24/7 service available 
07440168852 
Telephone 
01206890904 
Contact us by email 
info@caregiversltd.co.uk 

JOB APPLICATION 

 
Please complete this Application Form in block capitals in black or blue ink. 
Should you require more space please continue on a separate sheet clearly marking the section to which it relates. 

PERSONAL DETAILS 

DRIVING RECORD 

EDUCATION & PROFESSIONAL TRAINING (from year 11) 

LANGUAGES 

PERSONAL DBS CERTIFICATES 

If the position you are applying for (whether paid or voluntary) is listed in Schedule 1, Part II of the Rehabilitation of Offenders Act 
(Exceptions) Order 1975, we are entitled to ask Exempted Questions as defined by Section 113(5) of the Police Act 1997 about you. 
We are required to check a DBS Certificate in relation to any person who is a Care Manager or Care Worker. If your application is 
successful and before your appointment is confirmed, you will be required to submit a personal current and valid DBS Certificate for 
our inspection. 
 
Having a criminal record will not necessarily bar you from working with us. This will depend upon the nature of the position and the 
circumstances and background of your offences. We observe the “Code of Practice for Registered Persons and Other Recipients of 
Disclosure Information” published through the Disclosure & Barring Service on behalf of the Home Office, and we will provide you 
with a copy of it upon request. 

EMPLOYMENT HISTORY 

Please provide details of all employment, beginning with your present or most recent job first 

VOLUNTARY & COMMUNITY WORK EXPERIENCE 

JOB FLEXIBILITY 

REFERENCES 

Please provide details of 2 referees who we may approach with regards to this Job Application. These 
referees must not be members of your family, and one must be your present or most recent employer: 

DECLARATION BY JOB APPLICANT 

ANY PERSON, UPON SUBSEQUENT EMPLOYMENT, THAT IS FOUND TO HAVE KNOWINGLY SUPPLIED FALSE OR 
MISLEADING INFORMATION, OR HAS DELIBERATELY WITHHELD RELEVANT INFORMATION, MAY BE SUBJECT TO 
DISCIPLINARY PROCEEDINGS WHICH MAY RESULT IN DISMISSA 
IS AN EQUAL OPPORTUNITIES EMPLOYER 
 
The sole criterion for selection of applicants will be suitability for the Job Position, regardless of gender, background, culture, ethnic denomination, 
religious affiliation, marital status or disability. 
 
Data Protection Act 1998: Your signature on this document gives us the right, under the Data Protection Act 1998 to process the information you 
have given, including data of a sensitive nature, relating to your application for employment. Any processing of the data by us will be in accordance 
with our Policy and the processing principles set out in the Act. Application forms of unsuccessful candidates will be destroyed after 6 months in 
accordance with our Record-keeping Policy. 

Have questions? 

Your local team of Client Care Managers are on call 24/7 to answer your questions and work with you to design a customized plan of care that is right for you. 
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