ONLINE STAFF APPLICATION FORM

Please note you must have previous experience of working in care before applying to Careline.

PERSONAL DETAILS

Full Name		Mr Mrs Miss Ms Other
All previous names
Date of Birth		National insurance number
Address
Postcode		Tel No. (Landline)
Tel No. (Mobile)		Email

If you have a CV in electronic form you can attach it here instead of filling out the "Your Experience" and "Courses taken" boxes below.

Attach your CV by inserting the filename here:

YOUR EXPERIENCE

Position	Employer (with address)	Date from	Date to
Permanent work:



Agency work:

COURSES TAKEN

Course	Establishment	Date from	Date to

YOUR CLIENT GROUPS AND PREFERENCESWhich of the following services have you worked in before?

Learning Disabilities	Mental Health	Physical Disabilities	Older People
Children/Young Adults	Nurseries	Residential Services	Day Services
Respite Services	Domiciliary Services

What type of services do you prefer?
Which towns do you prefer to work in?
Do you want temping work only?	YES NO
Do you want a permanent position only?	YES NO
Do you want to do temping while we seek a permanent position for you?	YES NO
Date available to start
Will Careline be your only employment?	YES NO
If no, will Careline be your main employment?	YES NO


Are you a driver?	YES NO
What areas are you prepared to travel to?

Have you ever been convicted of a criminal offence including spent convictions?	YES NO
Have you ever been the subject of a disciplinary procedure?	YES NO

Please note you will be required to give contact details for at least two referees when you attend interview.

When you need agency or permanent staff, call your local Careline number:
	Reading:	0118 958 5858	Woking:	01483 772977	Newbury:	01635 524524
	Bracknell:	01344 868990	Southampton:	02380 768686	All Fax:	0118 958 2899
	Oxford:	01865 722221	Swindon:	01793 616263	Email:	enquiries@carelineagency.co.uk
	Basingstoke:	01256 474444	Slough:	01753 535358
	Head Office: Kings Lodge, 194 Kings Rd, Reading, Berkshire, RG1 4NH, UK