Care Worker Application Form
Do you hold a clean driving licence?
Are you eligible to work in the UK?
Driving in the UK
Full UK/EU Licence held Since
Foreign Licence held Country
Are you happy to drive in the UK?
Work status in the UK
Registered as Self Employed
Unique Tax - payer Ref (UTR)
Self Employed Care Worker Insurance
Date From Date until Employer, Position Reason for leaving
Qualifications and Training
Courses/Certificates held (eg. Moving and Handling, First Aid, etc.)
Do you suffer from any allergies?
Have you had any serious injury or illness in the last five years?
Do you have any special dietary requirements?
Would you look after a couple?
Would you object to being in a smoking household?
Do you mind household pets?
Location Preference (Rural, City, No preference)
List your hobbies
Are you happy to undertake housework?
How long are you planning to be a carer?
Experience caring for clients with
Brain Injury MS
Cerebral Palsy Pressure Areas
Dementia Spinal Injury
Experience with specialist equipment
Ceiling Track Hoist Stoma Care
Manual Hoist Catheter/Conveen
PEG Feeding Oxygen
Why do you want to be a carer?