Care Application – Blue Diamonds

Step 1 of 5

20%

SECTION 1 : Personal Details

Position applied for*

Name*

title First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Email*

Date of Birth*

DD slash MM slash YYYY

Are you eligible to work in the UK?*

National Insurance Number (NI)*

Are you DBS Certified?*

Yes

Disclosure and Barring Service

Do you have (UK) full driving license*

Yes

Do you have your own transport*

Yes

SECTION 2 : Rehabilitation of Offenders Act

Have you ever been convicted of a criminal offence?*

Yes

Have you any prosecutions pending?*

Yes

SECTION 3: Health

Are you registered disabled?*

Yes

SECTION 4: Education

Please list your qualifications in reverse order, starting with the most recent first. Also, include any training that you have received which did not lead to a qualification but which you feel is relevant to the post. If short-listed for an interview, please be prepared to bring original copies of any certificates relating to post-school qualifications or vocational qualifications.

Qualifications*

Date Obtained:

Place of study & address:

Examinations taken & grades:

Other Qualifications:

Date Obtained:

Place of study & address:

Examinations taken & grades:

SECTION 5: Employment Record

Employment History*

Please give summary details of all your previous employment (most recent first for a minimum of 10 years if Applicable). Please ensure you include all part-time and temporary positions held, even those that are not relevant to your application. Please ensure you include any periods of unemployment or any other time that is not accounted for.

Date From

Date To

Name of Employer:

Employer Address:

Length of Employment:

Reason for leaving:

Main Duties and responsibilities:

If currently employed how much notice are you required to give?

(weeks)

Reason for leaving or seeking new employment:*

SECTION 6: Reference

Reference*

Full Names

Job Title

Organisation

Phone

Address

Emergency Contacts:*

in case of emergency, who should we contact?

Full Names

Telephone

Address

SECTION 8: Personal Attributes

Please give details:

SECTION 9: Declaration

I confirm that the information provided in this application (and within my Curriculum Vitae if applicable) is both truthful and accurate. I have omitted no facts that could affect my employment. I understand that any false misleading statements could place any subsequent employment in jeopardy. I understand that any employment entered into is subject to documentary evidence of my right to work in the UK and satisfactory references. I expressly consent to personal data contained within this form being recorded for the purposes of assessing suitability for the post and may form the basis of any subsequent personnel file.

Signed*

Date*

DD slash MM slash YYYY

Blue Diamonds Care undertakes that it will treat any personal information that you provide to us, or that we obtain from you, in accordance with the requirements of the Data Protection Act 1998. After initial assessment, Blue Diamonds Care opportunities that may arise in the future. Please tick if you do not wish us to hold your details.

Please tick if you do not wish us to hold your details*

Yes

Upload CV & Other Document

Drop files here or

Accepted file types: pdf, doc, docx, jpg, png, Max. file size: 5 MB.

Recruitment Monitoring Form

What is your Ethnic Group*

Please indicate the ethnicity to which you feel you belong

African

Albanian

Arab

Baltic Estonian/Latvian/Lithuanian

Bangladeshi or British Bangladeshi

Black British

British Asian

Mixed British

Caribbean

Chinese

Commonwealth (Russian)

Filipino

Gypsy/Romany

Indian or British Indian

Iranian

Irish

Italian

Kurdish

Malaysian

Mid East

Mixed

Nigerian

Pakistani or British Pakistani

Vietnamese

White and Asian

White and Black African

White and Black Caribbean

White British

White Irish

Other

Please state where you saw this advert*

Friends

Google

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