Application Form

Position Details

Personal Details

Please provide us with your next of kin


Please give most recent first (NB. Successful applicants will be required to provide evidence of qualification)
Date | Full or Part-time | School/College/University | Examination Taken | Date | Results & Grades


Please give details of all training and other courses, which you have undertaken, particularly those related to care
Date | Course Title/Subject | Organising Body | Length of Course

Last Employment

Please provide details of your present, or if you are not currently employed, your most recent employment

Previous Employment

Please provide details of all work you have undertaken excluding your current employer. (A full work history is required). Start with the most recent first.
From | To | Employer (Name and address) | Job Title | Reason for leaving


We will obtain a reference from your most recent employer as stated on page 2. The law requires us to seek a reference from your most recent employer so, if your most recent job was not in care please ensure you enter the details of your most recent care employer in one of the reference boxes below. If you have not undertaken care work previously, this will not prevent you from being employed. In case we cannot obtain a second reference, please enter a third referee below. None of the people you nominate should be partners or family members.

Rehabilitation of Offender Act 1974 (Exemption Order)

Because of the nature of the work you are applying for, it is exempt from the provisions of the Rehabilitation of Offender Act 1974. You MUST let us know about any criminal convictions, cautions, reprimands, warnings, or final warnings you may have including those, which may be, for other purposes, considered spent.
Are you currently:
*if you have answered ‘Yes’ to any of these questions, please provide details of the offence and sentence below. Answering ‘Yes’ to these questions will not automatically disqualify you from employment. However, you should be aware that it is an offence to provide false or inaccurate information in order to gain employment. In the event that you start work and we later discover that you have not properly declared any convictions, reprimands, or warnings, this will be treated as gross misconduct and may result in your employment being terminated.

Data Protection Act
The information or data which you have supplied on this form will be processed and held on the computer and will also be kept in your personal records if you are appointed. The data may be processed by Sevacare UK for the purposes of equality monitoring, compiling statistics and for other employment records. In signing and returning this application you are deemed to have given your explicit consent to processing data contained in or referred to in it, including any data which may be considered to be sensitive personal information.