Midlands Care - Job Application Form

Midlands Care - Job Application Form

This is a perfect opportunity for you to start a rewarding career in care. Complete and submit the form below as part of the initial screening. If you are successful, we will be in touch within 5 working days.
Which location are you applying for?:
Select the setting that you are applying for
Position:
Select the job role you are applying for
Where did you hear about the Job Opportunity:
Full Time or Part Time?
When would you be able to start?
Do you have the legal right to work in the UK?
Will you at any point require a Certificate of Sponsorship of any form?

Your Details
Title
Full Name

First NameMiddle NameLast Name
Any previous names and relevant dates. If there are none please state 'None':
Date of Birth
Contact Telephone Number
Email Address
example@example.com
City of Birth:
Specify the city in which you were born
Country of Birth:
Specify the country in which you were born
Nationality (For DBS purposes ONLY):
If 'Other', Please Specify Your Nationality:
For DBS Purposes Only.
Mother's Maiden Name:
Your mother's LAST name before her marriage.
Note: The company will require proof of this right before an offer of employment can be confirmed - eg. Birth certificate and/or any other appropriate document required to confirm your right to work in the UK as required by the Asylum and Immigration Act 1996.

Address History

You need to provide us with atleast FIVE years of address history.
What is your current address (including postcode)
e.g. 10 Downing Street, London SW1A 2AA, United Kingdom
At which Date did you move to this address? (Use the calendar icon to select the date)
Previous address (inc postcode)
Date From

DayMonthYear
2 digit day, 2 digit month, 4 digit yearClick the calendar icon
Date To
Taken from entry above
Previous address (inc postcode)
Date From

DayMonthYear
2 digit day, 2 digit month, 4 digit yearClick the calendar icon
Date To
Previous address (inc postcode)
Date From

DayMonthYear
2 digit day, 2 digit month, 4 digit yearClick the calendar icon
Date To
Note: The 'Date From' entered above should be prior to the 'Date To' on the right hand side
Previous address (inc postcode)
Date From

DayMonthYear
2 digit day, 2 digit month, 4 digit yearClick the calendar icon
Date To
Note: The 'Date From' entered above should be prior to the 'Date To' on the right hand side
Previous address (inc postcode)
Date From

DayMonthYear
2 digit day, 2 digit month, 4 digit yearClick the calendar icon
Date To
Note: The 'Date From' entered above should be prior to the 'Date To' on the right hand side
Previous address (inc postcode)
Date From

DayMonthYear
2 digit day, 2 digit month, 4 digit yearClick the calendar icon
Date To
Note: The 'Date From' entered above should be prior to the 'Date To' on the right hand side

CV Upload

Please upload your latest CV below
CV File Upload

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Employment History

Midlands Care require your full employment status and history for at least 5 years.
Current Employer or reason for Non-Employment
Employment Status
Current Employer or current School / College / University attended.
* Must be completed if you are employed
Please always use the calendar icon to select the dates
When did this employment (or non-employment) commence.

DayMonthYear
We Require Full Employment Status History

Please list your previous employment status for at least 5 years including period of non-employment (do not leave gaps). Start with your most recent experience first.
Employment Status
Employer or School / College / University attended.
*Must be completed if you are employed
Date From

DayMonthYear
2 digit day, 2 digit month, 4 digit yearClick the calendar icon
Date To
Reason for leaving:
Note: The 'Date From' entered above should be prior to the 'Date To' on the right hand side
Employment Status
Employer or School / College / University attended.
* Must be completed if you are employed
Date From

DayMonthYear
2 digit day, 2 digit month, 4 digit yearClick the calendar icon
Date To
Reason for leaving:
Note: The 'Date From' entered above should be prior to the 'Date To' on the right hand side
Employment Status
Employer or School / College / University attended.
* Must be completed if you are employed
Date From

DayMonthYear
2 digit day, 2 digit month, 4 digit yearClick the calendar icon
Date To
Reason for leaving:
Note: The 'Date From' entered above should be prior to the 'Date To' on the right hand side
Employment Status
Employer or School / College / University attended.
* Must be completed if you are employed
Date From

DayMonthYear
2 digit day, 2 digit month, 4 digit yearClick the calendar icon
Date To
Reason for leaving:
Note: The 'Date From' entered above should be prior to the 'Date To' on the right hand side
Employment Status
Employer or School / College / University attended.
* Must be completed if you are employed
Date From

DayMonthYear
2 digit day, 2 digit month, 4 digit yearClick the calendar icon
Date To
Reason for leaving:
Note: The 'Date From' entered above should be prior to the 'Date To' on the right hand side
Employment Status
Employer or School / College / University attended.
* Must be completed if you are employed
Date From

DayMonthYear
2 digit day, 2 digit month, 4 digit yearClick the calendar icon
Date To
Reason for leaving:
Note: The 'Date From' entered above should be prior to the 'Date To' on the right hand side
Employment Status
Employer or School / College / University attended.
* Must be completed if you are employed
Date From

DayMonthYear
2 digit day, 2 digit month, 4 digit yearClick the calendar icon
Date To
Reason for leaving:
Note: The 'Date From' entered above should be prior to the 'Date To' on the right hand side
Employment Status
Employer or School / College / University attended.
* Must be completed if you are employed
Date From

DayMonthYear
2 digit day, 2 digit month, 4 digit yearClick the calendar icon
Date To
Reason for leaving:
Note: The 'Date From' entered above should be prior to the 'Date To' on the right hand side
Employment history beyond 5 years: (If applicable)
Write 'Not applicable' if you do not have any employment prior to 5 years.

Qualifications
Please detail any relevant qualifications and experience that will support your application.

Any History
Because of the nature of the work for which you are applying, this post is exempt from the provision of sec4(2) of the Rehabilitation of Offenders Act (exempt order 1975).

Applicants are therefore not entitled to withhold information about convictions or cautions which are current or 'spent' under the provisions of the act and in the event of employment, any failure to disclose such convictions or cautions could result in disciplinary action or dismissal by the employer.

Any information given will be kept confidential and will only be used in consideration of the position applied for.

Please click here for more details on The Rehabilitation of Offenders Act 1974
Have you ever been convicted or cautioned of a criminal offence?
If answered 'Yes' to the above please provide details.
Have you ever been dismissed or suspended for any pending case?
If answered 'Yes' to the above please provide details.

Reference Requests

Complete the section below with details of who will be providing you a reference. We need a total of at least 2 reference. One must be from your current/past work place and another can be a character reference or a reference from another previous work place. We reserve the right to request a third reference if we will necessary.
FIRST: Person Providing Reference:

First NameLast Name
Relationship
Email
example@example.com
Their Contact Telephone Number
Contact number for the first reference point.
SECOND: Person Providing Reference:

First NameLast Name
Relationship
Email
example@example.com
Contact Telephone Number
Contact number for the second reference point.

Additional Information
Do you have any disabilities and or injuries that we need to be aware of so that we can plan for and make reasonable adjustments to accomodate you should you be successful in your application?. Please state 'None' if applicable

Data Protection and Privacy Statement (in line with the GDPR Regulation guidelines 2018)
The information in this application form is requested in line with Midlands Cares privacy statement which can be viewed in full or on our website at www.midlandscare.co.uk or in any of our homes.

If your application is unsuccessful following the interview process, all application forms are destroyed and NOT held on file.

However, if you would like to be considered for a future position within our company, please consent below to allow us to hold your personal information securely for the internal business use and for a future application made by yourself. The information you provided in this form may be used for internal statistical analysis to help with our requirement processes.
Please note that we never share any personal data that would make you identifiable to anyone outside of our organisation and for further assurance, all our employees are subject to following strict confidentiality policies and procedures implemented by our senior management team at Midlands Care.
Please indicate whether you would like us to hold your application details on file
Signature
Please note that any approval of this 'application' by Head Office is only the first stage of the application process. The homes management team still reserve the right to offer / not offer any employment.
Should be Empty:

Midlands Care - Job Application Form

Your Details

Address History

You need to provide us with atleast FIVE years of address history.

CV Upload

Employment History

We Require Full Employment Status History

Qualifications

Any History

Reference Requests

Additional Information

Data Protection and Privacy Statement (in line with the GDPR Regulation guidelines 2018)