Start Date

Finish Date

Name of Company

Address

Contact Name

Job Tittle/ Position / Department

Contact Phone- (Include Country Code )

Email

Notice Period Required

Permission To Contact Your Reference
YesNo

Name Of Referee*

Address*

State Relationship With Referee*

Contact Phone (Include Country Code)*

Contact Email*

Start Date Since You Have Known Them*

Number Of Years You Have Known Them (Yrs)*

Permission To Contact Your Reference*
YesNo

Start Date

Finish Date

Name of Educational Institution

Address

Course / Faculty Contact Name

Department

Course / Faculty Contact Phone (Include Country Code )

Course / Faculty Contact Email

Permission To Contact Your Reference
YesNo

Please Select Your Type Of Reference
YesUnemployment Reference

Were You On Any Government Support?
YesNo

Start Date Unemployment

Finish Date Unemployment

Are You Available To Work Immediately? *
YesNo

Do You Have A Smart Phone ( You Will Use This To Access Your Work App ) *
YesNo

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

Do You Have A Valid DBS or Are You Prepared To Register For One? *
YesNo

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) *
YesNo

REHABILITATION OF OFFENDERS ACT 1974

The 48 - hour week Working Time Directive has been in force since 1st October 1998.
Under these regulations, St Georges Home 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 hrs 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.

Please Tick One Of The Following Statement And Sign *
YesNo

Signature *

Name *

Date *

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 in my own handwriting 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 St Georges Home 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 / Brankruptcy 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 St Georges Home 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 St Georges Home 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

Signature *

Full Name *

Date *