Care Assistant Application

Section 1: Personal Information

Please Fill In All The Necassary Fields

Name *

Street Address *

Apartment NumberFlat 5

City *

State/Province

Postal Code *

Country

Date of Birth *

Phone *

Email Address *

National Insurance Number *

Right To Work In The UK

Do you have the right to work in the UK? (Select Yes/No, Details If No) *

If No Please Give Details

Section 2 : Position Applied For

DBS (Yes/No, Certificate Number & Date) *

Section 3 : Employment History

Please provide full employment history for the last 5 years. Include all roles, even if not education-related. Explain any gaps in employment.

Click 'Add Item' To Add Another Employment

Company Name *

Position *

Employment Period From *

Employment Period To *

Job Responsibilities *

Reason For Leaving *

Gaps In Employment? (Select Yes/No, Details If Yes) *

If Yes Give Details Below

Section 5 : Referances

We require references covering at least the last 5 years of your employment history. One referee must be your most recent employer.

Referance 1

Name

Position *

Company Name *

Contact Number

Email Address

Referance 2

Name

Position *

Company Name *

Contact Number

Email Address

Section 6: Documentation Upload

Please upload any required documentation here

Upload Proof of Address 1 *E.g. Bank Statements, Utility Bills

No file chosen

Upload Proof of Address 2 *E.g. Bank Statements, Utility Bills

No file chosen

Upload Proof of ID *E.g. Passport, Driver License

No file chosen

Right To Work In The UK *Must be Passport if not already uploaded also accepted is a letter or payslip containing NI Number along with full Birth Certificate

No file chosen

Upload Proof of DBS Certificate *

No file chosen

Section 7: Rehabilitation of Offenders Act 1974 & Safeguarding Declaration

Because of the nature of the work for which you are applying, this post is exempt from the provisions of the Rehabilitation of Offenders Act 1974, and you are required to declare all convictions, cautions, reprimands, and warnings even if regarded as “spent.”

Criminal Convictions

Do you have any criminal convictions, cautions, reprimands, or warnings? (Yes/No, Details If Yes): *

If Yes Please Give Details

Safeguarding

Have you ever been subject to any safeguarding or disciplinary procedures in previous employment? (Yes/No, Details If Yes): *

If Yes Please Give Details

Todays Date *

Signature *