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Application Form
Personal Details
Title
Mr
Mrs
Miss
Ms
Dr
First Name
Surname
Date
Mobile Number
Email Address
Address
NI Number
Position Applied For
Select position
Care Assistant
Support Worker
Senior Care Worker
Admnistrator
Eligibility to Work in the UK
Nationality
Right to Work in the UK?
Yes
No
Immigration Status
Skilled Worker Visa
Student Visa
Indefinite Leave to Remain
Dependant Visa
CoS holder
Are you currently on a visa that requires employer sponsorship (e.g., Skilled Worker Visa)
No
Yes
If yes, are you seeking a new sponsor due to a change in employment or sponsorship status?
No
Yes
Education & Training
Education & Qualifications
Qualification
Place of Study
Grade
Date/Period
Relevant Training Courses
Course Title
Training Provider
Duration
Year Completed
Employment History
Employment History
Employer Name
Address
Reporting To (Job Title)
Contact Number/Email
Your Job Title
Start Date
End Date
Reason for Leaving
Duties & Responsibilities
References
References
Reference Type
Employer
Character
Tutor
Employer/Person Name
Job Title
Contact Email
Period From
Period To
Your Position
DBS & Working Hours
DBS Payment Agreement?
Yes
No
Registered on DBS Update Service?
Yes
No
Consent to Online Status Check?
Yes
No
Any Criminal Convictions?
Yes
No
Details of Offences
Do you consider yourself disabled?
Yes
No
Disability Details
Opt-Out of 48-Hour Working Week?
Yes
No
GDPR Consent
Next of Kin (NOK) Name
NOK Address
NOK Mobile
NOK Email
NOK Relation
Spouse
Parent
Sibling
Friend
Other
GDPR & Declaration
GDPR Consent
I agree to the processing of my personal data as outlined in the GDPR statement.
I do not agree to the processing of my personal data as outlined in the GDPR statement.
Signature (E-Signature)
Date Signed
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