Pre Application Form

Prefix

First Name *

Last Name *

Email Address *

Phone Number *

Address *

House No.

City

County/State/Province

ZIP / Postal Code

Country

National Insurance Number *

Do you have your own vehicle and a current, valid UK driving licence?YesNo

If Yes, What is your drivers Licence Number

Are you a citizen of the EU?YesNo

Do you need a work permit?YesNo

Can you communicate fluently in English?YesNoI am learning

Do you have any previous care experience (no experience necessary)?YesNo

What type of role/s are you interested in?

How did you hear about us?

Do you have any convictions, cautions, reprimands or final warnings that are not “protected” as defined by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (as amended in 2013)YesNo

Please detail any disciplinary action within the previous 3 years, including any current, “live” formal warnings

REFERENCES

Reference 1 (This should be your last employer or current employer)

Prefix

First Name

Last Name

Email Address *

Work Address *

Apartment, suite, etc

City

County/State/Province

ZIP / Postal Code

Country

Years Known *

Position *

Reference 2 (This should be your previous Employer)

Prefix

First Name *

Last Name *

Email Address *

Work Address *

Apartment, suite, etc

City

County/State/Province

ZIP / Postal Code

Country

Years Known *

Position *

Employment Availability Details

Please indicate holiday dates if already booked

Period of notice required in the present post

Earliest start date

Additional personal details