Job application formFirst Homecare LTD2022-04-28T06:41:00+00:00 First Name *Last Name *DATE OF BIRTH*GENDER*MaleFemaleEmail AddressPhoneADDRESS LINE 1*ADDRESS LINE 2CITY*POSTCODE*CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint HelenaSaint Kitts and NevisSaint LuciaSaint Pierre & MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemenZambiaZimbabweIF BRITISH PASSPORT NOT HELD, DO YOU HOLD ANY OF THE FOLLOWING?Select one...Indefinite leave to remain in the UKWork permit / sponsorship (Tier 2)Student visa (Tier 4)Working holiday visa / youth mobility (Tier 5)Ancestry visaSpousal / partnership visaBiometric residence permitOther (please specify)QUALIFICATION #1PLACE OBTAINEDDATE TO / FROMCERTIFICATE? (Y/N)QUALIFICATION #2PLACE OBTAINEDDATE TO / FROMCERTIFICATE? (Y/N)QUALIFICATION #2PLACE OBTAINEDDATE TO / FROMDATE TO / FROM CERTIFICATE? (Y/N)REFEREE NAMEORGANISATION*JOB TITLEWARD/DEPARTMENT (IF APPLICABLE)GRADE/BAND (IF APPLICABLE)DATES EMPLOYED (MONTHS/YEAR)*Email AddressPhoneCAPACITY IN WHICH KNOWN (E.G. MANAGER)*HTMLDeclaration I can confirm that I have read this document fully and that all the information provided is correct and to the best of my knowledge and belief. I give consent to contact referees regarding the information I have provided (after an offer of employment is made) unless specified otherwise. I will inform the company should anything change, that might affect my position and I understand the information given on this form will be processed by computer and used for registration purposes, under the Data Protection Act 2018. 1) I understand that if I am at any stage charged or cautioned with a criminal offence after signing this declaration, I must inform the company immediately.2) I am not aware of any condition, medical or otherwise, which would affect or limit my employment or performance, other than those declared in my pre-employment health questionnaire.3) I acknowledge and confirm that the company is authorised to apply for and obtain a Disclosure and Barring Service (DBS) check and references from any previous employers and educational establishments.4) I declare that the information given herein is true and complete and is not presented in a way intended to mislead. I agree that if I have given false or misleading information or omit to give relevant information now or in the future that the company may commence disciplinary action, resulting in, up to and including dismissal, in line with its disciplinary policy.5) I acknowledge that my personal details will be stored and handled correctly by the company in accordance with the Data Protection Act 2018, however, I agree that they may be made available for audit/review by relevant third parties. (This is relevant for all information including all documents - DBS, Occupational Health, References).6) I understand that if I am on a student visa, I can only work for 20 hours per week during term time. I understand that I have a responsibility to monitor this. In addition, if my position as a student changes I must inform the company.7) I understand that if I am on a Tier 2 Sponsorship Visa, I can only work for a maximum of 20 hours per week at the same professional level as my sponsorship. I understand that I have a responsibility to monitor this. In addition, if my position with my sponsored company changes, I must inform the company.8) I acknowledge that if any of my details stated on this Application Form change, or my circumstances change, which may affect my ability to work for the company, I must inform the company immediately.9) I confirm that I am not currently under investigation, or currently suspended, by my professional regulatory body or being investigated by my current or previous employer. I will inform the company if I am under investigation or suspended by my professional regulatory body or employer at any point while working for the company.I agree that I may work for more than an average of 48 hours a weekYesNoSIGNATURE (TYPED NAME IS SUITABLE)*PRINT NAME*DATE*Submit