Position Applied For (If Applicable)
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| PERSONAL DETAILS |
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Title |
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First Name(s) |
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Surname |
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Telephone |
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Mobile |
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Email |
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Address |
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Post Code |
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Marital Status |
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Number of Dependants |
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Age(s) -
Please separate with commas |
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National Insurance
No. |
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Nationality |
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Date Of Birth |
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Do you have a
valid UK Driving License |
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Expiry Date |
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Driving License
No. |
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Do
you have the use of a car for business purposes? |
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EMPLOYMENT HISTORY |
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Current Salary |
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£
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Required Salary |
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£
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Name And Address
Of Current Or Last Employer |
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Post Code |
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Telephone No. |
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Position Held |
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Salary (Or Hourly
Rate) |
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£
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Date Employment
Commenced |
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Date Employment
Ceased |
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Reason For Leaving |
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Name And Address
Of Previous Employer |
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Post Code |
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Telephone No. |
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Position Held |
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Salary (Or Hourly
Rate) |
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£
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Date Employment
Commenced |
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Date Employment
Ceased |
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Reason For Leaving |
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GENERAL EDUCATION |
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Secondary School Attended |
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Date Commenced |
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Date Left |
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FURTHER
EDUCATION |
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First College
/ University / Establishment Attended |
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Date Commenced |
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Date Left |
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Second College
/ University / Establishment Attended |
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Date Commenced |
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Date Left |
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PROFESSIONAL MEMBERSHIPS
(If you belong, or have belonged, to any professional
bodies or organisations, please list them here)
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Name And Address Of Body/Organisation |
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Position Held |
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Date Membership
Commenced |
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Date Membership
Ceased |
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Name And Address
Of Body/Organisation |
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Position Held |
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Date Membership
Commenced |
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Date Membership
Ceased |
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Name And Address
Of Body/Organisation |
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Position Held |
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Date Membership
Commenced |
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Date Membership
Ceased |
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| ADDITIONAL SKILLS
AND TRAINING |
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| Please Provide Details Of any Further
Skills You Possess, Or Training You Have Undertaken
That Is Relevant To The Care Professions |
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| GENERAL HEALTH |
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How
Many days Have You Been Absent From Work Due
To Ill Health During The last Three Years? |
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| Once You Have Completed This Form,
Please Proceed To The Online Health Questionairre |
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| REFERENCES |
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Please Provide
Details Of Two Personal Referees That Are Not
Related To You And Are Able To Comment On Your
Competence And Ability To Work Within The Care
Industry |
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Referee One: |
Name |
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Address |
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Post
Code |
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Telephone |
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Referee Two: |
Name |
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Address |
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Post
Code |
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Telephone |
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Please
Provide Referee Details Relevant To Your Current,
Or Most Recent Employer |
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Employer Reference : |
Name |
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Address |
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Post
Code |
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Telephone |
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Because of the sensitive
nature of the duties the post holder in a care
environment is expected to undertake, you are requested
to disclose any details of any criminal record
you may have. Only relevant convictions or information
will be taken into account, so disclosure need
not necessarily be a bar to obtaining a position
within the care industry. Please refer to the CRB
for further information.
Have you ever been convicted or bound
over by the courts or cautioned, reprimanded
or given a final warning by the police? (Please
note that care positions are exempt from the
rehabilitation of offenders act 1974, which
means that all convictions, cautions,
reprimands and final warnings on your criminal
record must be disclosed. if you are
in any doubt as to whether a matter should
be disclosed, please contact Care2Comment Ltd
for advice.
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If 'Yes' please record details of offences, penalties and dates in the
declaration below.
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| Are you aware
of any police enquiries undertaken following
allegations made against you, or any enquiries
by Social Services or other statutory bodies,
which may have a bearing on your suitability
for a post within the care industry? |
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If 'Yes' please provide details in the declaration below. |
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DECLARATION
OF CRIMINAL RECORD OR OTHER ENQUIRIES |
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| iF YOU HAVE ANSWERED
'YES' TO EITHER OR BOTH OF THE TWO PREVIOUS QUESTIONS,
YOU MUST PROVIDE FULL
DETAILS IN THE BOX BELOW, INCLUDING: DATES, NATURE
OF OFFENCE(S) AND OUTCOME/PENALTIES: |
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| DECLARATION,
AUTHORISATION AND FORM SUBMISSION |
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By submitting this form,
I hereby declare that the information I have provided
is, to the best of my knowledge, accurate and truthful.
I understand that to knowingly make a statement
that is false or misleading in a material aspect
of this form or supporting documentation may result
in a refusal of the application or dismissal if
discovered after employment has commenced.
By submitting this form, I also authorise care2Comment
Ltd of Abbotsland farm, New Dover Road, Capel
le Ferne, Kent, CT18 7HY to undertake all necessary
checks and verifications of any information I
have provided in relation to my employment application,
which could include any or all of the following: Criminal
Records Bureau, Police, Local Authority, Government
Agencies, Past Employment And Personal References. |
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