Bluebird Care Application Form

Bluebird Care Application Form

Confidential Application For Employment
Application form
Position applied for*
Date available to take up employment*

DayMonthYear
Date
Work Preference:
Please tick which options you would like to apply for*

Full timePart timeBankLive-in Care
I understand this role may include: shift work, unsociable hours and/or lone working. *
Personal details
Title*
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

TownCounty

Post Code
Phone Number*
Please enter a valid phone number.
Email address*
example@example.com
National insurance number*
Passport number
Passport issue date

DayMonthYear
Date
Do you own a car?*

YesNo
Do you hold a current licence?*

YesNo
If yes, licence type

FullProvisionalAutomatic Transmission OnlyManual TransmissionMotorbike licence
Driving licence number
Do you have any current driving convictions?

YesNo
If yes, give details including dates
For the purposes of this application and interview stage only, is there anything you would like us to be aware of so that we can make reasonable adjustments during the process?*
If yes, please include details
Where did you hear about Bluebird Care?*
Secondary education

Please provide details about your secondary education*

	School name, address and date attended	Examinations (subject, result, etc.)
1
2
3
4
5

Further education and training

Please provide details about any further education and training you have had

	Univerasity/College and date attended	Type of course	Subjects	Qualification or class of degree
1
2
3

Occupational qualifications

Please list any occupational qualifications you hold

	College/Institute or other name and date attended	Qualification/Level
1
2
3
4
5

Membership of professional body

Please list any memberships you have with any professional bodies

	Name	Level	Date
1
2
3

Previous employment

Please record below the details of your full employment history beginning with your current or most recent first. Any gaps must be explained. If Bluebird Care is going to be your first job, please write N/A in the boxes below.
Current/last employer*
Address*

Street Address

Street Address Line 2

TownCounty

Post Code
Job title*
Duties/responsibilities*
Start date*

DayMonthYear
Date
End date (if still current, leave blank)

DayMonthYear
Date
Reason for leaving*
Previous employment

Please include your full work history and any gaps explained.*

	Employer name and address	Job title	From (mm/yy)	To (mm/yy)	Reason for leaving
1
2
3
4
5
6
7
8
9
10

Please provide details of any other employment you have had not listed above including employer name, address, dates worked (from and to), and reason for leaving.
Please provide details to explain any gaps in employment*
General
Please detail and interests/hobbies (dive details of pastimes, sports, etc)
Please detail any offices held in social/sports clubs, etc.
Please detail any public duties (local councillor, etc) undertaken
If offered this position will you continue to work in any other capacity
If yes, give details
Community/volunteer experience
Please give the name and address of any organisations you have community/volunteer experience, as well as your position/title and duties
Additional supporting information
Please upload any documents such as CVs, training or qualifications certificates, etc. that you feel would support your application

Cancelof
Permission to work in the UK
Please upload any relevant documtents to support your right to work in the UK

Cancelof
Are there any restrictions to your residence in the UK that might affect your right to take up employment in the UK?*
If you are successful in your application would you require permission to work in the UK?*
Next of kin
First emergency contact name*

First NameLast Name
Relationship to you*
Phone Number*
Please enter a valid phone number.
Second emergency contact name*

First NameLast Name
Relationship to you*
Phone Number*
Please enter a valid phone number.
Referees
Work reference 1 (most recent employer) - not members of your own family*

First NameLast Name
Job Role*
Organisation*
Address*

Street Address

Street Address Line 2

TownCounty

Post Code
Phone Number*
Please enter a valid phone number.
Work email address ONLY, example "reading@bluebirdcare.co.uk"*
example@example.com
Work reference 2 - not members of your own family*

First NameLast Name
Job Role*
Organisation*
Address*

Street Address

Street Address Line 2

TownCounty

Post Code
Phone Number*
Please enter a valid phone number.
Work email address ONLY, example "reading@bluebirdcare.co.uk"*
example@example.com
Work, personal or educational reference - not members of your own family*

First NameLast Name
Address*

Street Address

Street Address Line 2

TownCounty

Post Code
Relationship to you*
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
GDPR and the Data Protection Bill 2018:

Requires that any staff handling personal data must follow certain principles in relation to the data that they hold. Individuals have rights of access to data that is held and rights to claim for damages if various offences occur. This covers all records.

In implementing this legislation, Bluebird Care (Reading, Wokingham, Windsor, Maidenhead, Bracknell) adopts a simple and straightforward policy.

If you are unsuccessful in obtaining employment with Bluebird Care (Reading, Wokingham, Windsor, Maidenhead, Bracknell), we would like to keep your data on file in case other suitable job vacancies arise in the Company for which we think you may wish to apply. You are free to withhold your consent to this and there will be no consequences for withholding consent.

Your details will be kept on file for 24 months.

If you choose not to have your details on file with us your application form will be held for 6 months and will only be referenced to explain our reason for not offering you a position at the relevant time.

If you would like to withdraw your consent to Bluebird Care (Reading, Wokingham, Windsor, Maidenhead, Bracknell) keeping your data on file please contact us on 0118 986 3552 at any point.
I would like for Bluebird Care (Reading, Wokingham, Windsor, Maidenhead, Bracknell) to keep my details on file in case other suitable roles become available*
Criminal Record Check
I have completed / will complete an application for a criminal record check and can further state that to the best of my knowledge and belief, there will not be any positive disclosure made that will preclude me from working with vulnerable adults or children.

I also give permission for a copy of the disclosure to which I am subject, being made available to a named authorised person upon written request, who acts on behalf of a National Government or Local Government Department for auditing purposes.
Name*

First NameLast Name
Signature*

Clear
Date*

DayMonthYear
Date
Working with Bluebird Care
It is Bluebird Care’s policy to employ the best qualified personnel and provide equal opportunity for the advancement of employees including promotion and training and not to discriminate against any person because of race, colour, ethnic origin, national origin, sex, sexual orientation, religion or belief, pregnancy, trans-gender status, marital or civil partnership status, age or disability.

I authorise Bluebird Care to obtain references to support this application once an offer has been made and accepted and release Bluebird Care and referees from any liability caused by giving and receiving information.
Name*

First NameLast Name
Signature*

Clear
Date*

DayMonthYear
Date
Declaration
Should be Empty:

Bluebird Care Application Form

Application form

Work Preference:

Personal details

Secondary education

Further education and training

Occupational qualifications

Membership of professional body

Previous employment

Previous employment

General

Community/volunteer experience

Additional supporting information

Permission to work in the UK

Next of kin

Referees

Criminal Record Check

Working with Bluebird Care

Declaration