OOJ Homecare Services Job Application Form

APPLICATION FORM

OOJ Homecare Services
Position applied for:
Name

SurnameFirst name(s)
Email
example@example.com
D.O.B:

MonthDayYear
Date
Current address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Moved to this address on (date):

MonthDayYear
Date
Previous address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Note: For Criminal Record check purposes, addresses covering the five years up to the application date must be supplied. If necessary, use another sheet of paper.
Post code:
Moved to this address on (date):

MonthDayYear
Date
Telephone number (home):
Please enter a valid phone number.
Telephone number (work - will be used withdiscretion):
Please enter a valid phone number.
Clean current driving License:
How long has your license been held?
Endorsements:
Details:
EDUCATION
TRAINING HISTORY/PROFESSIONAL STATUS
Date of Graduation/Qualification
Location/Details
Notes
ADDITIONAL COURSES ATTENDED
Employment History

Current/most recent first. Information must cover the whole of your working life to date. State the reasons for any breaks in employment. Use a separate attached sheet if required; please sign that sheet(s).
Name and address of your most recent/last employer:*
Name and address of employer prior to the employer listed above:*
Name and address of employer prior to the employer listed above:*
Other roles
Please give details of relevant experience. This may be taken from the work situation,voluntary work, charity or your own home.
ASSISTANCE WITH INTERVIEW AND ASSESSMENT
YesNo
If yes, please give details:
(Your GP will never be contacted without your permission)
NEXT OF KIN
Any offer of employment may be made subject to a satisfactory medical report.
IDENTITY DETAILS
National Insurance Number:
(All Applicants)
CAPACITY TO WORK IN THE UK
YesNo
If yes, please give details:
Note: Minimum age legislation dictates that Care workers in general must be 16 year sold or older. Please inform your interviewer immediately if you do not meet the specifications.
REFEREES

You must provide references from your two most recent employers. Please provide an additional character referee. 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
Previous employer to the one above
Previous employer to the one above
CRIMINAL RECORD
- Workers of The Agency are subject to the Health and Social Care Act 2008, 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 applied for 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 authorise OOJ Homecare Services Ltd to request a DBS Register check and a criminal records 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
Date
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Should be Empty:

APPLICATION FORM

EDUCATION

TRAINING HISTORY/PROFESSIONAL STATUS

ADDITIONAL COURSES ATTENDED

Employment History

ASSISTANCE WITH INTERVIEW AND ASSESSMENT

IDENTITY DETAILS

CAPACITY TO WORK IN THE UK

REFEREES

CRIMINAL RECORD