PLEASE READ NOTES ON ATTACHED PAGE TO HELP YOU COMPLETE THIS FORM COMPLETED FORMS SHOULD BE RETURNED TO THE ABOVE ADDRESS OR EMAIL TO PERSONAL INFORMATION Title Names in Full Surname Mr / Mrs / Miss / Ms Contact Address Contact Telephone Number(s) Personal Public Service Number (PPS) Postcode Home _______________________ Email address National Insurance Number Mobile ______________________ (if applicable) Do you have (please tick box) √ A full current driving licence that allows you to drive in the UK, Isle of Man or Republic of Ireland? Yes No   The use of a car for work? Yes No   Do you require a work permit to work in the UK? Yes No   Do you require a work permit to work in the Isle of Man? Yes  No  Do you require a work permit to work in the Republic of Ireland? Yes  No  Are you able to work flexible hours? Yes No   This is particularly relevant to within our care projects Do you have a disability? (see Note 1) Yes No   If yes, do you need any special arrangements to be made for you? Please Yes No   tell us here what you need. Give dates of any planned holidays From To Praxis Care may not be able to accommodate holidays. Where did you hear about this job? Newspaper NI Jobs Regional College NI Internal   Community  Praxis Care Website   Where you have ticked College’ or - please specify_______________________ ‘Newspaper’, ‘Regional ‘Other’ We use this information to measure the success of our adverts. REFEREES (see note 2) Name Name Address Address
PLEASE READ NOTES ON ATTACHED PAGE TO HELP YOU COMPLETE THIS FORM COMPLETED FORMS SHOULD BE RETURNED TO THE ABOVE ADDRESS OR EMAIL TO PERSONAL INFORMATION Title Mr / Mrs / Miss / Ms Names in Full Surname Contact Address Postcode Email address Contact Telephone Number(s) Home _______________________ Mobile ______________________ (if applicable) Personal Public Service Number (PPS) National Insurance Number Do you have (please tick √ box) A full current driving licence that allows you to drive in the UK, Isle of Man or Republic of Ireland? The use of a car for work? Yes  Yes  No  No  Do you require a work permit to work in the UK? Do you require a work permit to work in the Isle of Man? Do you require a work permit to work in the Republic of Ireland? Yes  Yes  Yes  No  No  No  Are you able to work flexible hours? This is particularly relevant to within our care projects Yes  No  Do you have a disability? (see Note 1) If yes, do you need any special arrangements to be made for you? Please tell us here what you need. Yes  Yes  No  No  Give dates of any planned holidays From To Praxis Care may not be able to accommodate holidays. Where did you hear about this job? Newspaper Internal  NI Jobs  Regional College Community NI  Praxis Care Website   Where you have ticked ‘Newspaper’, ‘Regional College’ or ‘Other’ - please specify_______________________ We use this information to measure the success of our adverts. REFEREES (see note 2) Name Address Name Address
TL-BH-M-18.1.docx