Application Form - FreedaCare

Name

First

Last

Email

Phone

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

National Insurance Number

Full Education & Training

Name of School/College

Dates Employed From/To

Qualification

Grade

Name of School/College

Dates Employed From/To

Qualification

Grade

Name of School/College

Dates Employed From/To

Qualification

Grade

Work Experience

Your work experience should cover a minimum of 5 years.

Work Experience 1

Company Name

Dates Employed From/To

Reason for Leaving

How did you hear about us?

Duties/Role

Work Experience 2

Company Name

Dates Employed From/To

Reason for Leaving

How did you hear about us?

Duties/Role

Work Experience 3

Company Name

Dates Employed From/To

Reason for Leaving

How did you hear about us?

Duties/Role

Work Experience 4

Company Name

Dates Employed From/To

Reason for Leaving

How did you hear about us?

Duties/Role

Work Experience 5

Company Name

Dates Employed From/To

Reason for Leaving

How did you hear about us?

of Layout Dates

Duties/Role

Supporting Information

Registrations/Certifications

If you are registered with a relevant
professional body (e.g. NMC) please
provide your registration details.

Body Number

Expiry Date

GSCC/ SSSC Registration Complete?

Yes
No

Do you hold a current valid driving license?

Yes
No

References

Company (present or most recent)

Start Date

End Date

Manager Name

Email

Phone

Company (present or most recent)

Start Date

End Date

Manager Name

Email

Phone

Disclosure of Criminal History

FreedaCare supports vulnerable people and is required to conduct enhanced
disclosure checks. Anything that appears on a Disclosure check will be risk-assessed based on
the role that you are applying for.

Do you have any unspent or spent convictions, cautions, reprimands, warnings or Bind Over orders that will appear on a Disclosure check; are subject to ongoing police or regulatory investigation or proceedings, or been disqualified from professional practice? Please provide full details if Yes*

Please confirm that you understand that FreedaCare will only appoint applicants who can demonstrate legality to live and work in the UK, as defined by the UK border agency and FreedaCare will request proof of Identification. (Please tick as appropriate).*

Yes
No

Emergency Contact Details

Name of Next of Kin

Relationship

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone

Document Upload

Upload your resume

Click or drag a file to this area to upload.

Upload your cover letter

Click or drag a file to this area to upload.

Proof of residency and right to work in the UK

Click or drag files to this area to upload. You can upload up to 3 files.

1 x Proof of ID (e.g Passport, Driving License 2x Proof of Address (e.g Utility Bill, Bank Statement)

National Insurance

Click or drag a file to this area to upload.

Copy of NI Card

Training Certificates

Click or drag files to this area to upload. You can upload up to 2 files.

Additional Information

GDPR Agreement

I consent to having this website store my submitted information so they can respond to my inquiry.