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									                             Application for Employment

Future Home                                                   Reference Number:

Care
                              ____________________________________________________________________
                              Post Applied for: Enter Job Title Here
We strongly recommend
                              Location: Enter Location Here
that you read all the
enclosed documents and
                              Full Time   Part Time     Nights Only    Bank
form before commencing
your application.
                              ____________________________________________________________________
                              Personal Details   Marital Status Single   Married
Please complete all
                              ____________________________________________________________________
sections fully as this
                              Surname Enter Here First Name Enter Here
information will be used
for short listing.
                              Mr.     Miss      Ms       Mrs
                              ____________________________________________________________________
Complete applications must
                              Address
be returned by 5:00PM
                              Line 1
on the closing date.
                              Line 2
Faxed copies and CV’s
                              Line 3
will not be accepted.
                              Postcode
                              ____________________________________________________________________
                              Telephone Details                     Home Enter Here
                              ____________________________________________________________________
                              Mobile Enter Here                     Work Enter Here
                              ____________________________________________________________________
                              Email Enter Here
                              ____________________________________________________________________
                              Date of Birth Enter Here
                              ____________________________________________________________________
                              National Insurance Number Enter Here
                              ____________________________________________________________________
                              May we contact you at work?           Yes           No
                              ____________________________________________________________________
                              If successful in your application how
                              soon would you be able to start?
                              Weeks/Months Notice Needed at Current Place of Work
                              ____________________________________________________________________




                                                                                              Page 1
Education
Please complete in date order. It is not necessary to list every qualification that you have gained, e.g. 6 GCSE’s/2A’s is
sufficient. Highlight any that are particularly relevant to the post. If appointed, you will be required to produce evidence of
relevant qualifications.

You may also wish to state any qualifications currently being studied for.

  Name and address of                                           Date                      Qualifications/Grades
  School College/University
                                              From                  To
  Name of School/College/University           Date From             Date To               Qualification/Grade
  Name of School/College/University           Date From             Date To               Qualification/Grade
  Name of School/College/University           Date From             Date To               Qualification/Grade
  Name of School/College/University           Date From             Date To               Qualification/Grade
  Name of School/College/University           Date From             Date To               Qualification/Grade
  Name of School/College/University           Date From             Date To               Qualification/Grade
  Name of School/College/University           Date From             Date To               Qualification/Grade



Other training undertaken.

List other relevant external / internal training course. Please include dates and length of course.

 Subject                                                       Date                       Length of course

                                             From                  To
 Subject                                     Date From             Date To                Length of Course
 Subject                                     Date From             Date To                Length of Course
 Subject                                     Date From             Date To                Length of Course
 Subject                                     Date From             Date To                Length of Course




                                 ____________________________________________________________________
Employment                       (1) Employer’s Name: Enter Here
                                 ____________________________________________________________________
                                 Address         Line 1
Please provide a full                            Line 2
employment history, starting                     Line 3
with complete details of                         Postcode
your two most recent jobs.       ___________________________________________________________________
Please also provide              Job Title Enter Here
reasons for any breaks           ____________________________________________________________________
in employment.                   From dd/mm/yy          To dd/mm/yy       Hours worked per week Enter Here
                                 ____________________________________________________________________
                                 Grade Enter Here       Salary Enter Here
                                 ____________________________________________________________________
                                 Main Duties Enter Here

                                 ____________________________________________________________________
                                 Reason for leaving Enter Here
                                 ____________________________________________________________________



                                                                                                                     Page 2
____________________________________________________________________
(2) Employer’s Name: Enter Here
____________________________________________________________________
Address         Line 1
                Line 2
                Line 3
                Postcode
___________________________________________________________________
Job Title Enter Here
____________________________________________________________________
From dd/mm/yy          To dd/mm/yy       Hours worked per week Enter Here
____________________________________________________________________
Grade Enter Here       Salary Enter Here
____________________________________________________________________
Main Duties Enter Here

____________________________________________________________________
Reason for leaving Enter Here
____________________________________________________________________

____________________________________________________________________
(3) Employer’s Name: Enter Here
____________________________________________________________________
Address         Line 1
                Line 2
                Line 3
                Postcode
___________________________________________________________________
Job Title Enter Here
____________________________________________________________________
From dd/mm/yy          To dd/mm/yy       Hours worked per week Enter Here
____________________________________________________________________
Grade Enter Here       Salary Enter Here
____________________________________________________________________
Main Duties Enter Here

____________________________________________________________________
Reason for leaving Enter Here
____________________________________________________________________

____________________________________________________________________
(4) Employer’s Name: Enter Here
____________________________________________________________________
Address         Line 1
                Line 2
                Line 3
                Postcode
___________________________________________________________________
Job Title Enter Here
____________________________________________________________________
From dd/mm/yy          To dd/mm/yy       Hours worked per week Enter Here
____________________________________________________________________
Grade Enter Here       Salary Enter Here
____________________________________________________________________
Main Duties Enter Here

____________________________________________________________________
Reason for leaving Enter Here
____________________________________________________________________




                                                                    Page 3
                                  Unpaid work/experience.
If you are not in paid work, please tell us what you are currently doing. Please also list unpaid work related to this post
e.g. voluntary work, community activities etc.


 Organisation                               Type of work                                   Dates                 Hours
                                            eg Voluntary                                                         Per Week
                                                                             From               To
 Organisation                               Type of Work                     dd/mm/yy           dd/mm/yy         Hours
 Organisation                               Type of Work                     dd/mm/yy           dd/mm/yy         Hours
 Organisation                               Type of Work                     dd/mm/yy           dd/mm/yy         Hours
 Organisation                               Type of Work                     dd/mm/yy           dd/mm/yy         Hours
 Organisation                               Type of Work                     dd/mm/yy           dd/mm/yy         Hours




Supporting Statement
This is where you give us specific information in support of your application. You will need to complete both the job
description and person specification.

You should demonstrate your ability or experience by giving examples, or voluntary or leisure experience. We may also
list desirable criteria. Again where you meet these criteria, you should explain how in your supporting statement.

The information you provide on your supporting statement does not have to be all about your previous employment, and
why you think you should get this post. We would like it if you told us more about you. What are your interests, what type
of things you enjoy doing, your characteristics and any previous life experiences you may have had etc.

The supporting statement is a very important part of our application. Please write your statement below:

The personal Statement is limited to the dimensions of this box.




                                                                                                                     Page 4
Other Information
Disclosure of Offences.           ____________________________________________________________________
Due to the nature of our          Do you have any criminal convictions or cautions? Yes     No
work this post is exempt          ____________________________________________________________________
from the Rehabilitation of        Is there any other information you                Yes     No
Offenders Act 1974.               wish to disclose?
ALL convictions AND
cautions should be                If the answer is yes, we may wish to discuss it should you be short listed for interview.
disclosed.                        Please give details and dates separately. You may enclose details in another email and
PLEASE NOTE that a                send to us along with this application form, or via post.
criminal record may not           ____________________________________________________________________
exclude you from this post,
but all details must be           ____________________________________________________________________
provided to us.                   Do you have a current / valid driving license?         Yes            No
                                  ____________________________________________________________________
                                  Are you able to produce documented                     Yes            No
Right to work.                    evidence of your right to work in the UK?
In accordance with the            ____________________________________________________________________
Immigration and Asylum Act        References
1996 we will require all new      ____________________________________________________________________
employees to produce              (1) Name Enter Here
evidence of their right to        ____________________________________________________________________
work in the UK.                   Company Address        Line 1
You will need to produce                                 Line 2
evidence of a NI number.                                 Line 3
Production of a P45 will be       ____________________________________________________________________
adequate. Where this may          Telephone Enter Here           E-mail Enter Here
be a problem you will be          ____________________________________________________________________
asked to produce other            Position In Company Enter Here          Relationship To Applicant Enter Here
evidence such as a NI Card
or a P60 covering the
previous financial year.          (2) Name Enter Here
You may also be asked to          ____________________________________________________________________
provide other relevant            Company Address      Line 1
documentation/evidence.                                Line 2
                                                       Line 3
                                  ____________________________________________________________________
References.                       Telephone Enter Here         E-mail Enter Here
Employment at Future              ____________________________________________________________________
Home Care is subject to two       Position In Company Enter Here      Relationship To Applicant Enter Here
written references and you
will not be able to start until
these have been                   Do you wish us to wait until after your
satisfactorily taken up. One      interview to contact your referees                                        Yes               No
must be your current or
most recent employer. If          ____________________________________________________________________
you have not recently been        I certify that the details given are, to the best of my knowledge, complete and
employed, please provide          correct, and I understand that any false information may affect my application
the name of a professional        or employment with Future Home Care
person who can comment
on your suitability.              Check this box to confirm                                      Date
Referees must not be
relatives or friends.             ___________________________________________________________________

                                  Please return to: jobs@futurehomecare.co.uk




                                                                                                                                   Page 5
Equal Opportunities
Monitoring Form
                                                                          Reference Number:
Future Home Care is              ____________________________________________________________________
striving to be an Equal          I define my gender as: Female   Male
Opportunities employer.          ____________________________________________________________________
The information contained        ____________________________________________________________________
within this form is kept         I am:                  Black    White        Mixed        Other
confidential and used only                                                    Race
for Human Resources
monitoring purposes. It is       ____________________________________________________________________
detached from the                If other please specify: Enter Here
application form before          ____________________________________________________________________
shortlisting and destroyed       ____________________________________________________________________
once monitoring is               I define my ethnic origin as: Arab     African      British
completed.
                                                                  Caribbean     Irish           Other
                                                                                                European
If you feel that the                                           S E Asian/ Other
categories do not apply,                                       Chinese    Asian       Other
please use the additional        ____________________________________________________________________
space provided to tell us        Please identify your age range: Under 25       25-41       Over 41
how you classify yourself.
If you do not wish to answer     ____________________________________________________________________
a particular question you
may leave it blank. We           Post applied for: Enter Here
appreciate that some
people may not wish to           ____________________________________________________________________
declare their gender or their
sexual orientation for fear of   Where did you see this post advertised? Enter Here
discrimination. We are also
aware that we may be             Thank you for completing this form.
indirectly discriminating
against certain groups of
people. It is for this reason
                                 Data Protection Act 1998
that recruitment monitoring
                                 I consent to Future Home Care holding and processing data contained in this
forms part of the
                                 Monitoring form for the purposes stated above.
organisation’s Equal
Opportunities Policy and is
                                 Check this box to confirm                      Date dd/mm/yy
an important tool in helping
us improve and actively
                                 ____________________________________________________________________
work against such
discrimination.
                                 (See overleaf for Statement of Intent)
We would like you to
participate in the process,
but should you choose not
to, your application will not
be affected.

Thankyou for your help.
                       Equal Opportunities Policy
                          Statement of Intent


Future Home Care recognizes that many different groups of people in society continue to
face both direct and indirect discrimination on the grounds of their race, colour, ethnic or
national origins, their religion, their age, gender, sexuality, antibody status, their domestic or
financial circumstances, disability, unrelated criminal convictions, class appearance, etc.

We believe that it is wrong to prevent equality of opportunity and recognise that passive
policies will not in themselves prevent discrimination.

The purpose of this document is to state our commitment to develop and promote equality of
opportunity through our policies and practices.

We will ensure that positive action programmes are implemented to identify, end and redress
any existing discrimination in its provision of services. Future Home Care will also ensure that
equality of opportunity in employment and recruitment becomes a reality in practice and will
implement a programme of action to this end.

We recognise monitoring and evaluation as essential tools in ensuring that equality of
opportunity is developed and maintained throughout the organisation and will regularly
conduct monitoring and evaluation of all areas of this policy.

Future Home Care expects all paid employees, volunteers and management committee
members to adhere to, promote and further develop our Equal Opportunities Policy. We will
use all our powers to ensure this policy is implemented.




                                                                                      Future Home Care Limited
                                                                             Registered in England No: 4829670

								
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