Employment Application

PERSONAL


MrMrsMissMs


NoYes*

*If Yes – Provide (upload) a copy of evidence for your Permit to Work in the UK


NoYes

EMPLOYMENT

*Provide (upload) Work related document

If currently Employed, provide details including: Company Name / Name of Present Employer, Address, Telephone Number, Nature of Business, Job title and brief description of duties.

List details of previous Employment - latest first. Excluding present employment. Include Name and Address of Employer, Position Held/ Main Duties and Dates.

QUALIFACATIONS


List any Formal Training and/or Job related Training Courses. Include Qualifications with dates and Name of Awarding Bodies.


NoYes*

REFEREES

Provide details of two persons to whom reference can be made. The first should be your present or last employer. Include Name, Position, Address and Telephone No.


NoYes


NoYes*

PERSONAL HEALTH BACKGROUND

Select if you are suffering or have suffered any of the following:
DiabetesHigh Blood PressureEpilepsyBack Pain or InjuryRecurrent HeadachesT.B.MigraineMental Illness, DepressionAny Heart ConditionSkin Conditions


NoYes*

Medical Declaration

I herby confirm that to the best of my knowledge I have not been aware of, or have never been advised of any reason by way of mental or physical incapacity that may deem I am not fit to carry out the duties for the position to which this application relates.

DECLARATION


NoYes*


NoYes


NoYes*


NoYes*

I declare that the information provided above is complete and accurate. I understand that any false information or deliberate omissions gives my employer the right to terminate any employment contract at any time. I understand these details will be held in confidence by the company, for the purposes of assessing this application, on-going personnel and payroll administration (where applicable) in compliance with the Data Protection Act 1998. I understand Lancashire Care Services Ltd reserves the right to require me to undergo a medical examination at any time during my employment by a party nominated by Lancashire Care Services Ltd.

PREFERENCE OF DUTIES

Day Shift’sNight Shift’sWeekdaysWeekendsAny Shift

NOTE: All required fields need to be completed and consents accepted in order to submit.