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Care Assistant
Section 1 Personal Details
First name
Last name
Address
Post Code
Home Telephone No
National Insurance Number
Daytime Telephone No
Mobile Telephone No
Date Of Birth
E-mail Address
Are you free to remain and take up employment in the UK with no current immigration restrictions?
Yes
No
Do you hold a full, cleaning driving licence valid in the UK?
Yes
No
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Section 2 Present Employment
Name Employer
Address
Post Code
Position Title
Date of Appointment
Salary
Dept/Section
Breif description of duties
Period of Notice
Last day of service
Reason for Leaving
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Section 3 Previous Employment
Name Employer
Address
Post Code
Post Held
Summary of duties
Reason for Leaving
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Section 4 Education
College/University Name
Course
Professional, Technical or Management Qualifications
Professional/Technical/Management Qualifications
Course Details
Membership of Professional/Technical Associations Please state level of Membership
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Section 5 Training and Development
Title of Training Programme or Course
Duration of Course
Section 6 Personal Statement
Ability, skills, knowledge and experience. Please use this section to explain in details how you meet the requirements of the Employee Profile. If you are or have been involved in voluntary/unpaid activities, please also include this information. Attach and label any additional sheets used.
Section 7 Rehability of Offenders Acts(1974)
Are you free to remain and take up employment in the UK with no current immigration restrictions?
Yes
No
If yes, please give details / dates of offence(s) and sentence:
Section 8 Protecting Children and Vulnerable Adults
Enhanced Checks Only (refers to Job Application Pack) Are you aware of any police enquires undertaken following allegation made against you, which may have a bearing on your suitability for this post?
Yes
No
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Section 9 Disability Discrimination Act
Do you have a disability which is relevant to your application?
Yes
No
If yes, please give details / dates of offence(s) and sentence:
Section 11 Referees
Referees One
Name
Position
Work Relaionship
Address
Post code
Telephone
Email
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Referees Two
Name
Position
Work Relaionship
Address
Post code
Telephone
Email
Are you willing for this referee to be approached prior to the interview?
Yes
No
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Bank Details
Name of Bank
Branch
Names as they appear on your card
Account Number
Sort Code
Section 12 Recruitment Monitoring Form
Application for the post of
What is your Ethnic Group?
Recruitment Monitoring Form
Gender
Male
Female
Do you consider yourself disabled?
Yes
No
If Yes, please give details:
Present Status
Internal Applicant
External Applicant
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Attachments
Passport/UK Birth Certificate/Driver's License(2mb)
Proof of right to work in UK(2mb)
Proof of Address (eg. utility bill- within the last three months)
Original certificates/diplomas/QCF Qualifications(2mb)
Certificate of training received in Domiciliary care(2mb)
Passport photograph(2mb)
Bank/Building Society details(2mb)
DBS Certificate(2mb)
National Insurance card/P45/P60(2mb)
Current Curriculum Vitae (CV)(2mb)
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