Employee Application Form
Personal Details
Name
Title (Miss, Mrs, Mr)
First Name
Middle Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Date of Birth
National Insurance Number
Position Applied for
Please Select
Care Worker
Senior Carer
Care Coordinator
Field Care Supervisor
Right to Work in the UK?
Yes
No
Please upload proof of right to work.
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Availability
Availability- Week 1
Rows
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
AM
Lunch
Tea
Bed
Availability- Week 2
Rows
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
AM
Lunch
Tea
Bed
Our usual shift patterns are 6.45am-2.30pm then 3.30pm until 10.00pm- please document below if you availability differs from these patterns (e.g. 7.30am start)
Employment History
Please complete full employment history since leaving full time education (you can upload a CV)
Are you uploading a copy of your CV?
Yes
No
If so, please upload here. If not please complete full Employment history.
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Emploment History
Rows
Name of Employer
Employed From
Employed to
1
2
3
4
5
6
7
8
9
10
Gaps in employment
Rows
Unemployed From
Unemployed to
Explanation of Gap in employment
1
2
3
4
5
6
Education and training
Rows
Date From
Date to
Name of Qualification
1
2
3
4
5
6
References
Rows
Name of Referee
Character/Employment
Telephone Number
Email Address
Can we contact this reference immediately?
Reference 1
Reference 2
Reference 3
Driving and Transport
Do you hold a full driving license and access to your own vehicle
Yes
No
Please upload your Driving License
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Please upload you MOT certificate
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Are you willing to obtain business insurance for your vehicle?
Yes
No
Criminal records history
Do you have any Cautions, convictions or investigations?
Yes
No
If yes please explain
Do you have a current DBS on the update system
Yes
No
Please upload your DBS certificate if you have one.
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Please upload Proof of address
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Health and Wellbeing
Do you have any health conditions or disabilities?
Yes
No
If yes please provide details.....
Do you require any reasonable adjustements?
Yes
No
If yes please provide details.....
Personal statement
Why do you want to work in the care industry?
Declaration
Personal Declaration
I Confirm that the information provided is true and complete
I understand that false statements may result in withdrawal of offer or termination of employment.
Applicant name
First Name
Last Name
Signature
Date
-
Day
-
Month
Year
Date
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