Application Form - Elite Choice Homecare

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VACANCY DETAILS

Vacancy Applied For *

How Did You Hear About This Vacancy?

PERSONAL DETAILS

Title

Surname *

Forename(s) *

Address *

Phone Number (include STD code)

Mobile Number *

Email Address *

ELIGIBILITY FOR EMPLOYMENT

Are There Any Restrictions
Regarding Your Employment?
E.g. Do You Require a Work Permit?
If you answer yes, please provide details

Eligibility Answer

AVAILABILITY FOR EMPLOYMENT

Please indicate the approximate number of
hours you are available to work each week
and whether there are any days or times of
the day that you are unavailable for work.

Availability Answer

EDUCATION & TRAINING

(starting with the most recent first)

School/College/Uni 1

Subject Studied

Qualification Grade

Date Awarded

School/College/Uni 2

Subject Studied

Qualification Grade

Date Awarded

School/College/Uni 3

Subject Studied

Qualification Grade

Date Awarded

School/College/Uni 4

Subject Studied

Qualification Grade

Date Awarded

School/College/Uni 5

Subject Studied

Qualification Grade

Date Awarded

School/College/Uni 6

Subject Studied

Qualification Grade

Date Awarded

Upload any files to support this section (optional)

EMPLOYMENT HISTORY

(starting with the most recent first and back to the time of leaving full-time employment. All gaps must be accounted for)
*If you haven't had more than one employer then please add not applicable in the other required employer fields.

Employer Name 1 *

Position Held/Duties *

From *

To *

Reason For Leaving *

Employer Name 2 *

Position Held/Duties

From

Reason For Leaving

Employer Name 3 *

Position Held/Duties

From

Reason For Leaving

Employer Name 4 *

Position Held/Duties

From

Reason For Leaving

Employer Name 5 *

Position Held/Duties

From

Reason For Leaving

Employer Name 6 *

Position Held/Duties

From

Reason For Leaving

Upload any files to support this section (optional)

SKILLS AND EXPERIENCE

This section should be used to provide further information regarding your skills and experience which are relevant to the role for which you are applying (please refer to the person specification). Such skills and experience need not have been gained through paid employment although it is important that you are able to provide evidence of your achievements by giving examples to support your application. You may wish to use the headings in the person specification in order to present the information clearly.

skills and experience

Upload any files to support this section (optional)

CRIMINAL CONVICTIONS

Do you have any criminal convictions?

Convictions

Yes

If yes, please give details below. Because of the nature of the role that you have applied for, this should include any spent convictions under Section 4(2) of the Rehabilitation of Offenders Act 1974. If you are offered a position you will be required to apply for an enhanced disclosure from the Disclosure and Barring Service. It is therefore advised that you declare any criminal convictions at the point of application.

If yes to conviction

Have you been involved in any previous incidents
of misconduct which have resulted in harm to a
vulnerable person?

Incident

Yes

If yes, please give details below.

If yes to incident

DRIVING LICENCE

Do you hold a full valid Driving Licence?

driving license

Yes

Do you have access to private transport?

private transport

Yes

INTERVIEW REQUIREMENTS

Is there anything concerning your medical history or state of health that is relevant to your application?

medical health

Yes

If you have answered yes to either of the questions in this section or require any particular arrangements to be made to enable you to attend interview, please give details below.

yes to special arrangements

REFERENCES

Please give the name, address and position/occupation of two referees. If you have previously worked in care we are required to request a reference from that employer even if it is not your most recent role. Character references from relatives cannot be accepted. References will only be taken up for the successful candidate.

Reference 1

Name *

Position *

Organisation *

Tel: *

Address *

Email *

Reference 2

Name *

Position *

Organisation *

Tel: *

Address *

Email *

DECLARATION AND SIGNATURE

By signing and returning this form you are giving your consent to Elite Choice Home Care using and keeping the information that you have provided for use in the recruitment process. If you are offered employment with us, you are also giving your consent for us to contact your referees and for them to release a reference to confirm your suitability to take up the position.

I can confirm that, to the best of my knowledge, the information supplied in this application is accurate.

Signed Name *

Printed Name *

Please tick this box to confirm that you have signed this form and filled it in to the best of your knowledge. *

Signature

Date *