Online Application















Next of kin

Please provide us with details of your next of kin.





Please give most recent first, (NB. Successful applicants will be required to provide evidence of qualifications)

Date Full-time / Part-time School / College / University Examination Taken Exam Date Results & Grades

Please give details of all training and other courses, which you have undertaken, particularly those related to care.

Year Course Title / Subject Organising Body Length of course

Last Employment


Please provide details of your present, or if you are not currently employed your most recent employment.













Previous Employment

Please provide details of ALL work you have undertaken (A full work history is required). Start with the most recent first. Continue in the "further information" section if necessary.

From Month/Year To Month/Year Employer (name and address) Job Title Reason for leaving

If there were any periods when you did not work since leaving school, please provide details.

From Month/Year To Month/Year Reason

Please provide details of three people who are able to provide references as to your character and suitability for the post you have applied for. One of these should be your current or most recent employer (see last employment section) wherever possible or applicable. None of the people you nominated should be partners or family members. The law now requires us to seek a reference from your most recent care service employer where applicable. Please confirm with the companies correct person and address to provide a reference e.g. you may find that the HR department via head office only provide references - and these details should be provided. Incorrect details provided to obtain references can delay your start of employment.

Reference 1









Reference 2









Reference 3









Day Morning Start Morning Finish Afternoon/Evening Start Afternoon/Evening Finish

Weekend Work


(Priority will be given to applicants able to work weekends)



Rehabilitation of Offenders Act 1974 (Exemption Order)

Because of the nature of the work you are applying for, it is exempt from the provisions of the Rehabilitation of Offenders Act 1974. You MUST let us know about any criminal convictions, cautions, reprimands, warning's or final warning you may have including those, which may be, for other purposes, considered spent.


Are you currently:



*If you have answered 'Yes' to any of these questions, please provide details of the offence and sentence below. Answering 'Yes' to these questions will not automatically disqualify you from employment. However, you should be aware that it is an offence to provide false or inaccurate information in order to gain employment.


Data Protection Act

The information or data which you have supplied on this form will be processed and held on computer and will also be kept in your personal records if you are appointed. The data may be processed by Sevacare UK for the purposes of equality monitoring, compiling statistics and for other employment records. In signing and returning this application you are deemed to have given your explicit consent to processing data contained in or referred to in it, including any data which may be considered to be sensitive personal information.

Confirmation of details

I confirm that the details in this application are accurate and complete.



* Required fields.

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