YOUR FULL ADDRESS including postcode*
National Insurance Number*
Do you have the right to take up employment in the UK?*
Are You Currently Employed?*
Start Date At Current Employment
2. CHARACTER REFERENCE (Must not be family)*
AN OFFER OF EMPLOYMENT IS MADE ON THE UNDERSTANDING THAT TWO ACCEPTABLE REFERENCES ARE RECEIVED (ONE BEING FROM YOUR CURRENT/MOST RECENT PLACE OF EMPLOYMENT), TOGETHER WITH A DISCLOSURE & BARRING SERVICES CHECK THAT IS SATISFACTORY TO THE AGENCY AND SHOWS THE STAFF MEMBER IS NOT BARRED FROM WORKING WITH VULNERABLE ADULTS. WE RESERVE THE RIGHT NOT TO OFFER YOU WORK OR TO IMMEDIATELY TERMINATE ANY ASSIGNMENT IF ANY INFORMATION ON THIS APPLICATION IS FOUND TO BE FALSE......................................................................................................................................................................................................*
DRIVING LICENCE - Do you hold a driving licence?*
Do you have any endorsements?*
If yes, please give details:
Do you have your own vehicle?
DECLARATION OF HEALTH - Has your employment ever been terminated on the grounds of ill health?*
Are you currently taking any prescribed medication?
Are you currently under the care of a doctor or other medical professional?
Have you had your vaccination against COVID-19?*
Approximately, how many days/weeks sickness absence did you have in the last 12 months?*
Are you currently suffering from or have you ever suffered from any of the below? (tick if yes)*
If you have answered YES to any questions in the declaration of health section please give details and approximate dates where relevant. This is particularly important if you have a qualifying disability under the Disability Discrimination Act, as it will enable us to identify what, if any, reasonable adjustments can be made.
For use in case of emergency please provide details of your Next of Kin / Emergency Contact with their full address and telephone numbers.*
I give full permission to ApproCare to contact my GP in the case of emergency or should they deem it necessary and in my best interests.
EXPERIENCE & QUALIFICATION - PLEASE ACCOUNT FOR YOUR MOVEMENTS SINCE LEAVING FULL TIME EDUCATION WITHOUT ANY UNEXPLAINED BREAKS. IF YOU DID NOT WORK FOR A PERIOD OF TIME, PLEASE STATE WHAT YOU WERE DOING EG: HOUSEWIFE/MOTHER/FATHER/JOBSEEKING ETC:*
Employment 1 Leave Date: (If applicable)
Employment 1 Job Title/Position Held:
Reason For Employment 1 Ending?
Previous Employer (Employment 2):
Employment 2 Job Title/Position Held
Reason For Employment 2 Ending?
Previous Employer (Employment 3):
Employment 3 Job Title/Position Held
Reason For Employment 3 Ending?
Any Other Previous Employments:
Date Of Leaving Full Time Education:*
When are you free to start work?*
Do you have any prebooked holidays or dates of unavailability? *
EXPERIENCE CHECKLIST - To correctly enable us to assess any experience or training needs you may or may not have, could you please TICK the appropriate boxes you have any personal or professional experience in:*
TRAINING COURSES - have you completed any of the following?*
Please list any other training completed and date of completion:
DECLARATION - Have you been convicted of any criminal offence at any time?*
If yes, please give details and dates:
