Employment Application Form

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Please answer all the questions

Email *

Surname *

First Name *

Position Applied for

Approximate Number of Hours Wanted

Full Time / Part time *

Full time

Part time

Current Address *

Please list all the previous addresses up to recent 5 years with start date and end date at each Address as we would need this information for a successful DBS check

Telephone Number

Own Transport (Yes / No) *

Yes

Maybe

Do you have a Driving License *

Yes

Any Endorsements on your Driving License

Yes

Clear selection

Give Details of Endorsements

Any relevant Training / Qualifications

Name of School/College/University

Qualifications Achieved ( Mention the recent one)

Date of Qualification

Location/Details

Details of any other courses Attended

Current Employment - Date Employed

YYYY

Current Employer - Nature of Business

Current Employer - Position held and reason for leaving

Current Employment - Salary/Rate

Current Employment - Name and Address

Previous Employment - Name and Address

Previous employment - Date Employed

YYYY

Previous Employment - Nature of Business

Previous Employment - Position held and reason for leaving

Previous Employment - Salary/Rate

DETAILS OF ALL YOUR EMPLOYMENT HISTORY since leaving school including month and year. Also, please indicate any GAPS in employment and the reason for these *

Do you require us to make any special arrangements in order for you to participate in the recruitment process?

GP Name *

GP - Telephone Number *

GP - Address *

Next of Kin - Full Name *

Next of Kin - Relationship

Next of Kin Telephone Number *

Next of Kin - Full Address

NI Number *

Employment Reference 1 - Contact person name *

Employment Reference 1 - Address *

Employment Reference 1 - Telephone Number *

Employment Reference 1 - contact Email *

Employment Reference 2 - Contact Person Name *

Employment Reference 2 - Full Address *

Employment Reference 2 - Email Address *

Employment Reference 2 - contact number *

Character reference 1 - Full Name *

Friends or relatives are not acceptable referees

Character reference 1 - Email Address *

Character reference 1 - Address *

Character reference 1 - Telephone Number *

Character reference 1 - Relationship to you *

Character reference 2 - Full Name
*

Character reference 2 - Address
*

Character reference 2 - Email Address
*

Character reference 2 - Telephone Number
*

Character reference 2 - Relationship to you
*

Please declare all criminal convictions, whether spent or not, charges, whether proceeded with or not and warnings and cautions in the space provided. If any additional please email us at hr@am2pmcare.com

I have read, understood and agree with the below terms *

I declare that to the best of my knowledge and belief the information given by me in this application is true, and I understand that the above information forms the basis of my contract of employment. I understand that if any of the information supplied by me is found to be falsely declared, my contract may have been fundamentally breached and my employment may be terminated immediately.I understand that I may not be offered a post until a satisfactory response has been received with respect to my DBS Register status, and that should I subsequently be offered a post, that offer will be subject to receipt of two satisfactory references, one of which must be from my previous employer, and that confirmation of the employment will be subject to a satisfactory criminal record check from the DBS.I understand that until a satisfactory response is received from the DBS, and my employment is confirmed, I will be supervised at all times at work, and will not seek or have unsupervised access to vulnerable people. By my signature, I authorise AM2PM Quality Care Limited to request a DBS Register check and a criminal records check from the DBS, on initial employment and at any time during my employment thereafter. I undertake to inform my employer immediately if my DBS Register status or criminal status changes at any time during my employment, such as by being charged with an offence (other than motoring offences), the administering of a warning, criminal conviction, referral to any register of barred Care workers, or withdrawal of any registration required by my employment status.

Agree

Disagree

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