Recruitment - Elite Care Agency

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Title • Date of Birth • Surname • First Names Address Post Code Email Address Telephone No. Mobile • Position Applied for: - Driving License Car Owner Current Occupation Position Name of Employer Date Started Brief Description of Job Previous Employment (Starting with the most recent. Please account for any breaks in employment) Position Held Name of Employer Date Started Date Left Responsibilities Reason for Leaving Qualifications Please list any qualifications you have gained (e.g. NVQ's, GCSE's, A-Levels, Degree, any other professional qualifications) Name of Qualification Subjects Result/Grade Name of School/College/University Date Awarded Other Training Please list any other training you have undertaken which is relevant to the post you are applying for. Name of Course Qualification Gained Dates Attended Relevant Skills and Experience Please show how you meet the personal specification for the post. • The information you give will be used in the short-listing process. Please be specific and give examples wherever possible - these can be drawn from any aspect of your life. Reason for Applying • Describe briefly in your own words why you are applying for this job, and what you would like to be taken into account in support of your application. Administration Details • National Insurance No.:- Have you a disability you would like us to know about If Yes, please give details: - Are you related to any employee of Elite If Yes, please give details: - • Please indicate the maximum number of hours you would be available to work per week Do you require a work permit to work in the UK? • When would you be available to start work: - Other Employment If offered this position do you intend to work in another capacity If Yes, what are your plans or commitments? References All offers of employment are subject to satisfactory references. This post involves working with vulnerable adults and due to the nature of work employment will not commence until two satisfactory references have been received. Please give details of two referees, one of whome should be your current or most recent employer, the other from previous employers or from educational establishments you have attended. Referee (1) Title • Name • Address • Post Code • Telephone No. May we contact this referee without further authority from you? Referee (2) Title • Name • Address • Post Code • Telephone No. May we contact this referee without further authority from you? Declaration I confirm that the information I have given on this form is correct and complete. I understand that any misleading statements may be sufficient reason for cancelling any agreement made. If successful in my application I understand that I will have to sign a Confidentiality Agreement. Because the post involves working with invulnerable adults I understand that if short listed, I will be asked to complete a Declaration of Criminal Record which must include details of any criminal convictions, cautions, reprimands, final warning and any other information that may have a bearing on my suitability for the post. I understand that an Enhanced CRB Disclosure will be sought in the event of a successful application

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