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Personal Details

Please Note: this information is kept private and confidential.

If you have resided at this address for less than 5 years, please provide details of your previous address below.

Are You Permitted to Work in the UK?



Do you have a full driving licence that allows you to drive in the UK?

Do you have access to a car that you can use for work?

Have you ever been banned from driving, or do you have any current points?

Does your car insurance include Class 1 Business Insurance?

Other Information

Do you have a passport?

Do you have a bank account?

Do you have a current/transferable DBS?

Emergency Contact


Please give information about qualifications gained relating to the role you are applying for. Include you grade and where you recieved the qualification from.

If you have undertaken any relevant training to this post please give details of them below including the dates and training providers.

Previous Employment

Current/Most Recent Job

Previous Job

Previous Job

Skills & Abilities

This is an important part of the application. Tell us why you are applying for this job. Your should also show how you meet the requirements of the person specification by providing details of your experience, skills and knowledge gained in employment, voluntary work or elsewhere.


Reference 1

Can we contact this person prior to interview?

Reference 2

Can we contact this person prior to interview?

Data Protection

The Data Protection Act 1998 requires that any staff handling personal data on others must follow certain principles in relation to the data that they hold. Individuals have rights of access to data that is held on them and rights to claim for damages if various offences occur. This covers manual as well as computerised records.

In implementing the legislation, Delta Care Ltd adopts a simple and straightforward policy that is, so far as is possible, easy to understand and unambiguous in its application.

If you are unsuccessful in this application, we will keep this form on file for 6 months should you wish to be considered for other vacancies within the organisation.

Rehabilitation of Offenders Act 1974 - Notice to Offenders

The position for which you are applying for is exempt from Section 4(2) of the Rehabilitation of Offenders Act 1974 by Virtue of the Rehabilitation Offenders Act (Exemption Order 1975). This means that you are not entitled to withold information relating to any convictions you may have had.

Delta Care Ltd is required under the Health and Social Care Act 2008, to obtain a criminal record check. This will be processed through the Disclosure and Barring Service (DBS). This was formed by merging together the functions of the Criminal Records Bureau (CRB) and the Independent Safeguarding Authority. This has to be completed in relation to any person who is a domiciliary care worker. Therefore, if you application is successful we will need to obtain this Disclosure before your appointment is confirmed.

Please advise us of any criminal convictions (excluding minor road traffic offences), cautions, reprimands or warnings you have recieved before we obtain an Enhanced Criminal Record Bureau Disclosure. Having a criminal record will not necessarily mean that you will not be able to work in the care sector but will depend on the nature of the position, the circumstances and background of your consequences.

Do you have any convictions to disclose?

Have you been convicted of a criminal offence or recieved a caution, warning or reprimand?

This information will be treated as strictly confidential and will not necessarily preclude you from employment.

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care home preston
care home preston
care home preston
care home preston
care home preston