Home Care Assistant Application Form

A career as a carer can be rewarding and life-changing - Apply now

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INDEPENDENT

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ESTABLISHED 25 YEARS

Home Care Assistant Application Form

Section One: Personal Details

Forename(s)*Surname*Primary Telephone No*Email Address*Full Address*When Could You Start Work?*Where Did You Hear About Us? Please Be Specific:I Am Applying For:*

I am applying for:

I am applying for: *

Full-time

Part-time

Weekends

Nights

Evenings

No Preference

Are There Any Days You Would Prefer Not To Work?*

No Preference

Are there any days you would prefer not to work? *

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

No Preference

Are You Available To Work Weekends?*

Please select are you available to work weekends?

Please select are you available to work weekends? *

Yes

* All of our Home Care Assistants are required to work at least one weekend in every two.

Section Two: Education

School / GCSE / A-levels

Name And Address Of Schools*Qualifications Gained*

Higher education / College / University

Name And Address Of Schools / College / University*Qualifications Gained*

Section Three: Previous Employment

Most Recent Previous Employment

Name And Address Of Employer:*Salary On Leaving*Reason For Leaving*

Other Previous Employment

Name And Address Of Employer:*Reason For Leaving*

Other Previous Employment

Please List Any Other Relevant Previous Employment

Section Four: References

Please give the name and address of two people from whom we can obtain a reference.

Please note that one reference needs to be from the manager of your last or present employer, at a business address.

Reference 1 (Professional reference)

Professional's Full Name*Professional's Full AddressProfessional's Telephone Number*Professional's Email Address*Professional's Company*Professional's Position*How Long Have You Known This Person And In What Capacity?*

Personal Reference

Full Name*Reference Full Address*Telephone Number*Email Address*CompanyPositionHow Long Have You Known This Person And In What Capacity?*

Section Five: Rehabilitation of Offenders Act 1974, and criminal records

Have You Ever Been Convicted Of A Criminal Offence?*

Please select have you ever been convicted of a criminal offence?

Please select have you ever been convicted of a criminal offence? *

Yes

If Yes, Please Give Details:Have You Ever Been Cautioned Or Issued With A Formal Warning Regarding Any Criminal Offence?*

Please select have you ever been cautioned or issued with a formal warning regarding any criminal offence?

Please select have you ever been cautioned or issued with a formal warning regarding any criminal offence? *

Yes

If Yes, Please Give Details:Signed (Type Full Name):*Date:

Section Six: General Information

Do You Hold A Current Full UK Driving Licence (or Another Licence That Entitles You To Drive In The UK)?*

Please select do you hold a current full uk driving licence (or another licence that entitles you to drive in the uk)?

Please select do you hold a current full uk driving licence (or another licence that entitles you to drive in the uk)? *

Yes

Do You Own Or Have Access To The Use Of A Car?*

Please select do you own or have access to the use of a car?

Please select do you own or have access to the use of a car? *

Yes

What Is The Registration Number Of Your Vehicle?Do You Have Business Cover On Your Vehicle Insurance?*

Please select do you have business cover on your vehicle insurance?

Please select do you have business cover on your vehicle insurance? *

Yes

If the answer to the above question is no, you should contact your insurance provider and arrange business cover as soon as possible. This should not cost any extra with most insurers.

Are You Registered Under The Disabled Act?*

Please select are you registered under the disabled act?

Please select are you registered under the disabled act? *

Yes

If Yes, Please Give Full Details:Do Require A Work Permit To Take Employment In The UK?

Please select do require a work permit to take employment in the uk?

Yes

If the answer to the above question is yes, please answer the following questions. Otherwise go to Section Seven.

Do You Hold A Current Work Permit?

Please select do you hold a current work permit?

Yes

Work Permit Expiry Date:Passport Nationality:Passport Number:Place Of Issue:Date Of Issue:Passport Expiry Date:

You have an automatic right to work if you are a citizen of the U.K., European Union and E.E.A and certain Commonwealth countries.

Do You Need Permission To Work In The UK?

Please select do you need permission to work in the uk?

Yes

If yes, please answer questions below. Otherwise go to Section Seven.

Are You Visiting The UK On A Working Holiday?

Please select are you visiting the uk on a working holiday?

Yes

Do You Hold A Student Visa?

Please select do you hold a student visa?

Yes

On Entering Britain, What Entry Was Placed On Your Passport By Immigration? (Please Give Full Details)Have You Recently Been Resident Outside The UK?

Please select have you recently been resident outside the uk?

Yes

If Yes, Please Give Full Details:

Section Seven: Declaration

The information I have given in this application form is, to the best of my knowledge, complete and accurate in all respects.

I understand that to knowingly give false information will disqualify me from being employed by Clarendon Home Care.

I understand that to legally work for Clarendon Home Care, I will need a C.R.B. check certificate which remains my property and agree to pay the costs of the C.R.B. check if I am offered employment.

Signed (Type Your Full Name)*

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