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01206 489542
Email address:
info@essexcaregroup.co.uk
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Home Care Colchester
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Application Form
Please leave blank:
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:
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