Application Form Job Application Form Previous Job Details Current Personal Next Additional Criminal Record Education Employment Experience Availability Gaps Preferences References Declaration Job Details Fields marked * are required Post Applied For * Nursing and Care Home Carer Live-In Care Services Domiciliary Care Support Work in the Community Where did you hear about us? * Job Centre Website Newspaper Friend Other Personal Details Fields marked * are required Title * Select Title Mr Mrs Miss Ms Surname * Forenames * NI Number Address * Date of Birth * Postcode * Email * Home Telephone Mobile Telephone * Legal / Eligibility Fields marked * are required Do you have the right to work in the UK? * Yes No Yes, with conditions Do you have a driving license? * Yes No Do you own a car? * Yes No Are you related to any current employee? Yes No Do you have any other work commitments? No Yes Criminal Record Declaration Fields marked * are required Have you ever been convicted of a criminal offence? * Yes No Have you ever received a police caution? * Yes No Are you currently under investigation for any matter? * Yes No Please provide details * Education & Qualifications Secondary Education: Test Secondary School - 2000-2005 - GCSEs including Maths, English, Science Qualifications: NVQ Level 3 in Health and Social Care - Distinction First Aid Certificate - 2018 Manual Handling Training - 2019 Higher Education: Test College - 2005-2008 - Diploma in Care Management Online Courses - 2015-2020 - Various Healthcare Certifications Other Training: Safeguarding Vulnerable Adults Training Medication Administration Training Dementia Care Training Infection Control Training Professional Memberships: British Association of Social Workers Royal College of Nursing Employment History Current Employer Name * Job Title * Start Date * End Date (or "Present") * Reason for Leaving * Responsibilities: + Add Another Employment Relevant Experience Please describe any relevant experience that makes you suitable for this position: I have over 5 years of experience working in elderly care homes, providing personal care, medication management, and emotional support to residents. My responsibilities include assisting with daily living activities, monitoring health conditions, administering medications, and maintaining accurate records. I'm passionate about making a positive difference in people's lives and have excellent communication skills. I've worked with residents with various conditions including dementia, Alzheimer's, and mobility issues. I'm trained in safeguarding, first aid, and manual handling techniques. Availability Please indicate your availability: Mornings Afternoons Evenings Nights Weekdays Saturday Sunday Live-in work pattern (if applicable): Gaps in Employment Please explain any gaps in your employment history: Preferences Preferred work location: Type of work interested in: Care Home Live-in Care Domiciliary Care Community Support Specialist Care Ideal weekly hours: References Reference 1 Company Name: Referee Name: Position: Address: Contact Details: Relationship: Reference 2 Company Name: Referee Name: Position: Address: Contact Details: Relationship: + Add Another Reference Declaration I confirm that the information provided in this application form is true and correct to the best of my knowledge. I understand that any false information may result in the withdrawal of any offer of employment or dismissal if employed. Your Name * Date * Signature (type your full name): Submit Application Previous Next
