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Employment Application Form

1st Homecare Employment Application Form

Job Post Details

Position applied for

Personal Details

Please select the option that applies to you.
Please select the option that applies to you.

General Information


Please give details of any education, technical and/or professional qualifications. If you are currently studying please provide details of the qualifications you are studying for.
Please list examinations to be taken / qualifications obtained, subject, results & grades.

Training / Job Related Training Undertaken In The Last 5 Years

Please list any course(s) which you have undertaken that are relevant to the job and/or specified on the person specification. Eg. Further and Higher Education (Degree, Diploma, BTEC, City & Guilds, NVQ etc)
Please list course title, length of course, and certificates / qualifications gained.


Please list membership of any organisation(s) relevant to the job.
Please provide name of organisation, type of membership and if the membership is current.

Skills, Abilities, Experience and Achievements

Please give details of your skills, abilities, achievements and experience (Including outside interests) and use examples to demonstrate how you meet each of the criteria listed in the person specification. (State who provided training and duration of training) Examples could include: short courses, skills training, external awards/activities etc

Present Or More Recent Employment

i.e Company Car, Employee Health Scheme etc.Write N/A if not applicable
i.e 2 weeks, 4 weeks, 6 months etc.
Please describe your main duties
Please provide as much detail as possible.

Posts working with Children, Young People and Vulnerable Adults

If applying for a post which involves working with children, young people and vulnerable adults, you are required to provide below the dates you were employed from and to, and provide details of any gaps in your employment.

Personal Statement

The information you provide in this section will be used in assessing your application for this post. A decision about if to interview you will be largely based on this statement. Outline your reasons for applying for this post and give your views on this area of work and client group.

Job References

Written references will be needed for any candidatewho is successful at interview. Please ensure your referees are aware of this, and are happy to provide this information. Referees will be asked for information on disciplinary issues, sickeness and absence. Please give details of two people whom you are not related and to whom a request for reference can be made.
Please note that your present or last employer should be given as your first reference.

Details Of Referee (1)

Details Of Referee (2)

Disclosure of Criminal Records

Because of the nature of some posts it is important that you complete this section carefully and accurately. Applicants for posts working with or having access to Vulnerable Adults are subject to an enhanced disclosure through the Criminal Records Bureau (England) or Disclosure Scotland (Scotland). Because the position for which you have applied may be covered by the Rehabilitation of Offenders Act 1974 and the Care Standards Act 2000, you are required to disclose all convictions and cautions no matter how long ago they occurred and regardless of whether the offence was committed a s a juvenile or adult.

Disclosure Scotland

Declaration (Please Read Carefully)

The information you provide on this form will be used for the purposes of assessing your suitability for appointment; this may involve contacting referees, previous employers, or educational establishments, to confirm the validity of information provided. If your application is unsuccessful we will dispose of this information in line with our Data Protection and Employment Policies. We will use the information you provide to fulfil our legal requirement to monitor equal opportunities; however, this will be used for statistical purposes only.

I have read this application form fully and I declare that the information I have given in support of my application is, to the best of my knowledge and belief, true and complete. I understand that if it is subsequently discovered that any statement is false or misleading, or that I have withheld any relevant information my application may be disqualified or, if I have already been appointed, I may be dismissed without notice.
By clicking "I Agree" you agree to the declaration above, and that all information submitted is factually correct to the best of your knowledge.
By typing your name in this box you are digitally signing this application form.
Todays Date

Entitlement to Work in the United Kingdom

To comply with the Asylum and Immigration Act 1996 all prospective employees will be asked to supply evidence of eligibility to work in the UK. We will ask to see an appropriate official document, for example, a document showing your national insurance number, if you have one, your birth certificate, passport etc.

Candidates selected for interview will normally be notified within 4 weeks of the closing date. Unfortunately, applicants who do not hear from us must conclude that their application has been unsuccessful on this occasion. Please note that the information provided may be shared with the Job Centre Plus.
By typing your name in this box you are confirming that you are eligible to work in the UK.
Todays Date
By signing and returning this form you acknowledge and understand the above legal requirement and that you recognise the restrictions on recruitment with which 1st Homecare is required to follow.
Please note you will be required to produce the documents / declarations required by legislation if short-listed for interview (if requested to do so).
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