Home from Home Care
Application for Employment –Oct 2009
Page 2 of 6
PLEASE COMPLETE THIS FORM IN BLACK PEN USING CAPITAL LETTERSBefore Completing, Please Ensure That You Have Read The Guidance Notes In The Application Pack Or On Our Website
Post You Are Applying For:
Home Applied To:
How Did You Hear About This Vacancy:
Date Of Publication & Ref. No. (If Applicable)
PERSONAL DETAILS
Surname:First Name(s):
Title: / Mr / Mrs / Miss / Ms
Maiden And/Or Any Other Names Used:
Current Address: / POST CODE:
Previous Address If You Have Been At The Above Address Less Than 5 Years: /
POST CODE:
Home Telephone No: / Include STD Code
Mobile Telephone No:
Other Contact No:
Email Address:
Nationality:
Do You Require A Work Permit To Be Employed In The United Kingdom: / YES / NO
Do You Own A Car You Can Use To Travel To Work: / YES / NO
Do You Hold A Full Licence That Allows You To Drive A Car In The UK: / YES / NO
Do You Have Any Endorsements (Points) On Your Licence: / YES / NO
Details Of Any Endorsements (Points) On your Licence:
MEDICAL
Do You Regard Yourself As Disabled? / YES / NONumber Of Days Absence From Work Through Illness In The Last 12 months
On How Many Occasions Did This Occur:
Do You Require Special Facilities For Interview: / YES / NO
If Yes, please give details:
Details Of Any Medication You Are Currently Taking:
REFERENCES (For External Candidates Only)
Give Names And Addresses (And Telephone Numbers, If Possible) Of Three Referees. The First Should Be Your Present Or Most Recent Employer (Or Head Teacher If You Are A School Leaver). The Third Should Be A Personal Referee. Please Note - Friends And Relatives Are Not Acceptable Referees For 1 and 2.1. Recent Employer Name: / Address / Telephone No:
2. Second Employer Name: / Address / Telephone No:
3. Personal Name: / Address / Telephone No:
May We Approach These Referees Prior To Interview? 1. YES/NO 2. YES/NO 3. YES/NO
(Referees Will Only Be Contacted If You Have Been Requested To Attend For An Interview. References Are Confidential)
FULL CAREER HISTORY (In Chronological Order)
PLEASE EXPLAIN ANY GAPS IN EMPLOYMENT
Name And Address Of Recent And Previous Employers / From / To / Appointments Held And Brief Descriptions And Current/Most Recent Salary / Reason For LeavingContinue On A Separate Sheet If Necessary
EDUCATION AND TRAINING
Secondary School/ College/ University Attended / Full Or Part-Time / From / To / Course(s) Taken Or Currently Studying / Examination Results(Incl Grades)
Other Relevant Training Courses Attended:
Professional Qualifications: Professional Body:
Details Of UK Registration: Name And Pin No.
Do You Speak Any Foreign Language? If Yes, Please Indicate:
General Information
Please Provide Life Or Work Experience In Relation To Your Answers. Continue Your Answers On A Separate Sheet If Necessary, Numbered As Follows:
1. Why Do You Want To Work For Home From Home Care?
2. Tell Us A Little Bit About Yourself (Who You Are, What Makes You Tick, What you Feel Strongly About And How Your Friends Would Honestly Describe You)
3. What Relevant Skills, Experience And Personal Qualities Do You Have To Meet The Requirements Of The Job Description And To Undertake The Role Applied For? (Specifically, Tell Us How You Meet The Requirements Of The Person Specification)4. What Are Your Proudest Achievements (At Work And Home)?
5. What Has Been Your Most Significant Achievement For A Person With Learning Disabilities? What Was Your Personal Contribution To This? How Did You Involve Others In This?6. Finally, Tell Us Any Reasonable Adjustments That You Think We Would Need To Make To Enable You To Undertake This Role?
MISCELLANEOUS
Are you related to any staff already working for Home From Home Care? / YES / NOIf YES then please give details:
Have you worked for Home From Home Care before? / YES / NO
If YES then please give details:
Have you applied for a position with Home From Home Care before? / YES / NO
If YES then please give details stating any other names you may have used.
If you are offered the position will you continue to work in any other capacity? / YES / NO
If YES then please give details:
What notice period do you have to give your current employer?
Rehabilitation Of Offenders Act 1974
Any disclosures will be treated in the strictest of confidence.
Have you at any time been convicted of a criminal offence or received a Police caution and or reprimand or warning? YES/NO
If the answer is YES please give full details including the nature of the conviction/caution/reprimand/
warning, which Police Force was involved, the outcome and dates.
Continue On A Separate Sheet If Necessary
Data Protection Act 1998
Home From Home Care Ltd undertakes to treat personal details on this application form from which you can be identified, with complete confidentiality. By submitting this application form you are consenting for your details to be used in our recruitment process in accordance with the Data Protection Act 1998.Equal Opportunities
Home from Home Care is an equal opportunities employer. No job applicant or employee is treated more or less favourably on the grounds of gender, sexual orientation, age, marital, status, race, colour, nationality, ethnic or national origins, creed, religion or disability.Declaration
To the best of my knowledge the above facts are a true statement of myself. I accept that providing deliberately false information could result in my dismissal.
Signature of applicant: ……………………………………………………………….. Date ……………………………………….
This completed form should be returned in the addressed envelope provided to:
Home From Home Care Ltd, 1 Langton House, Lindum Business Park
Station Road, North Hykeham, Lincoln. LN6 3QX
Telephone: 0845 0042323
Home from Home Care
Application for Employment –Oct 2009
Page 2 of 6