Job Application

Please give full details

Details of your current/most recent employer – the person that you name below must be in a position to give us a reference about you on behalf of your employer

in addition to the referee you gave above, please give name, address, telephone number and email address of a second referee. This should be a previous employer who knows you well enough to assess your suitability for the post but is not a family member or relative.

Details of your previous employment including voluntary work – please give a FULL EMPLOYMENT HISTORY. Start with your previous job and work backwards, accounting for any gaps between jobs. Continue on a separate sheet if you need to.

Details of your Education and Training – please start with the latest and work backwards

Reason for Applying – please use this space to write in support of your application.

  • Job Application
  • Personal Information about you
  • Employment
  • References
  • Previous Employment
  • Education
  • Reasons for applying
  • Have you ever been convicted of a Criminal Offence?
  • Declarations
  • Signature & Confirmation

Home Care Worker

How did you hear about this job? Please tick box

If Friend is member of Q1 Staff please give name:

If other please give details:

When are you available for work?

Do you have any holidays scheduled in the next 6 months?

Please indicate approximately how many hours per week you will be available for work:

Your Details

Forname / s



Previous Surname (if applicable)

Home Address (including postcode)

Telephone Number / s

Email Address

Employment History

Current/most recent employer

Address: Including post code

Contact Name (your 1st referee)

We will be requesting a reference from this person, can we contact them straight away?

Position of contact

Telephone Number

Contacts Email Address

Post held by you



Main Duties

Notice period required

Reason for wanting to leave


Contact Name (your 2nd referee)

We will be requesting a reference from this person, can we contact them straight away?

Position of Contact

Address (including postcode)

Telephone Numbers


Previous Employment

Please provide a list of your previous Employers, their name and address and type of business below. Please also tell use your job title and main duties and the dates you were employed and reasons for leaving.

Employment History


Please list the name of university, school, college or nvq awarding employer or other place with course studied, year and qualifications attained.


Reasons for applying

Say why you would like this particular job and how you meet the criteria in the person specification Highlight any relevant work experience (paid or unpaid) Highlight any relevant training or voluntary work Outline any relevant hobbies or interests

Reasons for applying


Because of the nature of the work for which you are applying, this post is exempt from the provision of Section 4 (2) of the Rehabilitation of Offenders Act 1974 by virtue of the Rehabilitation of offenders Act 1974 (Exemptions) Order 1975. This means that any criminal record, including details of all criminal convictions (even “spent” convictions), cautions, reprimands and any other information that may have a bearing on your suitability for the post must be disclosed. Failure to disclose details of any criminal record at the outset may result in an offer of employment being withdrawn. I hereby declare that:

I have no criminal record

If yes please provide details below


Do You have a current UK driving licence

Do you have access to a vehicle for work purposes?

Are you related to or do you have any relationship with a director or employee of Q1Care Ltd?

I understand that Q1Care Ltd will apply to the DBS for a “disclosure” about me which will reveal any criminal record about me.

I am eligible to live and work in the United Kingdom according to the Immigration Asylum and Nationality Act 2006 and will produce original documentation to confirm this upon request.

The information in this application is true and accurate. I understand that any false information may result in rejection or in the event of employment, dismissal or disciplinary action by Q1Care Ltd.