Application Form

    PRIVATE & CONFIDENTIAL

    Position Applied For:

    Where did you see this? Post advertised?

    PERSONAL DETAILS: (Block Letters Please)

    Surname:

    First Names:

    Address

    Email

    Mobile No

    Post Code

    Tel No: (Work)

    Do you hold a full driving licence?

    Date of Birth

    National Insurance No

    Car Available

    EMPLOYMENT HISTORY: (Most recent job first)

    Dates From

    Employed To

    Name/Address of Employer

    Job Title: Duties & Responsibilities

    Salary

    EDUCATION & QUALIFICATIONS (Please use extra sheet if necessary)

    From

    To

    Name & Address of Establishment

    Details of Qualifications/Courses attended

    Other Information

    Reason For Leaving Last Employment

    MEDICAL HISTORY

    REFERENCES Give two referees (one must be your current or most recent employer)

    REFERENCES 1

    Name

    Address

    Occupation

    Daytime telephone no

    Email

    REFERENCES 2

    Name

    Address

    Occupation

    Daytime telephone no

    Email

    AVAILABILITY

    Available to start work

    Number of hours available

    Are you willing to work weekends

    DECLARATION

    I declare that to the best of my knowledge, the information I have given on this form is true in every respect.

    Signature

    Date

    Please return completed form to:

    Amber Home Carers. 51A Sheen Lane, East Sheen London SW14 8AB

    Amber Home Carers is committed to an Equal Opportunities policy. In order to ensure the effectiveness of this policy, all applicants are asked to provide the following information, which will be treated in the strictest confidence.

    I would describe myself as:(please tick appropriate box)

    FOR OFFICE USE ONLY

    Application form sent

    Application form returned

    Invited to Interview

    Request References

    References received

    Rejection

    Offer made

    Start Date

    Induction pack

    Training

    Uniform/Tabard:ID photo

    CONFIDENTIAL

    DISCLOSURE OF CRIMINAL BACKGROUND OF THOSE WITH ACCESS TO CHILDREN AND VULNERABLE CLIENTS

    Due to the nature of your appointment as Care Assistant/Domestic Assistant you should appreciate that Amber Home Carers must enquire into the character and background of all staff. It is therefore essential that in making your application, you disclose whether you have any convictions, bind-over orders or cautions and if so, for what offences.

    The fact that a conviction, bind-over order, or caution has been recorded against you will not necessarily exclude you from consideration for this appointment.

    Have you any convictions, bind-over orders, cautions or pending prosecutions? (See notes)

    If yes please give details

    I give my permission for a Police Check to be made

    Signed

    Date

    Surname

    Post applied for

    Forename

    Sex

    Previous/other names

    Date of Birth

    Including maiden names

    Place of Birth

    Height

    Current address in full

    Post Code

    If less than 5 years please give previous address Previous address in full:

    Post Code

    Post Code

    I declare that the information I have given is correct. I understand that if I am employed, any false information will result in the termination of my contract with Star Care Uk Ltd.

    Signature

    Date

    Signed

    Date

    Date of next review

    Please call or email us to arrange your initial chat. Our care manager will visit you for a free, no-obligation home consultation to discuss your needs and how we would be able to help.
    If you would like to have a confidential discussion about our services please contact us on 0208 563 8209 or send us an email to info@amberhomecarers.com
     

    ENQUIRY FORM