Title Select an item... Mrs Ms Miss Mr Dr other
First Name
Last Name
Email
Telephone
Alternate Telephone
Date of Birth DD/MM/YY
Full address (including postcode)
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Have you done care work before? Select an item... Yes on a professional basis Yes for a family member/ friend No I have no previous care experience
Are you seeking temporary or permanent work? Select an item... Permanent role Temporary role
Please tell us why you want to work as a carer?
Please tell us about the experience you have that you feel is relevant to this role?
What do you think are the 3 most important qualities of a carer?
Are you currently working? Select an item... Yes No
What date are you available to start work? DD/MM/YY
Please tell us about your availability or preferred pattern of work
On what basis are you legally eligible for employment in the UK? Select an item... UK/EU passport holder Working holiday visa Ancestral visa Student visa Indefinite stay Grant of asylum Other
Do you hold a current valid UK driving licence? Select an item... Yes No
Do you own a car? Select an item... Yes No
Are you in good health? Select an item... Yes No
Have you ever been convicted of a criminal offence or received a caution,
reprimand or warning (other than motoring)? Select an item... Yes No
Can you provide us with details of two referees
(one of whom must be your previous employer)? Select an item... Yes No
How did you hear about us? Select an item... Friend Job centre Surrey advertiser Guardian newspaper Other local newspaper Gumtree Recruitment consultant Google Other internet search engine Other