Application Form for Employment


Under the Data Protection Act 1998 and the General Data Protection Regulation 2018, your personal details will be destroyed if you are not successful in securing a position in the company.

Application Form

Education and Training:

Personal Information:

Employment History:

Please list last 3 years of employment history (If any).


Employer #1:

Employer #2

Employer #3

Employer #4

Employer #5



Reference #1:

References #2:

Health Details:

Additional Information:

Read & Acknowledge As Appropriate:

The company is exempt from the provisions of the above act; applicants are not entitled to withold information about convictions which for other purposes are regarded as spent' in certain prescribed areas.

In the event of employment, any failure to discloe such convictions, included suspended sentences, could result in disciplinary action being taken which could result in dismissal.

Having read the above notes please complete (a) or (b) as appropriate.

2. DBS - Enhanced Disclosure

3. Health Declaration


The work within a Domiclliary care company is demanding in terms of physical requirements of all employees. The care and assistance to be given to clients due possibly to their physical handicap, involved with daily cleaning, changing beds, climbing stairs, etc.

In you own interest please do be certain in making you application for employment that you are fit for the job and that you will offer reliable attendance and be of benefit to the team.

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