledge the information provided in this application is correct and gives a fair representation of my qualifications and employment history, and that I am eligible to work in the United Kingdom.
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49
Declaration
*
This field is required.
I understand that any offer of work from PrimelyCare (TLBS LTD) is strictly subject to satisfactory references, fitness for work, and also Disclosure and Barring and Protection of Vulnerable Adults Register checks.
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50
Declaration
*
This field is required.
Any false information is an offence and could result in the application being rejected, or summary dismissal. I also understand work will be offered on the basis of suitability and availability and PrimelyCare accept no responsibility for accommodation arrangements during time not working whilst in the UK.
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51
Declaration
*
This field is required.
I understand that the information given on this application form may be held on computer or in files and will be processed according to the Data Protection Act 1998.
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52
Signature
*
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Sign Here by Typing Your Full Name
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