Highbarrow Care Home

Application

Application form

Title & Full Name

Position applied for

Telephone Number

Current Address & Postcode

National Insurance Number

Do you require a work permit?

Are there any dates you would be unavailable for interview?

Current/Most recent employer name & Full address

Job Title

Date of Appointment

Brief description of duties

Reason for leaving

Would you like to be contacted before a reference is requested?

Yes Please contact me

No I do not need to be contacted

Education

Relevant Training & Non-Qualification courses

Previous Employer 1

Date from

Date to

Previous Employer 2

Date From

Date to

Previous Employer 3

Date From

Date to

Application Statement

Hobbies & interests

Personal Reference (1) Name & Title

How do you know this person?

How long have you known this person?

Contact Number

Contact Email

Have you made this person aware that we will be contacting them for a reference?

Yes

Personal Reference (1) Name & Title

How do you know this person?

How long have you known this person?

Contact Number

Contact Email

Have you made this person aware that we will be contacting them for a reference?

Yes

By submitting this application you are declaring all of your details given to be true and accurate. YOu accept any omission of false statement may result in dismissal. You furthermore authorise the comapny to approach any government agencies, former employers, accountants or personal referees named to verify the information given adn authorise such agencies or individuals to provide the information requested. You acknowledge that an employment offer made by the company is subject to the receipt of references, DBS checks and medical clearance satisfactory to the comapny.

I agree

I do not agree

Declaration. You are applying for a position that will require contact with vulnerable adults, therefore we carry out a criminal record background check before appointment and on regular basis thereafter, see www.Gov.Uk/DBS for more details. Do you have any convictions, cautions, reprimands or final warnings that are not 'protected' as defined by the rehabilitation of offenders act 1974/ order 1975 (as amended in 2013) by SI 2013 1198? Please indicate your answer in item 1 or 2 below (certain old and minor offences do not need to be disclosed and they will be filtered from any criminal check which are 'protected'. For full details see www.Legislation.gov.uk or speak to the home manager. Any information will be completely confidential and will be considered only in relation to an application for positions to which the order applies

I have nothing to declare

I have something to declare

Contact

Where to find us:

Highbarrow Residential Home, Uttoxeter, ST148JT,

United Kingdom

01889 566406

manager@highbarrow.co.uk

Careers