APPLICATION FORM The recruitment process within this organisation has a minimum of two stages. The completion of this application form is part of stage one. This application will be reviewed and a decision made as to whether to proceed to stage two, the interview, based on this information. If posting then please send to: Petals Care Agency 194 Manford way, Chigwell, Essex IG7 4DG PLEASE COMPLETE FULLY AND IN CAPITALS Position applied for: Care Assistant Approx. no. of wanted Full-time / part-time Days/ Nights/Mornings/Afternoons/Evenings/ (please circle you want to work and the times you can work) Weekends only (please circle which you want to work and the times you can work) Live In Carer: Yes/No Live-in part-time: Yes/No Surname: First Name(s): Marital Status: Middle name(s): Previous surnames (Supply documentary evidence e.g. DOB: marriage certificate, deed of name change etc): Current Address: Post Code: Moved to this address on (date): Previous Address: Note: For Criminal Record check purposes, addresses covering the five years up to the application date must be supplied. If necessary, use another sheet of paper. Post Code: Moved to this address on (date) Telephone numbers: Mobile: Home: Work: (will be used with discretion) Own Transport (yes/no): Clean current driving licence: How long has your licence been held? Endorsements: National Insurance Number: P45 received Yes/No Current CRB Reference NO: P46 Filled and received Yes/No EDUCATION School/College/University Examinations Passed/Qualifications gained (Please supply copies of certificates)
APPLICATION FORM The recruitment process within this organisation has a minimum of two stages. The completion of this application form is part of stage one. This application will be reviewed and a decision made as to whether to proceed to stage two, the interview, based on this information. If posting then please send to: Petals Care Agency 194 Manford way, Chigwell, Essex IG7 4DG PLEASE COMPLETE FULLY AND IN CAPITALS Position applied for: Care Assistant Approx. no. of wanted Full-time / part-time (please circle you want to work and the times you can work) Days/ Nights/Mornings/Afternoons/Evenings/ Weekends only (please circle which you want to work and the times you can work) Live In Carer: Yes/No Live-in part-time: Yes/No Surname: First Name(s): Marital Status: Middle name(s): Previous surnames (Supply documentary evidence e.g. marriage certificate, deed of name change etc): DOB: Current Address: Post Code: Moved to this address on (date): Previous Address: Note: For Criminal Record check purposes, addresses covering the five years up to the application date must be supplied. If necessary, use another sheet of paper. Post Code: Moved to this address on (date) Telephone numbers: Mobile: Home: Work: (will be used with discretion) Own Transport (yes/no): How long has your licence been held? Clean current driving licence: Endorsements: National Insurance Number: Current CRB Reference NO: P45 received Yes/No P46 Filled and received Yes/No EDUCATION School/College/University Examinations Passed/Qualifications gained (Please supply copies of certificates)