Employee Application

Employee Application
Please Read!

The completion of this application form is part of stage one. This application will be reviewed, and a decision made as to whether to proceed to stage two, the interview, based on this information. If something does not apply please put N/A. PLEASE COMPLETE FULL APPLICATION.
Please complete all sections on this form
Title*
Name*

First NameLast Name
Are you at least 18 years of age?*

YesNo
Note: Minimum age legislation dictates that Care workers in general must be 18 years old or older. Please inform your interviewer immediately if you do not meet these specifications.
Date of Birth*

MonthDayYear
Date
Current Address*

Street Address

Street Address Line 2

CityPostal Code

County
Phone Number*
Email Address
example@example.com
Gender

MaleFemalePrefer no to say
Data Protection Statement The personal information (data) collected on this form, are used only for the purpose of this employment. Equality of Opportunity Statement The Agency’s Equal Opportunities Policy covers all employees, or potential employees, and embraces the principle that all people shall be treated equally, regardless of their age, gender, ethnic origin, nationality, colour, religion, marital status, sexual orientation, religion or belief, disability, or offending background.

Employment History
Details of past employment starting with the most recent
Details of past employment starting with the most recent
Details of past employment starting with the most recent
Please give details of relevant experience. This may be taken from the work situation, voluntary work, charity or your own home. Please use separate sheet if insufficient space is available.
Experience

Assistance with Interview and Assessment
Do you require us to make any special arrangements in order for you to participate in the recruitment process? For example, large print forms? Or additional time to complete forms?*

YesNo

References
You must provide references from your two most recent employers. Please provide an additional character referee. All will be contacted, therefore please inform the referees of the fact that you have used their name. If you are unable to provide the required references, please discuss the matter with us.
Reference*
Reference*
Reference*
SIGNATURE and DECLARATION IMPORTANT BEFORE SIGNING
I declare that to the best of my knowledge and belief the information given by me in this application is true, and I understand that the above information forms the basis of my contract of employment. I understand that if any of the information supplied by me is found to be falsely declared, my contract may have been fundamentally breached and my employment may be terminated immediately.
Date*

MonthDayYear
Date
Signature*

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Education