Care in House job application form

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Carer Application form

* Please fill in all mandatory fields

Contact Details
Title *	Mr Mrs Miss Ms
First name *
Surname *
Address & Postcode *
Country
Telephone *
Mobile *
Email *
Personal Details
Date of Birth *
Marital Staus *	Single Married divorced Widow
Nationality *
Height (meters)
Weight (kg)
Are a British citizen or from the EU? *	Yes No
If NO, do you need a British work permit? *	Yes No
Do you have a current clean EU driving licence? *	Yes No
What is your spoken English like? *	Good Medium Poor
Do you have any allergies?	Yes No
Do you smoke?	Yes No
Have you any disabilities?	Yes No
Have you any illnesses or medical problems?	Yes No
Have you suffered with any back or joint problems?	Yes No
Have you been convicted of a criminal offence?	Yes No
Caring Duties
As a carer, your duties will include a number of tasks, domestic support, personal care, please state yes or no whether you are willing to do them.
Domestic care including: washing, ironing, shopping, cooking & general cleaning. Yes No
Personal care including: getting up, going to bed & physiotherapy Yes No
Intimate Care including washing & toiletting Yes No
Are you willing to do live in work?	Yes No
What date are you available from?

Your CV and additional information Please send us your comprehensive CV to cv@careinhouse.com Please also include a current photograph of yourself
* I confirm that the information I have given is true & correct. Please tick the box.

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