Section 1: Personal Details
Do you hold a current UK driving license?
Do you own a car?
Section 2: Education and Training

Please list your educational qualifications and training in chronological order with the most recent first. Feel free to continue on a separate sheet if necessary but Please ensure you attach any additional sheets securely.

Section 3: Employment History

Please list below a complete record of other employments and include, if you wish, any voluntary activities either paid or unpaid. These should be in date order, starting with the most recent. Please explain any gaps in employment.

(Continue on separate sheet if required)

Do you have any commitments that prevent you from working certain hours/days? if so, please state below:

Are you currently working?
Section 4: Why would you like to work at GeoCare?

Please write a brief paragraph about why you want to work for GeoCare Services, why you want to work within the care industry and the qualities that you have that would make you the ideal candidate. 

(Continue on a separate sheet if necessary)

Section 5: Further Information
Criminal convictions

As defined by the Rehabilitation of Offenders Act 1974 and subsequent regulations, under section 4.2 you do not need to declare convictions which are 'spent'.

However, by virtue of the Rehabilitation of Offenders (Exceptions/Amendments) Order 1986 those provisions do not apply if you are applying for a job supervising, caring for or otherwise connected with people from the following list, you must always declare any convictions and/or cautions for criminal offences, even where they are'spent'.  For these purposes, this includes working with children, young and older people, those who are dependent on alcohol or drugs, and those with mental or physical disabilities, illness,injury or deformity, including people who are blind, deaf or without speech.

* Please note if you have any cautions orconvictions that you do not declare on this form then we will not be able tooffer you a position. Please list all cautions and convictions



Referee 1
Referee 2

The information that I have provided is to the best of my knowledge. I understand that giving false information or omitting relevant information could disqualify my application and, if I am appointed,could lead to my dismissal.

GeoCare Care Equal Opportunity Policy

We regularly review and improve our recruitment process; therefore we ask that you complete the following form to assist us with such improvements.

Information you provide in this form will not be used in selecting or not selecting you for an employment position, and is used to monitor our equal opportunities policy. This information is confidential and you will not be identified by any information you provide in this form. Completed forms will be detached from your application upon receipt and will not be held in employment files. This form is not part of your application.

Job Title Applied for:

Ethnic Origin (The following categories are recommended by the Commission for Racial Equality.  If you feel the choices do not provide a suitable option, please write down how you would describe your ethnic origin)

A White
D Black or Black British
B Mixed
E Chinese or other ethnic group
C Asian or Asian British
Next of Kin and Doctors
Emergency Contact Details

Can you please fill in this section so we have apoint of contact for you as an emergency contact number.

Doctor Details (if any)

If these details change, can you please ensure the office is made aware. These contacts will only be used in an emergency.

Holidays Booked
Do you have any holidays booked within the next year?
GeoCare Services requires certain information prior to candidates commencing employment, to ensure performance requirements for the position are met and a reliable service is provided. This information is to ensure compliance with relevant Health and Safety regulations. The information is also required in order to establish whether any reasonable adjustments may need to be made to assist you in performing your duties, in accordance with the Disability Discrimination Act 1995. All information provided is kept confidential and used only for the purposes detailed above in compliance with the Data Protection Act 1998.