AABHC APPLICATION FOR EMPLOYMENT

APPLICATION FOR EMPLOYMENT
Job title*
Please chose a job role.
Location
Title
First Names*
Surname*
Date of Birth*

DayMonthYear
Enter your Date of Birth as DD-MM-YYYY
Home Address
Postcode*
Autocompleted Address
National Insurance Number*
Mobile*
Email*

Confirmation Emailexample@example.com
Work
Other
Driving Licence Type*

Full UK/EU Driving LicenceNo LicenceProvisional UK Driving LicenceInternational Driving Licensce
If Yes are there any restrictions
Points on Licence. Valid for Only 1 Year.
Details of any driving convictions
Do you own your own Vehicle*

My Personal VehicleNo VehicleCyclist / Motor Cyclist
Right to Work in the UK*

UK/ EU CitizenPermanent ResidentVisa National (Restricted Work)No Right to Work
If Yes please provide your Right to Work Share code if applicable
Share Code Number
Upload your Share Code

Cancelof
Please attach supporting documents eg passport visa
Upload your International Passport

Cancelof
Next of Kin or Advocate Name & Address:
Name
Relationship
Address
Contact Number
Alternative Contact Number
EDUCATION DETAILS
Please provide details of education since the age of 11, including academic, vocational, and professional qualifications (e.g., NVQ in Health & Social Care Ensure you include the month and year.
Educational Establishment
Qualifications including grades
Dates

MonthDayYear
Date
EMPLOYMENT HISTORY
Please list your full employment history since leaving full-time education, starting with your most recent position. Ensure all gaps in employment are recorded, including dates and reasons.
Employer
To
Position held and brief description of duties
Reason for leaving
If there are gaps in your employment history please explain them below
Please supply details of two professional referees. Referees must include your most recent employer and someone who has known you in a professional capacity for at least five years (not a family member
Company
From
Referee Name
Position
Address
Postcode
Telephone
Email
example@example.com
Company
Referee Name
Position
Address
Postcode
Telephone
Email
example@example.com
Can we contact your current employer prior to the interview?

YesNoOther
SAFEGUARDING VULNERABLE INDIVIDUALS
Platinum Homecare 4 U Ltd is committed to safeguarding all individuals receiving care. You are required to demonstrate that you are of good character through referencing and your personal declaration in accordance with the Rehabilitation of Offenders Act 1974 and the Equality Act 2010. All necessary checks must be completed prior to employment.

Please confirm you have read and understood this and consent to us carrying out these checks:
REHABILITATION OF OFFENDERS ACT 1974
Due to the nature of this role, it is exempt from certain aspects of the Rehabilitation of Offenders Act 1974. An enhanced Disclosure and Barring Service (DBS) check will be conducted before appointment. This includes details of cautions, reprimands, or final warnings as well as

Please confirm you have read and understood this: Yes No]
I authorize and consent to checks being made with regards to safeguarding vulnerable individuals and the rehabilitation of offenders.*

YesNoOther
DBS Number*
DBS Expiry Date

DayMonthYear
Date
Is your DBS on the Update Service?

YesNoOther
Do you consider yourself to have any special needs or a disability?

If Yes, please provide details, including any reasonable adjustments required during the
If Yes please provide details including any reasonable adjustments required during the recruitment process
Would you require any adjustments to perform your role effectively?
If Yes please provide details
Please list any care-related or mandatory training you have completed (e.g., safeguarding, manual handling, infection control) along with the dates completed and expiry dates:
Safeguarding Adults
Manual Handling
Food Hygiene
Medication Management
Fire Safety Awareness
If additional training is not listed above, please include it here:
Training Name
Date Completed

DayMonthYear
Date
Expiry Date

DayMonthYear
Date
HEALTH AND WELLBEING
Do you have any physical or mental health conditions that could impact your ability to perform care-related tasks?
If Yes please provide details
I confirm that the information set out in this form is true and correct. I understand and agree that if I provide false or misleading information or omit any material facts, this may result in my application being rejected or my employment being terminated.

I certify that I am entitled to work in the UK and will provide documentary evidence upon request. I acknowledge that I am responsible for ensuring compliance with any statutory restrictions (e.g., student visa work-hour limits

I agree to Platinum Homecare 4 U Ltd sharing the information provided in this application with third parties as required under GDPR regulations and relevant contractual arrangements.
Signed

Clear
Date

DayMonthYear
Date
Should be Empty:

APPLICATION FOR EMPLOYMENT

EDUCATION DETAILS

EMPLOYMENT HISTORY

SAFEGUARDING VULNERABLE INDIVIDUALS

REHABILITATION OF OFFENDERS ACT 1974