ONLINE STAFF APPLICATION FORM Please note you must have previous experience of working in care or childcare before applying to Careline PERSONAL DETAILS Full Name (required) MrMrsMissMsOther 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 PREFERENCES Which of the following services have you worked in before? Learning DisabilitiesMental HealthPhysical DisabilitiesOlder PeopleChildren/Young AdultsNurseriesResidential ServicesDay ServicesRespite ServicesDomiciliary Services What type of services do you prefer? Which towns do you prefer to work in? Do you want temping work only? YESNO Do you want a permanent position only? YESNO Do you want to do temping while we seek a permanent position for you? YESNO Date available to start Will Careline be your only employment? YESNO If no, will Careline be your main employment? YESNO Are you a driver? YESNO What areas are you prepared to travel to? Have you ever been convicted of a criminal offence including spent convictions? YESNO Have you ever been the subject of a disciplinary procedure? YESNO Please note you will be required to give contact details for at least two referees when you attend interview.