Pacific Care Limited
Application for Employment
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Personal Details *
Surname
*
Other names
Email *
Phone number *
Home address in full *
SSSC Registration/PIN Number *
SSSC Registration/PIN Number Expiry Date *
MM
/
DD
/
YYYY
National Insurance Number *
Do you hold a full current driving license? *
Do you have any endorsements? *
Are there any dates when you will not be available for interview (e.g. holidays)? *
What is your period of notice? *
Post applying for *
Location *
Hours *
Required
References
Please give us the names and addresses of two referees who can provide information relating to your competency in a caring role, one of which must be your current or last employer. If you are a student, please give an academic reference. The company reserves the right to approach any past employer for a reference. 
Reference #1

Name
 *
Position held and relationship *
Organisation *
Address *
Telephone number *
May we contact prior to interview?  *
Reference #2

Name
 *
Position held and relationship *
Organisation *
Address *
Telephone number *
May we contact prior to interview?  *
Other Personal Details
Do you need a permit to work in the UK? *
Education and Training
Please provide details below of:
- School, college, university attended
- Attended from and to
- Examinations passed and when taken
Please provide details below of:

- Other training courses attended (work related and outside of work)
- Dates of courses
- Examinations passed and when taken
Please provide details below of:

- Additional qualifications, membership of professional bodies, etc.
Employment History
Current or last employer *
Job Title *
Address of employer *
Date of Appointment *
MM
/
DD
/
YYYY
Present Salary and Benefits *
Please provide a brief description of your main duties and responsibilities *
Previous employment (most recent first) #1

Please include: 
- Name and address of employer
- Dates worked
- Job title
- Reason for leaving
Previous employment (most recent first) #2

Please include: 
- Name and address of employer
- Dates worked
- Job title
- Reason for leaving
Previous employment (most recent first) #3

Please include: 
- Name and address of employer
- Dates worked
- Job title
- Reason for leaving
Other Relevant information 
Other relevant information and experience, including current duties. 
Please use this space to state your reason for applying for the post, relating your skills, experience and personal qualities gained through work or unpaid work to the requirements of the job. (If you need additional space, please continue in the box below.)
-
Rehabilitation of Offenders Act 1974
Under the provisions of the Rehabilitation of Offenders Act 1974 (Exclusions and Exceptions) (Scotland) Order 2003 (as amended), applicants are required to disclose information concerning convictions including those which for other purposes are regarded as spent under the Act. If you take up an appointment with the company and you have failed to disclose such information this could result in dismissal or disciplinary action. 
Have you been convicted in any court of any offence? *
I certify that, to the best of my knowledge, the information given on this form is correct.

Sign and date below
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