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Care Worker Application Form

Personal Details

Mobile Number

Do you hold a clean driving licence?

Are you eligible to work in the UK?

Languages Spoken

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

Previous Employment

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

Cancer Parkinson's

Cerebral Palsy Pressure Areas

Dementia Spinal Injury

Diabetes Stroke

Experience with specialist equipment

Ceiling Track Hoist Stoma Care

Manual Hoist Catheter/Conveen

PEG Feeding Oxygen

Why do you want to be a carer?

Live In Care Experience: 6+ Yrs. Yrs

General Care Experience: Live in care work

Gender: Female

Looking for work in the following Locations:
South West, Bristol, Devon, Dorset, Gloucestershire, Isles of Scilly, Somerset, Swindon

Other Information

English Language Level: Basic

Driving Licence: Full License - I have my own car

Care Qualifications: NVQ Health and Social Care

Care Skills: Dementia

Current DBS: Yes

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