Home Care Companions. Live in Home Help UK

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Carer Application Form

Thank you for taking the time to fill in our application form.

Our service to you is free of charge and we look forward to introducing you to some of our superb hosts throughout the UK.

Before you start, please make sure you have all the documents required at the end so your application form can be processed without delay.

If other, please specify

First Name

Home Telephone Number

Last Name

Mobile

Email Address

Age

Date of birth

If other, please specify

Current UK Street Address Line 1

Current UK Street Address Line 3

City

County

Post Code

Which live-in Position(s) appeal to you?

2-Week Rota Carer

3-Week Rota Carer

Permanent Full-Time Carer (employee)

Permanent Live-in Companion (employee - no personal care)

Part-Time Live-in Home-Share Companion

Do you have a preferred region / area?

When are you able to start?

If yes, please specify

Would you PREFER your client to be:

Male

Female

A Couple

No Preference

Please mark if you would NOT be happy with a host who is

Male

Female

A Couple

No Preference

Where would you NOT consider working?

Are there any times/days you cannot work?

What is your expected WEEKLY salary? (NB part-time companions may not need to pay tax)

Please list a summary of previous job titles you have held? (We will ask you for a full CV to be sent later on)

What educational / professional qualifications do you have?

What type of placement would you not be happy in?

Do you have any special wishes regarding your next placement?

How many years have you been driving?

Please state any endorsements on your license

If not, can you explain why not?

Are there any other duties you would not be willing to do?

How would you describe yourself in one sentence?

What are your hobbies?

If yes, please specify

What is your current state of health?

If yes, please specify

Nationality

Height

Passport Number

National Insurance number

Country of Birth

Weight

EU Settled Status Reference number

Personal Liability Insurance details (for self-employed carers on rota only)

In case of emergency, please provide details of your next of kin in the UK:

Emergency Contact: First Name

Emergency Contact: Last Name

Emergency Contact: Daytime Telephone Number

Emergency Contact: Mobile

Emergency Contact: Evening Telephone Number

Email Address

Age

Emergency Contact: Current UK Street Address Line 1

Emergency Contact: Current UK Street Address Line 2

Emergency Contact: City

Emergency Contact: County

Emergency Contact: Post Code

I hereby confirm that the above information is true to the best of my knowledge and I have read and understood the terms and conditions. Please write your full name and fill in todays date.

Full Name

Todays date

Once you have submitted the form, please email us all of the following documents to us at: info@homecc.co.uk
Please make sure all emails are clearly labelled with your name.
We cannot process your application form if any are missing.

• Photograph of yourself
• CV
• A letter to your host (you can address them as "Dear Host" and say a little about yourself / background)
• Photos (a few of you with friends and family so clients can get a feel for the type of person you are)
• Copy of your passport
• Copy of your DBS Certificate
• Copy of your driving licence (if you have one)
• EU settled status / work permit (if required)
• Certificates (qualifications/training) for carers. Not required for companions
• References (we need at least three recommendation letters or written references. NB. A phone number is not written)
• Personal liability insurance certificate (if you have one