Application for Employment – United Hands Care Ltd

1

Role Applied For

Position Applied For

Location

London Liverpool

Employment Type

Full-time Part-time

Availability

Day	Morning	Lunchtime	Teatime	Evening	Nights
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Earliest Start Date

Maximum Preferred Hours Per Week

2

Personal Details

Title

Full Name

Previous Names (if any)

Date of Birth (DD/MM/YYYY)

National Insurance Number

Email Address

Mobile Number

Alternative Phone

Current Address

Date Moved In (MM/YYYY)

Have you lived at this address for the last 3 years?

Yes No

3

Right to Work (UK)

All applicants must have the legal right to work in the United Kingdom. We are required to verify this before your start date. Please complete the section that applies to you.

A. British or Irish National

Yes — I confirm I am a British or Irish national and have an automatic right to work in the UK

You will be asked to provide your passport or birth certificate as proof before your start date.

B. All Other Nationals

If you are not a British or Irish national, you must provide evidence of your right to work in the UK.

Nationality

Home Office Right to Work Share Code

If you cannot provide a share code, explain why

You will be asked to provide original documents (passport, visa, BRP) before your start date. If your right to work is time-limited, we are required to carry out follow-up checks before it expires.

4

Education, Training & Skills

List your qualifications and training, starting with the most recent.

Secondary Education

School / Institution	Qualification(s)	Subject(s)	Grade(s)	Completed Date

Further / Higher Education

School / Institution	Qualification(s)	Subject(s)	Grade(s)	Completed Date

Other Trainings

Subject	Training Provider / Establishment	Date Obtained

5

Employment History (Last 10 Years)

List all roles for the last 10 years, starting with the most recent. You must explain any gaps of 3 months or more. Under Schedule 3 of the Health and Social Care Act 2008, we are required to obtain a full employment history with no unexplained gaps.

Employer 1 — Most Recent

Employer Name

Job Title / Position

Start Date

End Date

Key Responsibilities

Reason for Leaving

Was this role in health/social care or with vulnerable adults?

Yes No

Employer 2

Employer Name

Job Title / Position

Start Date

End Date

Key Responsibilities

Reason for Leaving

Was this role in health/social care or with vulnerable adults?

Yes No

Employer 3

Employer Name

Job Title / Position

Start Date

End Date

Key Responsibilities

Reason for Leaving

Was this role in health/social care or with vulnerable adults?

Yes No

Employer 4

Employer Name

Job Title / Position

Start Date

End Date

Key Responsibilities

Reason for Leaving

Was this role in health/social care or with vulnerable adults?

Yes No

Continue on a separate sheet if needed and attach.

6

Explanation of Any Gaps in Employment (3+ months)

If there are any gaps in your employment history, please explain them below. For example, caring for a child or family member, period of unemployment, time in education etc.

Gap 1 — Dates and Explanation

Gap 2 — Dates and Explanation

Gap 3 — Dates and Explanation

Continue on a separate sheet if more space is needed.

7

Supporting Statement

Please explain, paying careful attention to the Job Description and Person Specification, why you think you are suitable for this post. Where you do not have specific experience of a task, please explain why you think you could undertake this part of the job. You may include details of voluntary or unpaid work.

Job-related experience, skills and qualifications relevant to this role

8

References (Safer Recruitment)

Provide details for two referees. Where you have previously worked in health or social care, one reference should be from your most recent care role, not just your most recent employer. We will only contact referees after a conditional offer. References will be verified by contacting the organisation's main number.

Reference 1 — Most Recent Employer (or most recent care role if applicable)

Referee Full Name

Role / Position

Organisation

Phone Number

Professional Email Address

Relationship to You

Address

Reference 2

Referee Full Name

Role / Position

Organisation

Phone Number

Professional Email Address

Relationship to You

Address

Character Reference — If you have limited employment history, you may provide a character referee below

Character Referee Full Name

Relationship / Role

Phone Number

Email Address

9

DBS Disclosure & Suitability

United Hands Care Ltd provides services to vulnerable adults and has a legal duty to ensure safe recruitment. Your appointment is conditional upon a satisfactory Enhanced DBS disclosure, including a check of the Adults' Barred List. We will only request information we are legally entitled to obtain under the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975. We will not ask you to disclose protected (filtered) cautions or convictions.

Do you have a current DBS certificate (Update Service or issued within last 12 months)?

Yes No

DBS Level / Type

DBS Certificate Number

Date of Issue

Do you have any unfiltered convictions, cautions, reprimands or warnings?

Yes No

If Yes, provide details

Are you currently under investigation, charged, or awaiting trial?

Yes No

If Yes, provide details

Have you ever been barred or restricted from working with children or adults at risk?

Yes No

If Yes, provide details

Have you ever been subject to disciplinary action related to safeguarding concerns?

Yes No

If Yes, provide details

10

Health & Reasonable Adjustments

In accordance with the Equality Act 2010, we limit health-related questions at application stage to those necessary to assess reasonable adjustments and whether you can carry out the intrinsic functions of the role. A full health declaration will be completed post-offer.

Are you able to perform the essential duties of the role with or without reasonable adjustments?

Yes No

If adjustments are needed, describe the support that would help you

Do you require any adjustments for the interview or recruitment process?

11

Emergency Contact

Full Name

Relationship

Phone

Email Address

12

Equal Opportunities Monitoring (Optional)

United Hands Care Ltd has an Equal Opportunities Policy. This information is confidential, separated from your application before shortlisting, and does not form part of the selection process. It will be used solely for monitoring purposes.

Do you consider yourself to have a disability under the Equality Act 2010?

Yes No Prefer not to say

Ethnic Origin

Age Group

Religion or Belief

Gender

Male Female Non-binary Prefer not to say

13

Declaration & Signature

Please read carefully before signing:

I confirm that the information I have provided in this application is accurate and true to the best of my knowledge.
I understand that United Hands Care Ltd may carry out checks to verify the information I have provided, including contacting referees, verifying qualifications, and obtaining DBS disclosures.
I understand that providing misleading or false information may disqualify me from appointment or, if already appointed, may result in my dismissal.
I understand that my personal data will be processed in accordance with the Data Protection Act 2018 and UK GDPR for the purposes of recruitment and, if successful, employment.
I understand that any offer of employment is conditional upon satisfactory references, Enhanced DBS disclosure (including Adults' Barred List check), verification of right to work in the UK, and confirmation of fitness to carry out the role.
I understand that I will be required to complete a pre-employment induction training programme before starting work.

Confirmations (tick to agree)

I confirm the information provided is true and complete I consent to processing my personal data for recruitment purposes I understand employment is subject to satisfactory pre-employment checks

Applicant Name (Print)

Date

Signature