Employment Application Form

Ashmere Derbyshire Application Form

Fill the form below accurately indicating your potentials and suitability to job applying for. Please ensure that you read and complete all sections of the application form and sign the declaration.
Which position do you wish to apply for:

Care AssistantSenior Care AssistantNurseDomestic AssistantKitchen StaffActivities Co-OrdinatorManagementHead OfficeOther
Which Home do you wish to apply to:
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityTown

Post Code
Birth Date*

MonthDayYear
Phone Number*

Phone Number
Email*
example@example.com
Car Registration Number (if applicable)
How were you referred to us?*

Walk-InReferralNewspaper AdFacebookTwitterLinkedInOther (please specify)
CV Required

Cancelof
Tell us about you- What makes you passionate about working in care? Or if you want to get into social care, tell us why? What can you bring to the Ashmere Family?*
Your Most Recent Employer and Dates, along with roles and key responsibilities:*
Reasons for leaving your most recent employment:*
Previous Employers and Dates, along with roles and key responsibilities:*
Training and Certifications
Training and Certifications
Training and Certifications
Training and Certifications
References

Please provide details of two references who have known you in a work capactity where possible (one must be your most recent employer).

Please note, all offers of employment are subject to two satisfactory references, failure to provide or gain an unsatisfactory reference may result in the offer of employment being withdrawn.
Reference One*
Reference Two*
Criminal Convictions

The post you are applying for is exempt from the provisions of the rehabilitation of offenders act under the rehabilitation of offenders act (exceptions order) 1975. All previous convictions must therefore be declared. No convictions can be considered "spent" or too minor or too old to be in included.
Have you ever been convicted of a criminal offence, cautioned or served a sentence?*

YESNO
If "YES" please give details of all convictions, cautions, reprimands or police warning with dates:
A conviction does not mean that you will not be considered for employment as each application will be considered on merit, but failure to disclose an offence will result in withdrawal from consideration or immediate dismissal if appointed.
Are you legally permitted to work in the UK?*

YesNoOther (i.e. require sponsorship)
If successful after interview stages, are you happy to undergo a pre-employment health screening?

YesNo
Declaration: I declare that I have answered the above questions fully and completely and know of no reason why I should not be suitable for the post applied for or unable to fulfil the roles and responsibilities.*

Clear
Date*

MonthDayYear
If you have any queries when completing this form, please contact HR on 01773 571 535 or hr@ashmere.co.uk.
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Ashmere Derbyshire Application Form