Application Form

Please take your time to complete this application form. Following completion, please return the application form to Willow Home Care Ltd. Post review of your application, if you are a suitable candidate for the job role, we will contact you and invite you for an interview.

Willow Home Care Ltd aims to lead the way in Community Care, by providing a professional,safe, quality service, offering choice, reliability and sensitivity to meet the needs of each service user.

Willow Home Care Ltd strive to meet the key values, that underpin the quality of our care and support services we provide:privacy, dignity, independance, choice, rights and fulfilment.

Full Name *

Position Applied For: *

A JOB FIT FOR YOUR LIFESTYLE............

Our care service operates 24 hours a day, seven days a week, 365 days a year. Offering candidates flexible working to suit their life style choices on either a permanent, full time or part time basis.

Miss/Mrs/Ms/Mr *

Forename (First Name) *

Middle Name(s):

Surname: *

D.O.B: *

National Insurance No. (NI) *

Home Address: *

Post Code: *

Home Number: *

Mobile Number: *

Email Address: *

The best time to contact me to arrange an interview is (Please choose from the following options) *

PREVIOUS EMPLOYMENT

We will contact your previous employer to request a reference. All job offers are subject to satisfactory references.

Employment History *

	4	5	6
Company Name:	4	5	6
Address:	4	5	6
Email:	4	5	6
Contact Number:	4	5	6
Position Held:	4	5	6
Start Date:	4	5	6
End Date:	4	5	6

Employment History Continued *

	1	2	3
Company Name:	1	2	3
Address:	1	2	3
Email:	1	2	3
Contact Number:	1	2	3
Position Held:	1	2	3
Start Date:	1	2	3
End Date:	1	2	3

Save & Return

Use an account to return to saved work.

AVAILABILITY TO WORK

As you are aware, our service operates 7 days per week, we require all our staff to work alternative weekends. As a guideline, please let us know your availability. *

	7am - 3pm	3pm - 10pm	Nights
Monday	7am - 3pm	3pm - 10pm	Nights
Tuesday	7am - 3pm	3pm - 10pm	Nights
Wednesday	7am - 3pm	3pm - 10pm	Nights
Thursday	7am - 3pm	3pm - 10pm	Nights
Friday	7am - 3pm	3pm - 10pm	Nights
Saturday	7am - 3pm	3pm - 10pm	Nights
Sunday	7am - 3pm	3pm - 10pm	Nights

As per the Terms and Conditions, detailed in your contract, you will be required to work alternate weekends.. Could you please confirm, your acceptance of this requirement. *

Yes

No

Would you be willing to work hours, over and above your availability? as and when business requires. *

Yes

No

Are you applying for a full or part time position? *

Full Time

Part Time

Professional Referee Details

Please provide 2 professional references below *

	Name	Number	email	Relation to you
1	Name	Number	email	Relation to you
2	Name	Number	email	Relation to you

Character Referee Details

If you are unable to provide 2 professional references (above) please provide 3 character references (please note these cannot be family members). *

	Name	Number	email	Relation to you
1	Name	Number	email	Relation to you
2	Name	Number	email	Relation to you
3	Name	Number	email	Relation to you

HOW DID YOU HEAR ABOUT WILLOW?

Source: *

If an employee, please name the employee:

If other, please state where:

CRIMINAL CONVICTIONS

Have you ever been convicted of any criminal offence, either spent or unspent convictions, under the Rehabilitation Offender Act 1974? *

Yes

No

If Yes, please give details:

DRIVING LICENCE

I have a full UK driving licence (or EU equivalent) *

Yes

No

I have never been convicted of drink or drug related driving offences *

Yes

No

I have access to my own vehicle *

Yes

No

I am willing to obtain business insurance if successful for this position *

Yes

No