Please return to:

Elaine Middleton

The Poppy Centre

179 Townsend Lane

Liverpool

L13 9DY

Tel: 0151 330 5678

APPLICATION FOR THE POST OF – Care Assistant REF: HCAEP01/17

(Please complete this form in type or black ink. Extra sheets may be used if necessary)

PERSONAL DETAILS

Title:
First name(s):
Family name:
Address:
Postcode: / Tel No (Home):
Tel No (Work):
Mobile No:
E-mail address (optional):
NI number:
Would you require a Work Permit to take up this appointment?
(UK and EEA citizens do not require Work Permits)
If so, please provide details:

PRESENT OR MOST RECENT EMPLOYMENT

Job Title:
Name of Employer:
Address:
Postcode: / Date appointed:
Date left: (if appropriate)
Reason for leaving or wanting to leave:
Salary/Pay:
Period of notice required by present employer:
Brief description of duties and responsibilities:

EMPLOYMENT HISTORY (please include unpaid work at home or voluntary work if appropriate)

Age Concern Liverpool & Sefton reserves the right to contact any previous employer to verify the information supplied by the candidate

Dates
From To / Name and Address of Employer (state if unpaid) / Position Held
(title and main duties) / Reason for Leaving

EDUCATION AND TRAINING

Dates
From To / School/College/University / Qualifications Gained

PRACTICAL TRAINING e.g. apprenticeships, evening courses, software skills etc

Dates
From To / Organising Body / Course

ADDITIONAL INFORMATION IN SUPPORT OF YOUR APPLICATION Please give details of your past experience and skills which will show why you are suitable for this job. Please use the enclosed Person Specification to help. The items which are marked ‘Application Form’ (if applicable) in the method of assessment column are the most important to address here.

Continue on a separate sheet if necessary

WHY DO YOU WANT THIS JOB?

Continue on a separate sheet if necessary

DRIVING

Do you hold a current Driving Licence? Yes No
If driving is a requirement of the job please give details of any endorsements:

CRIMINAL CONVICTIONS

This post is exempt from the provisions of the Rehabilitation of Offenders Act. If you have received any convictions in the criminal court please enclose details in a separate envelope marked “for the attention of the interview panel”. It will only be opened if you are shortlisted for interview. Otherwise it will be destroyed. This includes, but is not limited to, previous convictions, cautions and bind-overs.
Please note that an offer of employment may be withdrawn if a conviction is not declared above and subsequently comes to light through a DBS disclosure.
Have you ever been convicted of a criminal offence? Yes No
Due to the nature of Age Concern Liverpool & Sefton’s work, which involves contact with vulnerable people, we ask you to inform us if you have ever been convicted of abuse?
Yes No
It is Age Concern Liverpool & Sefton’s policy to carry out Disclosure and Barring Service (DBS) checks prior to commencement of employment. Any adverse disclosure could result in the offer of employment being withdrawn.

REFERENCES

Please give details of THREE people we can contact for a reference. While we only require two, we ask for a third as a backup in case of difficulty acquiring either of your preferred references.
One of the referees must be able to comment on your work experience and should be either your present or most recent employer. None of your referees should be relatives.
THIS SHOULD BE THE MOST RECENT OR PRESENT EMPLOYER
Name:
Job title:
Address:
Postcode:
Tel No:
E-mail:
May we contact prior to interview? Yes No / Name:
Job title:
Address:
Postcode:
Tel No:
E-mail:
May we contact prior to interview? Yes No / Name:
Job title:
Address:
Postcode:
Tel No:
E-mail:
May we contact prior to interview? Yes No

DECLARATION:

I confirm that the information I have given is, to the best of my knowledge, true and complete

SIGNED: / DATE: