Application Form

PERSONAL DETAILS

Miss/ Mrs/ Mr/ Other *

Forenames(s) *

Surname *

Address *

Post Code *

Date of Birth *

N.I. Number

Tel Home

Tel Mob *

Email Address *

EDUCATION

From

School / College - Name & location

Examinations Taken / Level

Grades

PROFESSIONAL QUALIFICATIONS/TRAINING COURSES – original certificates required

Date

Qualifications / Other

Grade

WHY ARE YOU INTERESTED IN THIS POSITION WITH HOMECARERS LTD?
Please add any relevant experience you may have to the position applied for?

Have you been made aware of this position by a current employee of Homecarers Ltd? If so, who?

Have you ever worked for Homecarers Ltd before? If so, in what role and when?

When Can You Work
Tick the sifts you are available to work

Hours

Can You Work?

Preferred Shift

7am - 2pm

Yes

7am - 6:30pm

Yes

3:30pm - 6:30pm

Yes

3:30pm - 11:15pm

Yes

6:30pm - 11:15pm

Yes

Other:

Yes

Are there any days you cannot work? Please specify reasons

Please note: It is compulsory that all support workers are able to commit to working alternate weekends. As a minimum requirement, hours will be the same as during the weekdays. Staff can select to work extra on their working weekend or planned weekend off.

Are there any times that you are not available?

What date are you available to start work?

Do you require any assistance due to disabilities?

Please give details:

EMPLOYMENT HISTORY

Due to the nature of employment, it is required that you state ALL employment history from leaving school, you must include ALL periods of employment and explain fully any breaks in employment. This is statutory for all support staff.
Please start with your most recent employment

From and To Dates

Company name and address

Job title and responsibilities

Reason for Leaving

Are you currently in Employment
If yes, please give details of notice required

Yes

REFERENCES
(references will only be requested following your acceptance of position with the company)

Please provide a minimum of two referees, one of which must be your most recent employer. For employment references, they should be your most recent employers (no relatives). If you cannot provide two employment references, you must provide one employment reference and two character references. If you have not worked in the last 5 years you should provide 3 character references Character references - work colleagues, neighbours, friends of the family, business acquaintances, and clients. References will be applied for once you have accepted a formal offer

Reference 1

Employment or character:

Referee name:

Job title/relationship:

Company name if applicable:

Address:

Email address:

Contact phone number:

Reference 2

Employment or character:

Referee name:

Job title/relationship:

Company name if applicable:

Address:

Email address:

Contact phone number:

Reference 3

Employment or character:

Referee name:

Job title/relationship:

Company name if applicable:

Address:

Email address:

Contact phone number:

Reference 4

Employment or character:

Referee name:

Job title/relationship:

Company name if applicable:

Address:

Email address:

Contact phone number:

Reference 5

Employment or character:

Referee name:

Job title/relationship:

Company name if applicable:

Address:

Email address:

Contact phone number:

Reference 6

Employment or character:

Referee name:

Job title/relationship:

Company name if applicable:

Address:

Email address:

Contact phone number:

PLEASE SPECIFY AND TICK IN THE BELOW THE AREAS YOU ARE ABLE TO WORK IN?

CHESTER
Covers the below areas

Yes

Chester
Malpas
Tarporley
Ellesmere Port
Neston

WINSFORD
Covers the below areas

Yes

Winsford
Middlewich
Northwich
Helsby

EXTRA CARE HOUSING
Covers the below areas

Yes

Abbotswood
Devapoint
Kingswood
Hallwood

If you are applying for a specific role that has been advertised, please indicate the shifts, days & area that were stated in the advert:

DRIVING LICENSE & DBS

Do you have a full driving license?

Yes

Do you have access to your own transport?

Do you currently have/have held a full enhanced DBS?

Yes

If you have a transitional DBS we will need the barcode and photocopy – Please provide below

REHABILITATION OF OFFENDERS (EXCEPTIONS) ACT 1979

Have you ever been convicted of a criminal offence?

Yes

In accordance with the rehabilitation of Offenders (Exceptions) Act 1979 all convictions including those deemed spent must be disclosed (not including traffic offences). This includes convictions, cautions, reprimands, or final warnings

All successful applicants must undergo and DBS Disclosure. On sending this form you are agreeing to a DBS being carried out on offer of employment.

DECLARATION

In signing this form, you are giving your permission for the following:

You personal data to be stored and processed for the purpose of arriving at a selection decision and, for the successful candidate, future personnel administration.
Permission for your data to be shared with our training provider Richmond Training to enable them to prepare documents and assessments for your induction and any subsequent training and relevant funding.
You give the employer the right to apply for references (following acceptance of job offer) and to secure all additional information about you, if position related. You hereby release from your liability the employer and the representatives for seeking such information and all other persons, corporations and organisations for furnishing such information.

I understand that the position applied for/offered will be subject to the satisfactory outcome of references, proof of my right to work in the UK, a completed DBS and proof of qualifications. I declare that all information provided is accurate at the time of signing and understand that if I have entered any false or misleading information, this may lead to termination of any employment offered.

By submitting this form, you are agreeing to Home Carers Ltd's Privacy Policy.

Agree? (Required) *

Yes

Date *

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Application Form

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