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    Section 1 - Applicant’s Details

    e.g mr, mrs etc


    Section 2 - Next of Kin Details

    eg father, mother etc

    Section 3 - Full Employment Record (most recent first)

    If any of the above positions involved working with Vulnerable Adults or Children, please indicate below the contact details of someone who can verify your reason for leaving.

    Section 4 - Education and Training

    4b: Courses and Training
    Section 5 - Travelling for Work

    Section 6 – References
    Please provide contact details of TWO referees whom we may contact. One of these MUST be your present (or most recent) employer. If this is your first employment, ONE referee should be your secondary school/college of further education.
    Reference 1

    Reference 2

    Section 7 - Criminal Record
    We are required under the Health & Social Care Act 2008, to obtain an Enhanced & Barred Disclosure through the Disclosure and Barring Service for any person who is a domiciliary care worker. If your application is successful, we will need to obtain this check before we can confirm your appointment. We will only pass information from the disclosure to those authorised to receive it, in the course of their role. Please tell us about any criminal record you have in the section below, before we apply for the check. If you have a criminal record, we will not automatically disqualify you from a role with us. We carry out checks on staff periodically throughout their employment as part of our legal obligations and commitment to protecting the vulnerable adults and children we care for.

    Section 8 - Task Ability Schedule
    Please tick each task in which you are experienced:

    9a: Live-in Care

    9b: Other work pattern information

    Section 10: Right to Work in the UK
    I confirm that the information supplied by me on this form (and any other documents as part of this application) is correct and that any untrue or misleading information will give my employer the right to terminate any employment contract offered. I certify that I have answered all questions truthfully and fully and will notify Lydygold Consultancy if there are any changes or updates to the information given.

    Section 11: Applicant’s Declaration for Work

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