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BlueLine Care Services | Supported Living

0117 332 1135
admin@bluelinecare.co.uk

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Prefix

First Name *

Middle Name

Last Name *

Email Address *

Date of Birth

Position applied for:

Number of Hours

Full-time / Part-timeYesNo

Street Address *

City *

State/Province

ZIP / Postal Code *

Country *

Telephone number (home) *

Telephone number (work)

School/College/University *

School/College/University

Upload Your Educational Qualification *

Drag and Drop (or) Choose Files

Date of Graduation/Qualification *

Location / Details

Date of Graduation/Qualification

Subjects

Location

Uploads Qualification Obtained *

Drag and Drop (or) Choose Files

1). Name and address of your most recent/last employer: *

Nature of business *

Position held and reason for leaving

Date

2). Name and address of Employer prior to the employer listed above

Nature of business *

Position held and reason for leaving *

Date

Next of Kin Full Name *

Relationship *

Contact Number *

Address *

Nursing and Midwifery Council PIN (Nurses only) number:

National Insurance Number (All Applicants)

Text

You must provide 2 professional references one of which must be your current or last employer.

Name (1)

Address

Post Code

Tel No:

Job title *

Name (2) *

Address *

Post Code *

Tel No: *

Text *

Criminal Record

Workers of The Agency are subject to the Health and Social Care Act 2008, and will be subject to a Police Record Check through the DBS. Please declare all criminal convictions, whether spent or not, charges, whether proceeded with or not, and warnings and cautions.
You will not be eligible for work in a Care setting if you are on the DBS Register(s).

Please declare all criminal convictions, whether spent or not, charges, whether proceeded with or not, and warnings and cautions in the space provided below. *

Date

SIGNATURE and DECLARATION – IMPORTANT – READ BEFORE SIGNING I declare that to the best of my knowledge and belief the information given by me in this application is true, and I understand that the above information forms the basis of my contract of employment. I understand that if any of the information supplied by me is found to be falsely declared, my contract may have been fundamentally breached and my employment may be terminated immediately.

Full Name *

About Blueline Care Services

Blueline Care Services works in partnership with Social Services, Community Mental Health Teams (CMHT) and private individuals within leading Local Authorities across UK offering high quality supported housing for adults at risk.

Ltd co. No: 9379070