Application form | Jobs The Essex Care Group | Work

Full Name:

Address:

Email Address:

Mobile Phone Number:

Home Phone Number:

Date of Birth:

Which type of role are you looking for?

Homecare (Domiciliary / Community Care)

Supported Living (Adults with learning disabilities)

Live In Care

Any

How many hours are you looking for?

Full Time

Part Time

Bank Work

Any Type

Some of our roles require drivers. Do you hold a full UK driving licence?

Yes

No

If you have any current endorsements on your driving licence please provide details. (If none please put N/A):

Do you have access to a vehicle for work purposes? (This will be for your own use, to drive between clients):

Yes

No

Do you have any experience within the care industry? (Experience is not essential as training will be provided):

Yes

No

Are you related to any employee of the company? (If yes please provide name of employee):

Have you applied for any roles with us in the last 12 months?

If successful, when would you be available to start?

Please detail any knowledge, qualifications or experience relevant to the role you wish to apply for.

	Employment Reference 1 (Current or Last Employer)	Employment Reference 2 (Other Previous Employer)
Company Name	Company Name, Employment Reference 1 (Current or Last Employer):	Company Name, Employment Reference 2 (Other Previous Employer):
Managers Name	Managers Name, Employment Reference 1 (Current or Last Employer):	Managers Name, Employment Reference 2 (Other Previous Employer):
Employment Dates	Employment Dates, Employment Reference 1 (Current or Last Employer):	Employment Dates, Employment Reference 2 (Other Previous Employer):
Job Title	Job Title, Employment Reference 1 (Current or Last Employer):	Job Title, Employment Reference 2 (Other Previous Employer):
Reason For Leaving	Reason For Leaving, Employment Reference 1 (Current or Last Employer):	Reason For Leaving, Employment Reference 2 (Other Previous Employer):
Telephone Number	Telephone Number, Employment Reference 1 (Current or Last Employer):	Telephone Number, Employment Reference 2 (Other Previous Employer):
Email Address	Email Address, Employment Reference 1 (Current or Last Employer):	Email Address, Employment Reference 2 (Other Previous Employer):

	Character / Personal Reference 1 (Friend / Neighbour / Colleague)	Character / Personal Reference2 (Friend / Neighbour / Colleague)
Name	Name, Character / Personal Reference 1 (Friend / Neighbour / Colleague):	Name, Character / Personal Reference2 (Friend / Neighbour / Colleague):
Relationship	Relationship, Character / Personal Reference 1 (Friend / Neighbour / Colleague):	Relationship, Character / Personal Reference2 (Friend / Neighbour / Colleague):
Phone Number	Phone Number, Character / Personal Reference 1 (Friend / Neighbour / Colleague):	Phone Number, Character / Personal Reference2 (Friend / Neighbour / Colleague):
Email Address	Email Address, Character / Personal Reference 1 (Friend / Neighbour / Colleague):	Email Address, Character / Personal Reference2 (Friend / Neighbour / Colleague):

Do you have any convictions, cautions, reprimands, or final warnings that are not "protected" as defined by the Rehabilitation of Offenders Act 1974 / Exceptions Order 1975 (as amended in 2013). The amendments to the Exceptions Order 1975 (2013) provide that certain spent convictions and cautions are "protected" and are not subject to disclosure to employers, and cannot be taken in to account. Guidance and criteria on the filtering of these cautions and convictions can be found on the Disclosure & Barring Service website. (Decleration subject to the Rehabilitation of Offenders Act 1974):

Yes

No

If yes, please provide details.

If offered this position, will you continue to work in any other capacity?

Yes

No

If yes, please provide details:

Please detail any membership to professional organisations if applicable:

Are you eligible to work in the UK?

Yes

No

If successful in your application, would you require a work permit or permission to work in the UK?

Yes

No

Declaration: I agree the information provided is correct to the best of my knowledge. I understand that any omissions or false statements throughout the application process may disqualify me from employment, or lead to my dismissal.

Yes

No

Declaration: I consent to the information provided being used to process my application for employment, as per the GDPR privacy policy. (GDPR privacy policy is available to view under the "Latest Vacancies" tab).

Yes

No

Declaration: I consent to you contacting the above named referees in order to assess my suitability for the role applied for:

Yes

No

If required, please add any other information you wish to provide in relation to your application below: