Mine Care Job Application Form

Care Worker Application Form

Please fill out the following information to apply for our Care Job.
Applicant Contact Information
Full Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityCounty

Postcode
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Date of Birth

DayMonthYear
Date
Professional Background
Resume/CV Upload

Cancelof
LinkedIn Profile (Optional)
Employment History (list all work)
Health Information
ExcellentGoodFairPoor
YesNo
If yes, please give details
YesNo
YesNo
If yes, please provide details
YesNo
YesNo
YesNo
Full UKProvisionalInternational
YesNo
If yes, please provide details
Reference 1 of 2
Reference 1 - Name

First NameLast Name
Reference 1 - Profession
Reference 1 - Contact Number
Please enter a valid phone number.Format: (000) 000-0000.
Reference 1 - Email
example@example.com
Reference 2 of 2
Reference 2 - Name

First NameLast Name
Reference 2 - Profession
Reference 2 - Contact Number
Please enter a valid phone number.Format: (000) 000-0000.
Reference 2 - Email
example@example.com
Consent and Declaration
Permission to Contact Relevant Professionals

I understand that, to assist in the admission decision, it may be needed to contact professionals or agencies that have been involved in my care or support. I consent to these contacts being made only with my explicit permission, and I understand that any information gathered will be treated as confidential.

Requirement for Complete Information

I acknowledge that completing all requested information on this application form is essential for processing my application. I am aware that delays may occur.

Information Sharing for Application Processing

I consent to the potential sharing of information provided during my assessment with other relevant services, if necessary, to complete the application process.
Name

First NameLast Name
I have completed this application form truthfully and to the best of my knowledge. I understand that any misleading information could jeopardise my application process.
Signature

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Date

DayMonthYear
Date
Should be Empty:

Care Worker Application Form

Applicant Contact Information

Professional Background

Health Information

Reference 1 of 2

Reference 2 of 2

Consent and Declaration