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Please complete the online application form below.
Online Application Form
Contact Form
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(denotes required field)
Name:
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E-Mail Address:
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Address
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Position Applying For?
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Tel: Home & Mobile
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National Insurance Number
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Do you hold a current driving licence?
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Education
Please tell us about any Schools / Collages you went to and grades obtained?
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Any professional qualifications and dates obtained?
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Training
Details of training courses including dates and awards achieved; (copies will be required)
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Employment History
Please include employers name & address, responsibilties and reason for leaving
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(We require your last five years history)
General Information
Are there any times of the week you are not available?
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What date are you available to start work?
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Do you require assistance due to disability?
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Do you have access to transport at all times?
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Previous Experience Relevant to Possition Applied For
Please add details of why you have applied to work for starcare Ltd?
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References
References will only be requested following acceptance of position with Starcare Ltd (Please supply two)
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Medical Questionnaire (Pre-employment)
Please answer yes or no to the following questions. (If yes, please give details)
Are you receiving any treatments or ongoing medication?
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Do you have any allergies?
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Have you lost time at work/college/school due to illness in the last 2 years?
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Have you ever suffered an injury at work requiring time off from work?
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Were you ever discharged from previous employment on medical grounds?
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Have you suffered from or received treatment for MRSA?
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Do you suffer from any of the following? Please answer Yes or No
Arthritis / Rheumatism
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Mental Health Problmes
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Alcohol or Drug related problems
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Anaemia or blood disorder
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Asthma
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Epilepsy, head injuries, vertigo
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Eye / Ear conditions
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Diabetes
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Skin conditions eg: dermatitus, eczema
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Bronchitus, persistent cough or wheeze
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Difficulties with walking / bending
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Back injury / problems
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Neck injury / problems
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Heart / Liver or Kidney problems
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Any other health related problems
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If you answered yes to any of the above please give further information
Rehabilitation of Offenders (Exceptions) Act 1979
Have you ever been convicted of a criminal offence?
In accordance with the Rehabilitation of Offenders (Exceptions) Act 1979 all convictions must be disclosed (not including traffic offences). Applicants are assured that the information regarding spent convictions will not necessarily disqualify them from consideration.
All successful applicants must undergo and pay for a CRB disclosure, on sending this form you are agreeing to a CRB being carried out and paid for, on offer of employment.
Declaration
On sending this form you are giving your personal permission for your personal data to be stored and processed for the purpose of arriving at a selection decision and, for the successful candidate, future personnel administration. You give the employer the right to investigate all references (following acceptance of any position offered) and to secure all additional information about you, if position related. You hereby release from your liability the employer and its representatives for seeking such information and all other persons, corporations and organisations for furnishing such information. On sending this form you declare that all information is accurate at the time of sending the form and understand that if you have entered any false or misleading information this may lead to termination of any employent offered.
Do you agree to all of the above? Yes or No
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