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services@telopeamsl.com

01234 248 969

Personal Care Assistant application

To apply for a Personal Assistant or live-in care vacancy, please complete the form below.

Job reference number (if applicable):

Title:

Date of Birth:

NI Number:

Forename:

Surname:

Address

Address 1:

Address 2:

Town:

Postcode:

Home Tel No.

Mobile Tel No.

Email Address:

Please list below all the current skills you have attained.

	Skill/Course	Level	Date Acquired	Awarding Organisation
1	1, Skill/Course:	1, Level:	1, Date Acquired:	1, Awarding Organisation:
2	2, Skill/Course:	2, Level:	2, Date Acquired:	2, Awarding Organisation:
3	3, Skill/Course:	3, Level:	3, Date Acquired:	3, Awarding Organisation:
4	4, Skill/Course:	4, Level:	4, Date Acquired:	4, Awarding Organisation:
5	5, Skill/Course:	5, Level:	5, Date Acquired:	5, Awarding Organisation:

Please select which duties/activities you are happy to carry out:

Personal Care:

Yes

Maybe

Domestic Care:

Yes

Maybe

Social Support:

Yes

Maybe

Economic Care:

Yes

Maybe

Any other duties:

Yes

Maybe

Please list any further interests/hobbies you have:

Validation checks

Can you please confirm if you have any of the following:

A CRB Certificate:

Yes

Please be advised that a CRB Certificate is valid for all posts. (If you do not currently have a CRB certificate, we can help you apply for one.)

A full drivers licence:

Yes

A working Visa:

Yes

Please note a Visa is only required if you are not an EU Resident.

Current employment details

If you are currently working for an Organisation, please enter the details below:

Organisation:

Address 1:

Address 2:

Town:

Postcode:

Line Manager:

Telephone No:

References

Reference 1

Name:

Organisation:

Telephone No:

Email Address:

Reference 2

Name:

Organisation:

Telephone No:

Email Address:

It is not compulsory to upload a CV, however if you would like to please click on the 'Browse' button below:

Upload CV:

Equal Opportunities Monitoring

This data is for informational purposes only and will not have an impact on any potential employment opportunities.

Ethnicity Group

White:

Mixed:

Asian or Asian British:

Black or Black British:

Chinese or other ethnic group:

Gender:

Religion:

Where did you hear about this vacancy:

Disclaimer

I agree that the information I have submitted to Telopea Managed Services Limited, and which appears on their Register of Personal Assistants may be used to match with the requirements of potential employers.

I understand that Telopea Managed Services Ltd will not use the information I have provided for any purpose other than facilitating my potential employment as a Social Care Personal Assistant, and will destroy all copies of the information at my request.

Please confirm:

I have read the above disclaimer and agree to the Terms and Conditions

Thank you for taking the time to complete the application. You will hear from us shortly