Phone:
07868102532
Email:
info@marielle24-7healthcareservices.com
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APPLICATION FORM FOR CARER/SUPPORT WORKER
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APPLICATION FORM FOR CARER/SUPPORT WORKER
STRICTLY CONFIDENTIAL Application for Employment
Please type or complete this form in black ink
POSITION APPLIED FOR
Date of Application
Surname
First Name
Previous Name
Home Telephone No.
Mobile No.
Date of Birth
E-Mail
Address
National Insurance No.
Please notify us of any dates you are available for interview:
Are you a citizen of the EU?
YES
NO
Do you need a work permit?
YES
NO
Current Driving Licence?
YES
NO
Do you have a car for work use?
YES
NO
Do you have an updated DBS? If yes, please attach
YES
NO
If you have an updated DBS? If yes, please attach
Do you have any Certificates in Care? If yes, please attach
YES
NO
If you have any Certificates in Care
𝗡𝗘𝗫𝗧 𝗢𝗙 𝗞𝗜𝗡
Surname
First Name
Address
Relationship
Home Telephone No.
𝗣𝗥𝗘𝗩𝗜𝗢𝗨𝗦 𝗘𝗠𝗣𝗟𝗢𝗬𝗠𝗘𝗡𝗧
A full employment history must be detailed beginning with your current employment and covering all reasons for gaps in any given year.
From - To
𝗘𝗺𝗽𝗹𝗼𝘆𝗲𝗿𝘀 𝗡𝗮𝗺𝗲 (most recent)
𝗣𝗼𝘀𝗶𝘁𝗶𝗼𝗻 𝗛𝗲𝗹𝗱
𝗦𝗮𝗹𝗮𝗿𝘆 & 𝗕𝗲𝗻𝗲𝗳𝗶𝘁𝘀
𝗥𝗲𝗮𝘀𝗼𝗻 𝗳𝗼𝗿 𝗟𝗲𝗮𝘃𝗶𝗻𝗴
More
From - To
𝗘𝗺𝗽𝗹𝗼𝘆𝗲𝗿𝘀 𝗡𝗮𝗺𝗲 (most recent)
𝗣𝗼𝘀𝗶𝘁𝗶𝗼𝗻 𝗛𝗲𝗹𝗱
𝗦𝗮𝗹𝗮𝗿𝘆 & 𝗕𝗲𝗻𝗲𝗳𝗶𝘁𝘀
𝗥𝗲𝗮𝘀𝗼𝗻 𝗳𝗼𝗿 𝗟𝗲𝗮𝘃𝗶𝗻𝗴
More
From - To
𝗘𝗺𝗽𝗹𝗼𝘆𝗲𝗿𝘀 𝗡𝗮𝗺𝗲 (most recent)
𝗣𝗼𝘀𝗶𝘁𝗶𝗼𝗻 𝗛𝗲𝗹𝗱
𝗦𝗮𝗹𝗮𝗿𝘆 & 𝗕𝗲𝗻𝗲𝗳𝗶𝘁𝘀
𝗥𝗲𝗮𝘀𝗼𝗻 𝗳𝗼𝗿 𝗟𝗲𝗮𝘃𝗶𝗻𝗴
𝗘𝗗𝗨𝗖𝗔𝗧𝗜𝗢𝗡
(𝑶𝒓𝒊𝒈𝒊𝒏𝒂𝒍 𝒅𝒐𝒄𝒖𝒎𝒆𝒏𝒕𝒔 𝒂𝒔 𝒑𝒓𝒐𝒐𝒇 𝒐𝒇 𝒒𝒖𝒂𝒍𝒊𝒇𝒊𝒄𝒂𝒕𝒊𝒐𝒏 𝒘𝒊𝒍𝒍 𝒃𝒆 𝒓𝒆𝒒𝒖𝒊𝒓𝒆𝒅 𝒂𝒕 𝒊𝒏𝒕𝒆𝒓𝒗𝒊𝒆𝒘)
Secondary School / College / University
Exams Taken
Result
Secondary School / College / University
Exams Taken
Result
Secondary School / College / University
Exams Taken
Result
𝗥𝗘𝗛𝗔𝗕𝗜𝗟𝗜𝗧𝗔𝗧𝗜𝗢𝗡 𝗢𝗙 𝗢𝗙𝗙𝗘𝗡𝗗𝗘𝗥𝗦 𝗔𝗖𝗧 𝟭𝟵𝟳𝟰 – 𝗡𝗢𝗧𝗜𝗖𝗘 𝗧𝗢 𝗢𝗙𝗙𝗘𝗡𝗗𝗘𝗥𝗦
Because of the nature of the work involved, the post for which you are applying is exempt from Section 4(2) of the Rehabilitation of Offenders Act 1974 by virtue of the Rehabilitation Offenders Act (Exemption Order 1975). This means that you are not entitled to withhold information relating to any convictions you may have had.
Do you have any convictions to disclose?
YES
NO
Any information should be given on a separate sheet and sent with this application form. This information will be treated as confidential and will not necessarily preclude you from employment
𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗣𝗘𝗥𝗦𝗢𝗡𝗔𝗟 𝗗𝗘𝗧𝗔𝗜𝗟𝗦
Outside interests, leisure time activities and other personal information which you think may assist us in evaluating your application.
𝗥𝗘𝗙𝗘𝗥𝗘𝗡𝗖𝗘𝗦
Please give the name and address of at least two referees, one of whom must be your present employer or your most recent employer
Name
Satus
Address & telephone Number
Name
Satus
Address & telephone Number
Name
Satus
Address & telephone Number
This organisation seeks to work in a flexible and family-friendly manner with its staff, however, unsocial hours are part and parcel of a quality care service. Weekend working is a requirement for all staff, the frequency of which will be determined at interview
Please indicate holiday dates if already booked
Period of notice required in the present position
Acceptance
Thank you for completing this application form. I declare that to the best of my knowledge, all of the information contained and documented herein is complete and truthful.
Send
