Online Application

Title^*   Miss Ms Mrs Mr

Forename(s)^*  

Surname^*  

Previous Names  

Address^*  

Postcode^*  

Telephone^*  

Mobile  

E-mail Address  

Date of Birth^*  

National Insurance Number^*  

Do you have a current full driving licence?^*   Yes No

If yes to the above do you have the use of a car?^*   Yes No

Are you eligible to work in the United Kingdom?^*   Yes No

Next of kin

Please provide us with details of your next of kin.

Name  

Relationship to you  

Address  

Telephone Numbers  

Please give most recent first, (NB. Successful applicants will be required to provide evidence of qualifications)

Please give details of all training and other courses, which you have undertaken, particularly those related to care.

Last Employment

Are you presently unemployed?^*   Yes No

Please provide details of your present, or if you are not currently employed your most recent employment.

Job Title  

Referee Name  

Employer  

Address  

Post Code  

Telephone (landline)  

Date Appointed  

Date of Leaving (if applicable)  

Reason for Leaving (if applicable)  

Basic Pay £  

Basic Pay Per   Year Month Week Hour

Reference: May we apply for a reference prior to your interview?^*   Yes No

Previous Employment

Please provide details of ALL work you have undertaken (A full work history is required). Start with the most recent first. Continue in the "further information" section if necessary.

If there were any periods when you did not work since leaving school, please provide details.

Please provide details of three people who are able to provide references as to your character and suitability for the post you have applied for. One of these should be your current or most recent employer (see last employment section) wherever possible or applicable. None of the people you nominated should be partners or family members. The law now requires us to seek a reference from your most recent care service employer where applicable. Please confirm with the companies correct person and address to provide a reference e.g. you may find that the HR department via head office only provide references - and these details should be provided. Incorrect details provided to obtain references can delay your start of employment.

Reference 1

Referee Name^*  

Company Name  

Full Address^*  

Postcode^*  

Telephone No.  

E-mail  

This person is/was* my Employer/Manager/Other, please state^*  

Reference: May we apply for a reference prior to your interview?^*   Yes No

Reference 2

Referee Name^*  

Company Name  

Full Address^*  

Postcode^*  

Telephone No.  

E-mail  

This person is/was* my Employer/Manager/Other, please state^*  

Reference: May we apply for a reference prior to your interview ?^*   Yes No

Reference 3

Referee Name  

Company Name  

Full Address  

Postcode  

Telephone No.  

E-mail  

This person is/was* my Employer/Manager/Other, please state  

Reference: May we apply for a reference prior to your interview ?   Yes No

Weekend Work

Are you able to work weekends?^*   All/Most Weekends Alternate Weekends No Weekends

(Priority will be given to applicants able to work weekends)

Additional Comments  

Please provide any further information to support your application  

Rehabilitation of Offenders Act 1974 (Exemption Order)

Because of the nature of the work you are applying for, it is exempt from the provisions of the Rehabilitation of Offenders Act 1974. You MUST let us know about any criminal convictions, cautions, reprimands, warning's or final warning you may have including those, which may be, for other purposes, considered spent.

Do you have or have you ever had any criminal convictions, cautions, reprimands, warnings or final warnings?^*   Yes No

Are you currently:

Under suspicion or investigation in relation to any criminal offence?^*   Yes No

Awaiting trial for any criminal offence?^*   Yes No

*If you have answered 'Yes' to any of these questions, please provide details of the offence and sentence below. Answering 'Yes' to these questions will not automatically disqualify you from employment. However, you should be aware that it is an offence to provide false or inaccurate information in order to gain employment.

Details (if applicable)  

Data Protection Act

The information or data which you have supplied on this form will be processed and held on computer and will also be kept in your personal records if you are appointed. The data may be processed by Sevacare UK for the purposes of equality monitoring, compiling statistics and for other employment records. In signing and returning this application you are deemed to have given your explicit consent to processing data contained in or referred to in it, including any data which may be considered to be sensitive personal information.

Confirmation of details

I confirm that the details in this application are accurate and complete.

Signed (Enter your full name)^*  

Date^*