Domiciliary Care Assistant Application

  • Domiciliary Care Assistant Application

    Apply for a role by completing your personal, professional, and availability details.

  • Applicant Information

    Please provide your current contact details.
  • Do you have the right to work in the UK?*
  • Do you have a full UK driving licence?*
  • Do you have access to a vehicle?*

  • Position Applying For & Availability

    Tell us about the role you are interested in and your availability.
  • Availability (select all that apply)*
  • Preferred Hours (select all that apply)*
  • Preferred Number of Contracted Hours*
  • Preferred Start Date*
     - -
  • How did you hear about us?*

  • Qualifications & Training (relevant to care)

    List your care-related qualifications and training.

  • Employment History (last 5 years or since leaving full-time education)

    Please provide your full employment history.

  • References (must not be family members)

    Please provide contact details for two references.
  • Consent to contact Reference 1 immediately?*
  • Consent to contact Reference 2 immediately?*

  • Additional Information (optional)

    This section is not mandatory.
  • Are you comfortable with technology?
  • Would you like extra support with digital tools during induction?
  • Would you be able to work shifts at short notice?

  • Care Experience

    Share your experience in care roles.
  • Do you have previous experience in care?*
  • Which of the following do you have experience of? (Select all that apply)

  • Safeguarding & Criminal Record Declaration

    This section is confidential and will only be seen by those directly involved in the recruitment process.
  • Are you currently bound over or do you have any unspent convictions issued by a Court or Court-Martial in the UK or abroad?*
  • Do you have any unspent police cautions, reprimands or final warnings in the UK or abroad?*

  • Health & Wellbeing

    Let us know if we can support you during the interview or in the workplace.
  • Do you have any health conditions or disabilities we should be aware of to support you through the interview process or in the workplace?*
  • Do you have any allergies?*

  • Emergency Contact

    Please provide details for someone we can contact in an emergency.

  • Supporting Information & Declaration

    Please read the privacy statement and declaration below.
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  • Privacy Statement: We collect and store your information only for recruitment purposes. By submitting this form, you agree to us holding the details you’ve provided. If you are shortlisted, we may also record shortlisting scores and interview notes. We will keep your data until the vacancy is filled. Once the recruitment process is complete, we will either delete your data or ask if you’d like us to keep it for future opportunities. Your data will be securely stored by the Registered Manager and only used for this role. You have the right to: • Access your data • Correct or update your data • Withdraw your consent • Restrict how your data is used • Be informed about how your data is processed • Request deletion of your data ('right to be forgotten')
  • Date*
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  • Should be Empty: