Application Form

Please fill out all the required fields

Personal Details

Employment Desired *

Position Being Applied For *

Full Name *

Date Of Birth *

Current Address *

Address 2

City *

Country *

Mobile Phone *

Email *

Emergency Contact(Next Of Kin)

Emergency Contact Full Name*

Relationship with the Emergency contact *

Emergency Contact's Address *

Emergency Contact's Address 2

Emergency Contact's City*

Emergency Contact's Country*

Emergency Contact Number *

National Insurance No(NINO) OR UTR *

Right To Work

Do You Have The Right To Live & Work In The UK *

Nationality

Work Permit / Passport / Visa No.

Work Permit/ Passport / Visa Expiry Date *

Right To Work Documents You Can Submit

Do you have UK Passport? *

EEA Passport/ID Card *

UK Birth Certificate/ Adoption Certificate *

Entry Clearance/ Visa Stamp/ Resident Permit *

Home Office / Border Authority Authority Letter *

Certificate Of Application *

Other - Please Specify

Driving

Do You Drive ? *

Do You Have A Valid Drivers License? *

Do You Have A Vehicle For The Purposes Of Work? *

EMPLOYMENT REFERENCES

Job Tittle/ Position / Department

Previous Employment Start Date

Previous Employment Finished Date

Name of Company

Address Line

City

Country

Employer Contact Name

Employer Contact Phone- (Include Country Code )

Employer Email

PERSONAL/CHARACTER REFERENCES

Name Of Referee*

Referee Address*

Referee City*

Referee Country*

State Relationship With Referee*

Referee Contact Phone (Include Country Code)*

Referee Contact Email*

Number Of Years You Have Known Them*

EDUCATIONAL REFERENCES

Name of Educational Institution

Admission Date

Completion Date

Institution Address *

City *

Country *

Referee Contact Name *

Department

Referee Contact Number (Include Country Code )

Referee Contact Email

TRAINING & COMPLIANCE

Are You Available To Work Immediately? *

Do You Have Previous Experience In The Role You Are Applying For? *

REHABILITATION OF OFFENDERS ACT 1974

The Following is a summary of the Rehabilitation of Offenders Act 1974.
Please ensure
that you read through this carefully and that you are aware of its meaning.

WHAT IS THE ACT?

The Rehabilitation Of Offenders Acts 1974 was introduced to enable criminal conviction
to be ''spent'' or forgotten after a period of rehabilitation. After this period, with some exceptions, an
offender will not normally be obliged to mention the conviction when applying for a job, obtaining
insurance, or when involved in other criminal legal proceedings.

HOW LONG IS THE REHABILITATION PERIOD?

The period of rehabilitation will depend on the sentence given, not the actual time
served in custody.

Have You Ever Been Cautioned Or Convicted Of A Criminal Offence ( Subject To The
Rehabilitation Of Offenders Act 1974) *

REHABILITATION OF OFFENDERS ACT 1974

The 48-hour week Working Time Directive has been in force since 1st
October 1998.
Under these regulations, GO Care must obtain your written permission if you wish to work
for more than 48hrs per week
If you do wish to work more than 48 hours per week, you
need to sign the agreement below. If you change your mind about this later, you will need to inform the
Human Resources Department in writing giving three months' notice so that your roster may be
amended.
Employees working at night have the opportunity for a free health assessment. If you wish to
avail yourself for this assessment, please contact the Human Resource Department
The directive state that
the healthcare industry is not bound to comply with the regulations relating to night work longer than eight
hours in a twenty four, rest period of eleven hours per day per week or a rest period for every six hours
worked, provided that you allow the same rest at a later time.
If, however, you wish to work and be paid
for rather than take a rest break, you can do so provided that there is work available and you have returned
the signed agreement enclosed.
If you have any queries or need further explanation, please do not
hesitate to contact the Human Resources Department or speak to your line manager.

DECLARATION OF CONSENT

I certify that the information I have provided in this application is correct to the
best of my knowledge and belief and agree to co-operate by providing any additional information required. I
fully understand that it is a criminal offence to make false statements on this application form under
Section 16 of the Theft Act 1968.

I also understand that any false statement may be sufficient cause for rejection of my
application or, if employed, dismissal.

I further certify that I have completed the application form myself and understand that
my employment is subject to satisfactory vetting in compliance with BS7858:2019 or as may
be amended.

I authorise St Georges Home Care and any third party nominated by the company to
perform a vetting service and to hold the information contained in the Application for Employment. Such
information will be subject to the Data Protection Act.

I understand and agree that any offer of employment is conditional to the verification
to GO Care's satisfaction, of the information provided on the Application Form.

I confirm that the information I have provided on the Application Form is true and
complete to the best of my knowledge.

I understand that the check will involve verification of the details as specified
below:
CHECKS TO BE CARRIED OUT
Passport/ID & relevant visa- right to work in
the UK
Residency check
County Court Judgement / Bankruptcy
checks (Credit Reference)

5 years employment checks.

I understand that all documents supplied will be checked for authenticity and
that all forgeries will be reported to the relevant authorities.

I also understand that it may be a criminal offence to obtain employment by
deception and that any misrepresentation, omission, of a material fact or deception will cause for
immediate cancellation of consideration for employment, or dismissal if already employed.
I
hereby authorise GO Care, to verify information presented on my Application Form, which may include
explicit or sensitive personal data for the purpose of the Data Protection Act 1998 and the
obtaining of documents and / or information covered by the European Directive 95/46

I authorised GO Care to perform credit reference and reference checks of my
employment, including current employment and to contact the Department of Works and Pensions to
confirm periods of unemployment ( if any).

I understand that if an unsatisfactory reference is received from my current
employer after i have accepted a role with St Georges Home Care, that St Georges Home Care may
terminate my employment with immediate effect.

I confirm that my consent is explicit, fully informed and freely given for the
purpose of the Act*