Candidates/Staff Form

Please complete all sections of this form in block capitals.
What position are you applying for?

How did you hear about the vacancy?

PERSONAL DETAILS
First Name

Surname

Any previous names(if applicable please provide name & dates )

From

To

Date of Birth

Nationality

Company Use Only
Ref No

Address:

Postcode:

Home Tel No:

National Insurance Number:

Do you need a permit to work in the UK?
YesNO

If yes, please provide your work permit / visa number:
Are there any restrictions on your visa? YesNO
If yes, please detail:
Visa expiry date (if applicable):
Do you have a full driving licence?YesNO
Is it clean?YesNO
If no, please give details:
Do you have daily use of a car? YesNO
How long are you prepared to spend travelling to work?

Mobile No:

E-mail Address:

Are you lawfully resident in the UK?
YesNO
Are there any restrictions on your continued residence in the UK?
If yes, please state your home office / port reference number here:

Please provide details of Next of Kin to be contacted in Emergency :
Name of the person:
Relationship to you :
Address :
Phone Number:
What kind of work are you looking for?
PermanentTemporaryBoth
When are you available to start work?

Notice period (if applicable):
BANK DETAILS
Name of Bank / Building Society
Name on Account
(if LTD give limited company name)
Branch Address
Sort Code
Account Number

“I confirm that these are my correct bank details and I acknowledge that my payments will be made directly into this account from Vcare Services”
Name
Date (dd/mm/yyyy)
EDUCATION & QUALIFICATIONS
Please include both educational and vocational qualifications starting with the most recent and going backwards in time.
Dates (from-to)
Educational Institution
Qualifications Obtained
TRAINING COURSES ATTENDED
Dates (from-to)
Course Title
Topics Covered / Qualification
VOCATIONAL SKILLS & COMPETENCE
Please provide details of any specific skills or competence that is particularly relevant to your application (e.g. any registration , any special industry skills etc.)
EMPLOYMENT HISTORY
Please detail your full employment history starting with your most recent employer (stating if it was a recruitment agency), and continuing backwards in time. Please ensure that dates provided include both month and year. Continue on separate page if necessary.
Current Employer
Company Name
Dates of Employment
Job Title
Reasons for Leaving
Salary on Leaving
Notice Period (if relevant)
Duties / Responsibilities of Role

Company Name
Dates of Employment
Job Title
Reasons for Leaving
Salary on Leaving
Duties / Responsibilities of Role

Company Name
Dates of Employment
Job Title
Reasons for Leaving
Salary on Leaving
Duties / Responsibilities of Role

Company Name
Dates of Employment
Job Title
Reasons for Leaving
Salary on Leaving
Duties / Responsibilities of Role
ADDITIONAL INFORMATION, HOBBIES & INTERESTS
Please provide any further information that you feel may support your application.
DISCLOSURE AND BARRING SERVICES AND REHABILITATION OF OFFENDERS ACT (1974) DECLARATION
REHABILITATION OF OFFENDERS ACT (1975)
Because of the type of work that you have applied for, the Rehabilitation of Offenders Act (1974) (Exemptions 1975 apply) requires that it is a requirement on people who apply for social care positions to disclose any conviction that would otherwise be considered ‘spent’.

Have you been convicted of a criminal offence?(if yes , please provide details)
Have you been given a conditional discharge for a criminal Offence?( if yes , please provide details)
I UNDERSTAND THAT ANY INFORMATION I GIVE WILL BE TREATED IN THE STRICTEST CONFIDENCE. ANY INFORMATION THAT I GIVE THAT DETAILS ANY OFFENCES – WILL NOT JEOPORDISE MY APPLICATION.
SIGNED:
Date:
CRIMINAL RECORDS BUREAU DISCLOSURE
Before you can commence working as a Care Worker in the community, the Company must obtain a CRB clearance for you. You will have already completed the form and supplied documents that confirm your identity.

The Company will keep the documentation under the terms of the Data Protection Act 1998. The CRB documents will only be checked by CQC Inspectors for inspection purposes under the Care Standards Act 2000 when the Company’s records are checked.

I GIVE MY CONSENT TO THE DISCLOSURE OF THE CRB DOCUMENTATION RELATING TO MY APPLICATION ONLY IN THE CIRCUMSTANCES DESCRIBED ABOVE.

SIGNED:
Date:

REFERENCES
Please provide details of two previous employers from whom we can obtain references. Any offer of employment is conditional on our receiving two satisfactory references. We will not approach your present employer until an offer of employment has been made and verbally accepted.

Most Recent Employer
Contact Name:
Contact Job Title:
Company Name:
Address:
Telephone Number:
E-mail Address:

Other Employer
Contact Name:
Contact Job Title:
Company Name:
Address:
Telephone Number:
E-mail Address:

DECLARATION
I confirm that the information I have given is correct and that I have not withheld any information of which the company should be made aware. I also understand that giving any incorrect or misleading information could lead to my subsequent dismissal, or withdrawal / termination of assignment.
Signed:

EMPLOYMENT HISTORY CONTINUATION PAGE
Additional Page for Continuation of Employment History (if necessary)
Company Name
Dates of Employment
Job Title
Reasons for Leaving
Salary on Leaving
Duties / Responsibilities of Role

Company Name
Dates of Employment
Job Title
Reasons for Leaving
Salary on Leaving
Duties / Responsibilities of Role

Company Name
Dates of Employment
Job Title
Reasons for Leaving
Salary on Leaving