Where did you first find this vacancy ? *

Company Website

Jobcentre

Guardian

Charity Jobs

Reed

Indeed

Other

Preferred client group *

Learning Disabilities & Autism

Mental Health

Older People

Administration

Other

No Preference

Preferred hours *

Full Time

Part Time

Have you a current in-date DBS certificate? *

Yes

No

Is it registered for the DBS update service?

(This is a £13 per year subscription with the update service.)

Yes

No

Have you previously applied for a post with Harpa Care? *

Yes

No

Are you over 18 years old? *

Yes

No

Applicant Name *

First Name

Last Name

Do you have an NI Number? *

Yes

No

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Mobile *

(###)

###

####

Home Phone

(###)

###

####

Work Phone

(###)

###

####

Car driver *

Yes

No

Car owner *

Yes

No

Do you have any endorsements on your licence? *

Yes

No

Are you a UK or EU/EEA national? *

(If so you will need to provide proof of this at your interview)

Yes

No

If you are not a UK or EU/EEA national can you provide proof of permission to work in the UK?

If you cannot provide proof of permission to work in the UK we cannot accept your application as you are unable to work legally in the UK. If you can provide proof of permission to work please state the nature of your permission to work in the UK, any restrictions on the hours you are permitted to work and the expiry date of the permission.

Yes

No

Expiry Date

MM

DD

YYYY

Please confirm your current employment status *

Paid employment

Not in paid employment

Education/Training

Present or most recent employment (paid or unpaid)

This includes any roles prior to moving to the UK (if applicable). Please provide 10 years employment history if applicable

Not applicable

Employer 1 Name *

First Name

Last Name

Employer Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Employer Phone Number *

(###)

###

####

Date from *

MM

DD

YYYY

Date to *

MM

DD

YYYY

Employment Status *

Employed

Self Employed

Employer 2 Name

First Name

Last Name

Employer Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Employer Phone Number

(###)

###

####

Date from

MM

DD

YYYY

Date to

MM

DD

YYYY

Employment Status

Employed

Self Employed

Have you ever had any gaps in Employment?

Yes

No

Date from *

MM

DD

YYYY

Date to *

MM

DD

YYYY

Date

Please enter the date this was awarded.

MM

DD

YYYY

Date from

MM

DD

YYYY

Date to

MM

DD

YYYY

Referee Name *

First Name

Last Name

Address (business addresses only) *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Telephone *

Country

(###)

###

####

I consent that my referee may provide full relevant employment details to Harpa Care: *

Please Check

Referee Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Telephone *

Country

(###)

###

####

I consent that my referee may provide full relevant employment details to Cergus Group: *

Please Check

Do you consider yourself to have a disability? *

Yes

No

Prefer not to say

Have you ever been convicted of any criminal offence? *

Please note that all positions are subject to an enhanced DBS check. You will be asked to declare all Criminal convictions in further details if an offer of employment is made.

Yes

No

GDPR *

Please Check

DECLARATION *

I declare that, to the best of my knowledge and belief, all statements contained in this form are correct and I understand that should I conceal any material fact, I will, if engaged, be liable to the termination of my contract of service with such notice as may be appropriate.

Please Check

Submission Date *

MM

DD

YYYY