Carer Application Form
Important: please do not completed this form if you are not residing in the UK or do not have access to your own vehicle
Your Name
First Name
Last Name
Have you ever been known by any other name or alias? (please state here or leave blank if not)
State maiden names or any other names you have been known by previously
Your Email Address
example@example.com
Your Phone Number
Date of Birth
-
Month
-
Day
Year
Current Address
Street Address
Street Address Line 2
City
County
Postcode
How long have you lived at your current address? (Months & Years)
If you have lived in your current address for less than 10 years, please provide all your addresses in the last 10 years here:
Care Home being applied for
Please Select
White Rose House
Astley Grange
How did you find out about us?
Google
Word of mouth
Other
Are you a driver and do you have access to your own car?
Yes
No
Do you have Business Insurance on your car (you will need this in order to use your car for work)
Yes
No
Not at present, however I will obtain Business Insurance if I am successful in securing this job
Do you require any reasonable adjustments to attend interview or training as a result of a health condition or disability?
Yes
No
Prefer not to say
If you have answered 'yes' to the last question - please state what reasonable adjustments would help you:
Do you have a DBS?
I have a live DBS registered on the Update Service
I have a paper DBS less than 12 months old
No
If you've answered 'No' to having a DBS are you happy to pay for one?
Yes
No
Is there likely to be any cautions, warnings or convictions (or any other information) flag up on your DBS?
There are convictions on the DBS
No convictions on the DBS
If you've answered 'yes' to the last question please state what information will flag up on your DBS:
Submit
Should be Empty: