Application Form

Personal Details

MrMrsMsMiss
YesNo

Driving

YesNo
CarPSVHGVMotorcycleFullProvisional
YesNo

Employment (Present or most recent)

Previous Employer: Please list all previous employment (Please continue on a separate sheet if necessary).

YesNo

Experience: (Please tick where appropriate for Care / Holiday applicants only to complete)

AutismElderlyAdultsMental HealthDementiaDiabetesChildren with DisabilitiesEpilepsyLearning DisabilitiesSign LanguageSensory ImpairmentContinence & Stoma CarePersonal CareSocial CareOther

References

Please give details of two referees-one of who should be your present or most recent employer. Please note that we reserve the right to contact any previous employer for a reference. Complete the address in full or this could delay your appointment.

Please tick the box if you do not wish this referee to be contacted before interview.
Please tick the box if you do not wish this referee to be contacted before interview.

Special Needs

YesNo

Health

YesNo
YesNo
YesNo
YesNo

DBS Clearance

YesNo

Safeguarding

YesNo
YesNo

DECLARATION

To the best of my knowledge the information I have given on this form is correct, and may be used as part of my contract of employment. I understand that: The provision of false information may result in disqualification of my employment.

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