Application Form
Position applied for
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Preferred location
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Name
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First Name
Last Name
Previous Names (write N/A if not applicable)
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Date of birth
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Day
-
Month
Year
Date
Phone number
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Email
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example@example.com
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Marital Status
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Gender
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Place of Birth
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Are you a United Kingdom (UK) National?
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Yes
No
Can you prove that you are legally entitled to work in the UK?
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Yes
No
Do you require Sponsorship from this role in order to work? (Please note we are not able to offer Sponsorship at this time).
yes
no
Nationality
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If you are NOT a United Kingdom (UK) National , Please detail your current immigration status and the relevant visa currently held (including Visa number) - State N/A if not applicable)
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What is your National Insurance number?
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Are you a driver?
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Please Select
Yes - with business insurance
Yes - however I don't hold business insurance, but I will ensure I obtain this if successful
No
Are you related to any of our current members of staff or Service Users?
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Yes
No
Are you aged over 21? (Required for some posts)
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Yes
No
Equality Act 2010 Under the Equality Act 2010 the definition of disability is if you have a physical or mental impairment that has a “substantial” & “long-term adverse effect” on your ability to carry out normal day-to-day activities. Further information regarding the definition of disability can be found at: www.gov.uk/definition-of-disability-under-equality-act- 2010. For the purposes of this application & interview stage only, is there anything you would like us to be aware of so that we can make reasonable adjustments during the process? (Type N/A if not applicable)
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What attracts you to this role
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Employment History / Professional Registrations
Employment History Please record below the details of your full employment history beginning with your current or most recent first.
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Rows
Employer Name
Employer address
Role
Start Date
End Date
Email
Contract phone number
Reason for Leaving
Most Recent Employer
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3
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5
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9
10
Explanation of Gaps Use this section to detail any gaps in employment and why
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Professional Memberships / Registrations
Rows
Professional Memberships / Registrations
Name of Organisation
Registration Number
Renewal Date
Details
1
2
3
I confirm I am happy for Compassionate Home Care Solutions to request my references
*
Yes
No
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Education
Include the subject/qualification and grade gained
Education (include School / College / University, Date From, Date To, Examinations, *: (All qualifications will be subject to a satisfactory check).
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Rows
Qualifications
Grade achieved
School / College / University
Date From
Date To
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9
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What relevant training and qualifications do you?
Training Courses attended or completing (evidence of attending courses is required)
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Rows
Training Name
Training provider
online or face to face
date training completed
date training expires
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3
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5
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7
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10
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12
13
14
15
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Working Hours
I understand this role may include: shift work, unsociable hours and lone working.
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Yes
No
Please select your availability (in general)
Rows
Days
Nights
Sleep ins
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
I agree that I may work for more than an average of 48 hours a week. If I change my mind I will give compassionate Home Care Solutions one weeks written notice
Yes, I Agree
No, I do NOT agree
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Emergency Contact
please provide emergency contact details
*
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Upload CV
Upload CV
*
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Declaration
The information in this application form is true and complete. I agree that any deliberate omission, falsification or misrepresentation in the application form will be grounds for rejecting this application or subsequent dismissal if employed. Where applicable, I consent that can seek clarification regarding professional registration details.
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Yes
No
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