SAFE KEEP CARE APPLICATION FORM

SAFE KEEP CARE
Position Applied For
Availability (Hours/Days)
Example: '40 hours per week/ 4 days a week
N.I Number
First Name
Last Name
Phone Number

Area Code (For Landlines Only)Mobile Number
Emergency Number

Area Code (For Landlines Only)Mobile Number
Date of Birth

MonthDayYear
Date
Full Address
Do You have a valid UK Driving License?
Type Yes/No
Upload Driving Licence (optional)

Cancelof
Email
NMC PIN Number (Optional)
Expiry Date

MonthDayYear
Date
Next Of Kin
Relationship
Full Address
Postcode
Part 2: Equal Opportunity

We are an Equal Opportunity Employer. The aim of our policy is to ensure that - job applicant or employee recrives less favorable treatment on the grounds of rare, color, creed, nationality, ethnic or national origin, religious belief, political opinion or affiliation, sex, marital status, sexual orientation, or disability, or is disadvantaged by conditions or requirements which cannot be shown to be justifiable.

Our selection criteria and procedures are frequently reviewed to ensure that individuals are selected, promoted and treated on the basisof their relevant merits and abilities. All employees are given equal opportunity and are encouraged to progress within the organization.We are committed to an ongoing program of action to make this policy fully effective.

To ensure that this policy is fully and fairly implemented and monitored, and for no other reason, would you please provide the following information:
AsianBlack AfricanBlack CarribbeanEast AsianWhiteNative AmericanOther
MaleFemaleOtherPrefer Not to Say
SingleMarriedDivorcedOther
Nationality
Part 3: All Qualifications & Trainings
Provide details of vocational and academic qualifications you have, with the most recent at first.

Rows	Qualification	Institution	From	To

Part 4: Previous Employment

Start with your most recent employer. Please cover all jobs (all periods/gaps between jobs should be accounted for or explained:

Rows	From	To	Name and address of employer	Position Held/ Role Description	Reasons for leaving
Date
Date
Date
Date
Date
Date
Date
Date
Date
Date

IMPORTANT: Please explain all gaps in employment below
I declare that the information contained in this application is true and complete to the best of my knowledge. I understand that if have given untrue or misleading information this may result in disciplinary action and/or dismissal.
Name
Signature

Clear
Date

MonthDayYear
Date
Criminal Convictions (Rehabilitation of Offenders Act)

You are required to disclose any convictions that are current (not 'spent' under the Rehabilitation of Offenders Act 1974 You may be required to disclose convictions that are "spent' if the post you are applying for is exempt under the Act, e.g if you will be working with children or vulnerable adults. Please read the general information section contained within the job pack for guidance.
Have you ever been convicted of a criminal offence or received a police caution?
Type Yes/No
If yes, please give full details in a seperate document. We will only take them into account if we consider them relevant to the post which you have applied for.
Disability Discrimination Act 1995 and 2005
Do you have any disabilities?
Type Yes/No
If you typed yes, please describe the disability you have and any particular requirements you might have.
Part 5: References

Please provide details of two referees, one being your present or most recent employer. Relatives are not allowed. (Referees are not usually contacted unless you are shortlisted for an interview)
Name Of Referee 1
Position
Address
Phone Number

Area Code (For Landlines Only)Mobile Number
Email address
example@example.com
Name Of Referee 2
Position
Address
Phone No

Area Code (For Landlines Only)Mobile Number
Email address
example@example.com
SELF EMPLOYMENT DETAILS
UTR Number
Full Name
Contact Number
DOB
National Insurance Number
BANK DETAILS
Name of the Bank
Address
Sort Code
Account Number
I hereby declare that the information I have provided within this application is true and agree for Safe Keep Care UK to receive and hold my personal information. I confirm that I have full authority to use the above bank/building society to receive my wages.
Employee Signature

Clear
Date

MonthDayYear
Date
Safe Keep Care 268 Bath Road, Slough, Berkshire Tell:01753 701127

Email: info@safekeepcare.com

Visit www.safekeepcare.com

Company Reg No: 13180705
Should be Empty:

SAFE KEEP CARE

Part 4: Previous Employment

Disability Discrimination Act 1995 and 2005

SELF EMPLOYMENT DETAILS

BANK DETAILS