Job Application for Employment 
Buttercup House Care Home 2017
Position applied for: 

Are you applying in response to a newspaper advertisement? Please give details of the newspaper and the date of insertion: 

Personal details 
Full name: ______________________________ 

Home address: 

Home telephone number: ______________ 
National Insurance Number: ______________
Male:  Female:  (please tick) 
Do you have a full current valid driving licence: Yes  No  (please tick) 
Is your driving licence:  Commercial?  Private?   (Please tick) 
If commercial, please state class of vehicle: ______________
Please give details (if any) of any previous motoring offences and details of any current penalty points on your current driving licence: 

	
Are you eligible to live and work in the United Kingdom?  Yes  No  (please tick) 
Will you be able to provide a, passport, P60, United Kingdom birth certificate or work permit to show that you are eligible to work in the United Kingdom? Yes  No  (please tick) 
Have you a current bankruptcy order against you?  Yes  No  (please tick) 
Have you ever been declared bankrupt: Yes  No  if your answer is yes please give details: 

	
If your application is successful on what date will you be able to start work? 

Is there any reason why you would not be able to start work immediately if your application is successful?  Yes  No  if your answer is yes please give details: 

	
Do you have any outstanding holiday arrangements? Yes  No  if your answer is yes please give details: 

You may be required to travel during the course of your employment, have you any objection to this requirement?  Yes  No If your answer is yes please give details: 

	
Education, Qualifications, Previous Experience or Skills  
Please list secondary schools, colleges or universities you have attended: 
Name of School or College/University 	Dates attended 	Qualifications obtained 	

  	  	  	

  	  	  	

  	  	  	

  
  	  	  	
(Use separate sheet if necessary) 

Please state why you applied for this job and why you believe that you have the necessary skills or experience and aptitude: 

	
Current and previous employment 
Are you currently employed:  Yes  No   
Have you ever been fairly or unfairly dismissed by an employer? Yes  No  if your answer is yes please give details: 

	
Details of current or last employment: 
Name of employer: 	
Address: 	

Date employment commenced and/or finished: 	
  	
Tel No: 	
Job Title: 	
Job description, duties and responsibilities: 	

  	
Salary or rate of pay: 	
Why did you or why do you wish to leave this employment? Please give full details: 	

  	
  	
Details of first previous employment: 
Name of employer: 	
Address: 	

Dates of employment period: 	
Tel No: 	
Job Title: 	
Job description, duties and responsibilities: 	

  	
Salary or rate of pay: 	
Reason for leaving this employment? 	

  	
Brief details of all other previous employment: 

	
Do you have any current part time jobs, which you will continue during this prospective employment?  Yes  No   
If your answer is yes please give details: 

	
Details of references 
Please give the details of two references that we can contact in respect of this job application. The referees must not be not related to you: 
First reference: 
Name: 	
Address: 	

Tel No: 	
Occupation: 	
Second reference: 
Name: 	
Address: 	

Tel No: 	
Occupation: 	
PLEASE NOTE THAT THE EMPLOYER IS REQUIRED BY LAW TO CHECK AND COPY ONE OR A COMBINATION OF THE FOLLOWING ORIGINAL DOCUMENTS NAMED IN LIST 1 AND LIST 2 (note that these lists are amended from time to time – if in doubt, check with the Home Office) AND ANY OFFER OF EMPLOYMENT WILL BE SUBJECT TO THE APPLICANT PRODUCING THIS REQUIREMENT.
LIST 1 
Documents which provide the defence if produced alone 
Any one of the documents included below in List 1 will be acceptable by the employer to check and copy:
•	A passport showing that the holder is a British citizen, or has a right of abode in the United Kingdom. 
•	A document showing that the holder is a national of a European Economic Area country or Switzerland. This must be a national passport or national identity card. 
•	A residence permit issued by the Home Office to a national from a European Economic Area country or Switzerland. 
•	A passport or other document issued by the Home Office which has an endorsement stating that the holder has a current right of residence in the United Kingdom as the family member of a national from a European Economic Area country or Switzerland who is resident in the United Kingdom. 
•	A passport or other travel document endorsed to show that the holder can stay indefinitely in the United Kingdom, or has no time limit on their stay. 
•	A passport or other travel document endorsed to show that the holder can stay in the United Kingdom; and that this endorsement allows the holder to do the type of work you are offering if they do not have a work permit. 
•	An Application Registration Card issued by the Home Office to an asylum seeker stating that the holder is permitted to take employment. 
Once one of these documents from a potential employee has been checked and copied there is no need for the employer to ask for any further documents contained in List 2. 
LIST 2 
Documents which provide the defence if produced in combination 
List 2 covers the combinations of documents which will be acceptable by the employer as an alternative to documents contained in List 1. It will not be acceptable to see and copy one document from the first combination and one from the second combination. 
First combination 
(A)  A document giving the person’s permanent National Insurance Number and name. This could be a: P45, P60, National Insurance card, or a letter from a Government agency. Along with checking and copying a document giving the person’s National Insurance Number, the employer must also check and copy only one of the following documents listed below:
•	A full birth certificate issued in the United Kingdom, which includes the names of the holder’s parents; OR 
•	A birth certificate issued in the Channel Islands, the Isle of Man or Ireland; OR 
•	A certificate of registration or naturalisation stating that the holder is a British citizen; OR 
•	A letter issued by the Home Office to the holder which indicates that the person named in it can stay indefinitely in the United Kingdom, or has no time limit on their stay; OR 
•	An Immigration Status Document issued by the Home Office to the holder with an endorsement indicating that the person named in it can stay indefinitely in the United Kingdom, or has no time limit on their stay; OR 
•	A letter issued by the Home Office to the holder which indicates that the person named in it can stay in the United Kingdom, and this allows them to do the type of work you are offering; OR 
•	An Immigration Status Document issued by the Home Office to the holder with an endorsement indicating that the person named in it can stay in the United Kingdom, and this allows them to do the type of work you are offering. 
Second combination 
(B) A work permit or other approval to take employment that has been issued by Work Permits UK. Along with a document issued by Work Permits UK, the employer should also check and copy one of the following documents listed at below: 
•	A passport or other travel document endorsed to show that the holder is able to stay in the United Kingdom and can take the work permit employment in question; OR 
•	A letter issued by the Home Office to the holder confirming that the person named in it is able to stay in the United Kingdom and can take the work permit employment in question. 
Documents that will no longer provide you with any part of your defence 
There may be some documents that employers routinely check at present which will be removed entirely from both List 1 and List 2 . After 1 May 2004: employers should no longer check for the following documents: 
•	A Home Office Standard Acknowledgement Letter or Immigration Service Letter (IS96W) which states that an asylum seeker can work in the United Kingdom. If you are presented with these documents then you should advise the applicant to call the Home Office on 0151 237 6375 for information about how they can apply for an Application Registration Card; 
•	A letter issued by the Home Office stating that the holder is a British citizen; 
•	A passport describing the holder as a British Dependent Territories Citizen which states that the holder has a connection with Gibraltar; 
•	A short birth certificate issued in the United Kingdom which does not have details of one of the holder’s parents; 
•	A card or certificate issued by the Inland Revenue under the Construction Industry Scheme. 
The following documents have never been acceptable as proof of a person’s right to work in the United Kingdom, and should not form any part of the employer’s documents checks.
•	A temporary National Insurance Number beginning with TN, or any number which ends with the letters from E to Z inclusive; 
•	A driving licence issued by the Driver and Vehicle Licensing Agency; 
•	A bill issued by a financial institution or a utility company.   

Declarations by the applicant: 
The information I have given on this form is true and I understand that if any of the above information is found to be untrue there may be sufficient grounds for my dismissal if I am employed.   
I confirm that I will produce proof of my entitlement to work in the United Kingdom by producing one or a combination of the documents listed in either List 1 or List 2 above. 
I give my consent for referees and previous employers to be contacted for references in respect of this job application.  
I understand that if the employer offers me employment, the offer will be conditional on my health being satisfactory for the position I am offered. Therefore, I accept that the employer reserves the right to carry out appropriate health checks relevant to the job position I am offered and hereby give my consent for the employer to carry out appropriate health checks after a job offer has been made.
Signed by Applicant: 
  
Date: 

NB The information given on in this form and any references applied for will only be used in relation to this application for employment. 
Applicants should also note that we are an equal opportunities employer. We aim to recruit staff on their suitability for the position advertised, without consideration of age, sex, religion, marital status, disability or ethnic origin. 
Applicants may extend their answers on separate sheets of paper to the above questions if they wish.