Application Form

Please complete this application with as much information as possible. If you experience any technical difficulties or require further assistance please call HomeCareDirect on 0845 061 9000

Step 1 of 4

25%

Job Type
Personal Details
Title
Surname*
Forename(s)*
Previous Surname(s)
Address*
Street Address Address Line 2 City County Postcode
Email Address*
Contact Telephone Number*
Mobile
Work
National Insurance Number*
Preferred Language
Do you require documents and correspondence in a different format (easy read, braille, different language)? If so please let us know and we will arrange this for you
Do you hold a full, current driving license?
Do you have your own transport?
Is your vehicle insured for business use?
Attach CV (optional)
Accepted file types: pdf, doc, docx.
To be completed by non-British and non-ec nationals only
Date of entry into UK
Are you a student?
Do you require a work permit?
Do you hold a current visa?
Expiry Date

Availability
Please select as appropriate the hours you would be available to work.
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
N.B - By ticking the above boxes you are not guaranteeing to be available for all those periods, for all of the time, nor to be available every hour during these periods. You are indicating you will seek to be available during these times to provide care, unless your circumstances change, when you will be free to discuss your times available to provide care with the client, and if appropriate, and/or the responsible person in relation to the need for continuity of support for the client.
If you are currently working, how much notice are you required to give?
Have you applied to work for HomeCareDirect previously?
If yes what was the outcome?
Date of application
Educational Details
Please supply details of all relevant qualifications and training. Please include any in-house training undertaken. We will require copies of all qualification certificates.
Schools
From (Month / Year) To (Month / Year) School Attended (Name & Address) Qualifications Obtained Grade Awarded
College
From (Month / Year) To (Month / Year) School Attended (Name & Address) Qualifications Obtained Grade Awarded
Further Education/Courses
From (Month / Year) To (Month / Year) School Attended (Name & Address) Qualifications Obtained Grade Awarded

Employment History and References
Please provide details of all previous employment which must include any gaps between employment (i.e. periods of travel, studying, voluntary work, periods of unemployment). References will be sought covering a minimum of the past 5 years. One reference must be from your current or most recent employer. Please enter details covering your employment history over last 5 years, if you have been out of work for any of this period please give details of these gaps or complete section as Not Applicable.
Contact Name and Details of Current Employer
Organisation*
Contact Name*
Contact Telephone Number*
Contact Email Address
Address*
Street Address Address Line 2 City ZIP / Postal Code
May we contact this person for a Reference?*
Position Held*
Salary*
Reason for Leaving?*
Main Duties and Responsibilities*
Dates of Employment From (mm/yy)*
Dates of Employment To (mm/yy)*
Contact Name and Details of Prevous Employers
Organisation
Contact Name
Contact Telephone Number
Contact Email Address
Address
Street Address Address Line 2 City ZIP / Postal Code
May we contact this person for a Reference?
Position Held
Salary
Reason for Leaving?
Main Duties and Responsibilities
Dates of Employment From (mm/yy)
Dates of Employment To (mm/yy)
Organisation
Contact Name
Contact Telephone Number
Contact Email Address
Address
Street Address Address Line 2 City ZIP / Postal Code
May we contact this person for a Reference?
Position Held
Salary
Reason for Leaving?
Main Duties and Responsibilities
Dates of Employment From (mm/yy)
Dates of Employment To (mm/yy)

Personal References
If you have not already supplied us with two valid employment reference contact details (above) please include contact details for three personal references who we may contact.
Contact Name Relationship Address Telephone Number Email Address
Gaps in Employment
Dates of Gaps in Employment - Please add as necessary
From (mm/yy) To (mm/yy) Reason for Gap in Employment
Have you ever been the subject of disciplinary/suspension/dismissal?
If yes please give details*
Additional Information
Please provide details of your suitability for the position you have applied for. Please include details of any skills, qualifications, experience, voluntary work or general life experiences that may be relevant.
Disclosure and Barring Service
Because of the nature of the work for which you are applying, it is exempt from the provisions of the Rehabilitation of Offenders Act 1974 by virtue of ROA 1974 (Exceptions) Order 1975. Applicants are required to give details of ALL convictions for criminal offenses including those which would otherwise be endorsed as ‘spent’ by virtue of the above Act. Failure to disclose details of convictions/warnings/cautions or reprimands could result in dismissal.
Have you ever been convicted of a criminal offence?*
If yes please give full details*
Include details of any warnings/cautions/reprimands
Do you have a portable DBS check?
If yes please provide the date of issue and reference number:
If your application to work for HomeCareDirect is successful would you prefer an online or paper DBS form?*
HomeCareDirect will send you either the paper version of the DBS application form or the links to the online application process
Please confirm your authorisation for the below to be undertaken:*
1. Checks made with the DBS adults barred list information. 2. Checks made with the DBS children’s barred list information. 3. A request will be made to my GP concerning my health where applicable. 4. Reference request will be made to my previous employers.
Date of above confirmation*
I would like to receive a HomeCareDirect brochure?
Declaration
I declare that all the information I have given in this application is correct. I understand that my application is subject to satisfactory references and a medical letter from my doctor where required. I have received a job description and understand that I am required to fulfil all aspects of it. I fully understand that should I be made an offer of employment and any statement is found to be materially incorrect, then my employment may be terminated without notice or other reason given.
Name*
Please note - By providing us with your First and Last name here you are providing an 'e-signature' which confirms you adhere to the above declaration.
First Last
Date of 'e-signature'*
Want to keep updated with HomeCareDirect? Tick here to subscribe to our newsletter for useful advice and the latest news from HomeCareDirect
- Yes
- No
Where did you hear of this opportunity to work for HomeCareDirect?*

From (Month / Year)	To (Month / Year)	School Attended (Name & Address)	Qualifications Obtained	Grade Awarded

Contact Name	Relationship	Address	Telephone Number	Email Address

From (mm/yy)	To (mm/yy)	Reason for Gap in Employment

Application Form

Step 1 of 4

Personal Details

To be completed by non-British and non-ec nationals only

Availability

Educational Details

Employment History and References

Contact Name and Details of Current Employer

Contact Name and Details of Prevous Employers

Personal References

Gaps in Employment

Disclosure and Barring Service

Declaration

What services and activities are available in your area?

Interested in being a personal assistant?